Categorie: Nieuws

Op deze pagina vindt u alle nieuwsberichten van Huisartspraktijk Neeteson in chronologische volgorde.

10 insider tips I bet you don’t know about your GP

10 insider tips I bet you don’t know about your GP

We’ve all been to the doctor, right?  We know how it works; we know how to get an appointment and what to say when we go.  I’m always surprised at how little people do understand about how their doctor’s surgery really works, and how to get the best out of them.  Most people don’t realise that a GP runs a small business and that they get paid a set fee to provide all of your care.  Do you have any idea how long your appointment slot is, or how many patients your GP will see each day?  Hopefully you won’t need to visit your GP very often, but a bit of insider knowledge can help you when you do need to go!  How many of these insider tips and nuggets did you already know?


  1. Your Doctor would like to give you more time
    • Most GPs provide just 10 minutes for an appointment. Although this might not seem very long you must remember that this has increased over the past 20 years from a typical 7.5 mins per appointment, and from even shorter appointments before then.  GPs can choose to offer longer appointment times, but there is a balance between length of appointment and how many appointments they make available.  This is obvious when you think about it – do you offer fewer, longer slots, or more, shorter ones?  What would you do?  Depending upon your reason for attending, 10 minutes might be more than enough time, or woefully inadequate.  Got a sore throat?  You might be in and out in 5 minutes.  Hearing voices and suicidal?  You might be in there for half an hour, or probably longer. Your doctor will rely on a variety of problems presenting to balance these demands on their time, and hopefully will run roughly to schedule.  Often they will run late.
    • You can help this by understanding how long your appointment slot is (just ask when you book), and working with your doctor to get things done in the time allowed. If you already know you are going to need more than 10 mins, ask reception if you can have a longer slot. They will probably be happy to oblige.


  1. Your Doctor does not like lists
  • Well, let me clarify this. Your Doctor would advocate you knowing what you are coming for, and if writing this down in advance will help you, then I would suggest you do so.  However, bearing in mind point one above, if you only have 10 minutes and if you pull out a list of 5 problems this is pretty stressful for your GP.  Were you expecting 2 minutes per problem?  Be realistic.  Prioritise what you want from your doctor.


  1. If you arrive 10 minutes late, you have missed your appointment.
  • What I mean is that if you are 10 minutes late (or more), then you are not just late, but your appointment slot has come and gone. The next patient is now due.  Remember that the impact of being late is not just on your doctor.  They may be prepared to finish their surgery late in order to see you, but what about all the other patients who have booked in and arrived on time?  If you arrive late, this is who you are causing hassle for, all the people around you in the waiting room.  I guess I’m just asking you to think – is this fair?


  1. Your Doctor is not telepathic
  • Pretty obvious, right? Yet it seems that people think their GP will know what they are worried about, which of their problems is a priority for them and what their hidden fears are.  A good doctor will no doubt explore all of this with you, but you can short-cut this.  Be up front about what is on your mind.  If you are worried because you think your rash or lump might be cancer, then say so.  If you want to exclude some rare condition because your mother had it – let the doctor know.  Try not to leave your main problem until the end.  You would be amazed how many people get through the whole consultation and then, at the end, say something like “While I’m here, can I mention this chest pain I’ve been getting?”


  1. Your Doctor is a specialist
  • They have just specialized in being a generalist! Don’t make the mistake of thinking that there is a hierarchy of doctors, with GPs at the bottom and hospital consultants at the top. Your GP will have spent a minimum of 5 years in training AFTER medical school. They are experienced doctors qualified to look after you. Sometimes people think that going to A&E means you get to see a ‘proper doctor’ – remember that the junior doctor in A&E is likely significantly less experienced than your GP. Many people think that being a GP is the hardest job a doctor can do. If you are concerned that you might need to see a specialist, then talk this through with your GP – they are in a really good place to decide with you if that is what is needed, or not.


