'Being Healthy Isn't Individual Choice - It Depends On Your Circumstances'

You're Professor of General Practice. Like the GP profession, this is very broad. What do you and your team research?

'You're right, it is broad, but our priority is research for the people who need it most. At the Health Campus, for example, we study how to reduce health inequalities in society. This involves sustainability and climate justice. In our department, we also focus heavily on elderly care. I also specialise in sex and gender differences, including women's health.

This year, we launched a major study on women at higher risk of cardiovascular disease because they had preeclampsia during pregnancy. There's a guideline recommending more frequent check-ups for these women, but in practice, that doesn't happen enough. What do women themselves need? And how do you ensure GPs follow through? These are the questions we want to answer.

'We also take a broader view. Here in Leiden, we focus on common conditions, formerly called minor ailments. Despite their prevalence, research is scarce. As a result, GPs sometimes face risky decisions. Our research aims to fill the gap. Our PhD candidate Roeland Watjer studied, for example, the effect of antifungal nail polish. Studies like these help us provide better care for many people.'

Your inaugural lecture is titled 'Fighting for health'. What do you want people to take away from it?

'That although our health system is accessible in theory, in practice, it isn't for everyone. We simply don't know enough about certain groups. Take women: even though healthcare is available, they don't always receive the care they need.

'The same applies to people with psychiatric problems - because of long waiting lists, for example. And there are many more: people in the LGBTIQ+ community, those with a migrant background, long COVID patients and people with obesity. They often don't get the best care.

'In my lecture, I explore whether it's a coincidence that these are often stigmatised groups. I don't think it is. There's an underlying layer of unconscious bias or discomfort with these patients. We need to acknowledge this and act - not just in consultations but also in research. If you only read English-language studies, you adopt a very Western perspective. You might learn a lot from Korean research, for example.

'The same goes for teaching. Doctors from lower socioeconomic backgrounds - or any minority - often experience unequal treatment, sometimes not even getting a place on the programme. If we train doctors from diverse backgrounds, we'll treat patients more inclusively. That also reduces health inequalities. That's the fight for health I refer to in the title of my inaugural lecture.'

Your social engagement really stands out. What motivates this?

'I think it's personal. My parents had the chance to study, although it wasn't guaranteed. This means I grew up with opportunities. But we know that people in low-income neighbourhoods live in poor health for up to 25 years longer. It's shocking if you think about it. Being healthy isn't an individual choice - it depends on your circumstances. As a GP, I see the effect of this injustice: it has a huge impact.'

You also want medical students to learn more about careers outside hospitals. Why is that important?

'When I was a student, the medical training in Leiden focused on hospital specialisms. So it's no surprise that students only saw those role models and didn't know what else was out there. Fortunately, career orientation in medical training is broader now. Students can explore work in nursing homes or youth health, for example. Our department organises theme weeks on professional orientation. And there's a national campaign, Next Level Doctor, introducing students to careers beyond hospitals.

'The most important thing is that students can make informed choices. Not everyone needs to become a GP, but it helps to know early what options exist outside hospitals. If you meet an addiction specialist, paediatrician, environmental health doctor or forensic physician sooner, you'll know if that's right for you.'

What's the highlight of your career?

'All the choices that led to the realisation that I wanted to become a GP. During my internships, I realised I didn't want to work in a hospital. When I joined a great GP practice with a great trainer, I knew it was for me. These moments are crucial.

'I still smile when I remember telling my parents I was going to do GP training. My mother's first reaction was: "A GP? But you're so good at learning.' That reflects how people used to view GPs. It wasn't always seen as a full medical specialism. Fifty years ago, you automatically became a GP after medical training. I'm glad to see that's changed. Today, we have more patients receiving primary care and our own guidelines and collaborations.

'Hospital specialists now even refer patients with complex care needs to GPs because they say we understand what's going on in the patient's life. So they're pleased we can take a look. The complexity of a disease belongs in secondary or tertiary care, but the complexity of multiple conditions combined with psychosocial factors and the patient - that's what we GPs are good at.'

Looking ahead, where will the GP profession be in 10 or 15 years?

'I hope we'll keep focusing on person-centred, generalist care and seeing people in their context. Three people with the same symptoms should leave with care tailored to their individual needs.

'The work in GP practices will rely less on the GPs themselves and more on the teams who work there: nurse specialists, physician assistants, support staff... It's teamwork, and I'm glad it's becoming more visible.

'I also expect more collaboration with other sectors - social services, nursing, hospitals. And on the subject of hospitals, I staff will work across hospitals and GP practices. Then you share knowledge from hospitals to GP practices and vice versa. These links between specialisms matter because they give us a clearer picture of what people experience and what support they need.'

Hedwig Vos's inaugural lecture 'Fighting for Health' will be given on 21 November and will be streamed live on the Leiden University website.