Why does a person become a dermatologist? I explained this in the description of my training: 'By a twist of nature, I knew at an early age that I wanted to become a dermatologist'. This twist caused me to have psoriasis, a chronic skin disease characterized by redness and silvery-white scaling, especially on the elbows, knees, lower back and scalp. Its cause is unknown, but it is considered an autoimmune disorder. Many patients with psoriasis also develop inflammation of the tendons (enthesitis psoriatica) and joints (arthritis psoriatica). The abnormalities on my skin started when I was 13 (a classic starting age) and the tendon and joint inflammations in 1999. Since then I daily take anti-inflammatory drugs and painkillers for this reumatic disease. The pills suppress the inflammation and pain pretty well, but I have to keep taking them or it will worsen. Fortunately, my skin has been doing well for a long time (knock on wood). Anyway: I wanted to become a dermatologist and I succeeded.

In the last semester of my training, which lasted until December 31, 1979, I had decided not to stay in the Groningen  University Dermatology Clinic after graduation. I had been offered the job of chef de policlinique, succeeding Dr. Kruizinga, but Prof. Klokke did not want to give me the opportunity to do a PhD, so I declined the honor. As a consequence I had to find a practice and applied for a vacancy in the eastern part of the Netherlands. However, there they preferred another applicant over me! I was surprised and angry. Rumor had it that the colleague in question had already failed his surgery exam three times and that the fourth time, when he finally succeeded, he was so impressed with his own performance that he took the wrong exit on the spot and ended up in the broom closet. And I had lost to someone like that? Incidentally, some modesty befits me here; after all, I had almost failed the surgery exam myself. Well, every disadvantage has its advantage, to use the immortal saying of the great philosopher Cruyff (Johan Cruyff, the best Dutch football player in history) once again, and that advantage was that I would go to 's-Hertogenbosch and be received there with open arms. This was a practice in two hospitals, the Catholic Carolus Hospital and the Protestant Willem-Alexander Hospital. I had some reservations about this, because I have always been little Biblefast and already then I was not so convinced of the beneficial effects of religion. Nevertheless, I decided to apply anyway. The incumbent dermatologist instructed me: 'At the Carolus, it doesn't matter what you are, as long as you are Protestant at the Willem-Alexander.' So, asked about this particular subject during the job interview at 'the WAZ,' I mumbled 'I come from a Protestant home.' The faces of the members of the application committee lit up.........  

I had heard from various sources that the dermatologist I wanted to succeed had changed over the years from a respectable Catholic gentleman, who had held positions in the Dutch Society of Dermatology and Venereology, into someone who held somewhat eccentric views on dermatology and practice. Out of piety, I will not go into further detail (unfortunately, you are missing a bunch of juicy stories), but the result was that he had a very small practice. The Catholics in the Carolus still came ('Mister Doctor'), albeit in small numbers, but the Protestants from the Bommelerwaard did not accept his eccentric behavior, which is why he only saw a few patients there three afternoons a week. This caused me some concern, because the other patients went to the Groot Ziekengasthuis in the center of the city and I didn't know if they would come to me.

Anyway: the job interviews went well, in my opinion. I did, however, receive some backlash in the WAZ from the director, Rudolf Spittuler, when I indicated that I wanted my wife (or actually fiancée, we were not yet married) Janny to be my physician assistant. He was afraid that she would not be able to separate private from work and that we might have disagreements at work. A not illogical line of thought, by the way. Nevertheless, he was persuaded; later a colleague wrote me why. 'I was on your admissions committee and without further ado you were accepted because we were convinced we had hooked something special'. Later, when the practice had started, Rudolf did spend two whole days with Janny to make sure everything was going well.

My wife Janny as assistant in our practice, late 1990s

Application successful

I was admitted as dermatologist to both hospitals (it must have been sometime in October 1979) and was able to take over the practice on January 1, 1980, exactly one day after completing my training as a dermatologist in Groningen. So there was work to be done. It was customary in those days that the goodwill for taking over the practice was an amount of the annual turnover minus the mandatory pension remittance. This meant that I could take over the business cheep as the retiring dermatologist saw very few patients. However, he calculated differently. When he started, he reasoned, the value of a referral card was 5 guilders; now the value of the referral card was 35 guilders, 7 times as much. Therefore, he wanted to collect from me 7x the 50.000 guilders that he had paid to his predecessor. That was unacceptable to me, so I contacted the medical director of the Carolus, Sjoerd de Jong, a former surgeon from Friesland. He knew exactly what to do and growled at the dermatologist: 'Now look here, v.. L..., If you continue to be annoying, I'll throw you out and put De Groot in your practice, and then you can say your goodwill compensation goodbye'. The colleague took no chances and the goodwill was set at a little more than the annual earnings, so I had met him halfway. Later one of the ENT doctors at the Carolus would speak the prophetic words 'You have bought a little grocery store on the corner and you can turn it into an Albert Heijn' (the Dutch version of The Kroger Co. in the USA and Tesco in the United Kingdom).

By the way, the incumbent colleague was not hateful. A short time later he organized a farewell reception for his patients where I could be introduced. With amazement and also with some vicarious shame I saw the old man standing there, with his wife at his right side and his mistress at his left.

It was of course impossible for me to start the practice on January 1, 1980, so I agreed with the hospitals that it would be the beginning of February. In the meantime, all sorts of things had to be organized, and Janny and I had to move to the province of Brabant, of course, in the vicinity of 's-Hertogenbosch ('Den Bosch'), where both hospitals were located. Fortunately, housing was quickly arranged. The director of the Carolus Hospital told me that I could temporarily rent the house of one of the anesthesiologists, who had just bought another house in Vught. And so in early January 1980 we moved from Groningen to Vught. I don't remember much about it. What I do remember is that I had forgotten to lock the 80 centimeters deep drawers in my antique desk, which I had received as a gift from the father of my best friend Peter Bartstra. So when - I was standing by - the desk was lifted and tilted, one of those heavy drawers flew right over the crown of one of the movers. If they had held the desk slightly more oblique, he would have lost his teeth or suffered a concussion. The movers remained amazingly laconic about it.

Quickly organizing things 

In addition, of course, all sorts of things had to be arranged for the practice during the month of January. Informing health insurance funds and general practitioners, stationery, prescription pads, making sure I got the right equipment, getting to know staff members and other important hospital employees, contacting the local bank manager, arranging accounts and, of course, getting funds for the goodwill. The latter was no problem at all. The ABN bank preferred to give me as much money as possible ('Please do not hesitate to withdraw some more, doctor'). Well, not surprising, the interest rate was gigantic and the financial prospects of beginning medical specialists excellent. A year later we would buy a house in Den Dungen and on the mortgage we had to pay almost 12% interest! On the other hand, on deposits one would get 8% interest. Those were the days! Now you get 1.2% interest on a one-year deposit. Furthermore, in that month we were invited by the mayor of Vught to meet him; the red carpet was rolled out for us!

Can you start sooner please?

One of the fondest memories I have of that period is that in mid-January we received a call from the secretary of the incumbent dermatologist, who at that time was still manning the practice for making appointments and other calls. She asked me if I couldn't start earlier than February 1, because she was getting a tremendous number of calls and the consultation hours in the Willem-Alexander Hospital were already getting pretty full.... The rumor of a new sherrif in town had quickly spread in the larger 's-Hertogenbosch area! So, my worries of not getting enough patients immediately turned out to be unnecessary. Naturally, I also made my appearance with the colleagues at the Groot Ziekengasthuis, the largest hospital in 's-Hertogenbsoch, Siebert Holla and Wicher Bergsma. That was a very pleasant meeting. They welcomed me warmly to 's-Hertogenbosch and predicted that I would have a large practice: there was more than enough for all of us!

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