  1. Your Doctor is self-employed
  • Did you know this? Why does it matter?  GP partners own the business of the practice and are ‘independent contractors’ to the NHS.  Many members of staff at the surgery, including some of the doctors, will be employed, but by the surgery not by “the NHS”,.  This has a number of implications:
  • Firstly, your GP receives a set amount of money per patient per year to provide all of their care. It doesn’t matter whether you see your GP every week all year, or don’t attend for 5 years; your GP gets the same amount of money for looking after you.  You must not think that by seeing your GP you are ‘doing them a favour’ by bringing in money for your attendance!  The amount of money your GP earns varies from practice to practice (they are all individual small businesses) but the average is around £140 per patient per year.  This is really good value (less than 40p per patient per day), particularly when you consider this is the money the practice receives to provide all the services and pay all the staff including the doctors.
  • Secondly, this means that your doctor’s surgery is contracted to provide certain things, and not others. It’s worth remembering this as this is why you will sometimes be asked to pay for things.  In simple terms your GP is contracted to provide medical care, but not to do things outside of this such as the multitude of letters they are asked to sign.  If ANYONE asks you to “get a note from your doctor”, you should really question this before heading off to the surgery.  Many of these requests are unnecessary and just seek to move a perceived risk from one person to the doctor, who may not be in a position to carry that risk.  Check out this website first for more info:

  • The payment GPs receive is not affected directly by referrals or prescribing – the costs for this are in a separate budget. If your GP decides to prescribe an expensive medicine for you they are not paying for it themselves.  People often think that GPs switch medicines to cheaper ones in order to personally benefit financially.  NOT TRUE!  They are doing this to help the NHS budget as a whole, which I would hope we would all be in support of.
  • Because they are small businesses, they bear any increasing costs themselves. Rising indemnity fees (insurance against being sued) have to be paid by the doctor themselves.  A doctor working only 2 days per week can be paying £6,000 per year on indemnity insurance.  Why does this matter to you?  Because if they are paying £6,000 on that they are not spending that £6,000 on another receptionist, or nurse, or another doctor.  The higher the costs, the less likely the surgery is to be able to add in additional services.  So, bear this in mind when you are thinking of suing your GP!
  • Despite what The Sun might tell you, your doctor does not earn £700k per year (unless your GP happens to be the sole one in the country that does … )


  1. Your Doctor wants the best for you
    • If your GP decides not to refer you on, or not to prescribe anything, or not to investigate you it is not because they are trying to be difficult or just trying to save money (don’t forget, their take home pay is not affected by these things). It’s usually because they don’t feel you need any of the above.  They also understand, probably better than you, the risks associated with over referral, over treatment and over investigation.  This is not a game where you need to see how much you can get from the NHS.  This is about keeping you healthy, investigating when appropriate, and treating when we need to.  Bearing this in mind, your GP will not mind explaining it to you – just ask.  If you were hoping for an X-ray, mention this and have a grown up conversation with your doctor about the pros and cons of doing that.


  1. Your Doctor is not taking part in a medical drama.
    • When you watch the TV, watch out for the doctors. I bet, 9 times out of 10, that they get the diagnosis right, first time.  I’m afraid this is not real life.  Many conditions are not at all obvious, and time is the only sensible way to start to differentiate between them.  GPs often get vilified in the press for not picking up serious illness (“I attended my GP 3 times before they referred me with my cancer…”).  In reality serious illness often initially presents the same as mild, self-limiting illness.  A cough, for example, can be caused by many things, from a simple viral infection to lung cancer.  The patient who presents to their GP with a cough that they have had for less than a week is unlikely to get a chest X-ray on the first visit, but if it has failed to settle after 3-4 weeks, then that’s a different story.  Be aware of this and remember that this is complex stuff.  In particular, ask about the things that you should watch for and under what circumstances you should return for review


  1. Your Doctor might play golf, but probably not in their lunchbreak!
  • The traditional view that people have of GPs is that they see a few patients in the morning; a couple of visits, then are free until evening surgery at 5pm. Plenty of time for 18 holes in the afternoon?  The traditional view is out of date.  Most GPs see 18-20 patients in morning surgery, followed by visits, and then a further 18-20 patients in the afternoon.  Many GPs see more than this.  In addition to these face to face consultations, there will be phone calls and paperwork.  Paperwork is an essential part of patient care, but takes time.  It consists of looking through the results of the investigations that have been ordered, reading letters from consultants, acting upon these letters (consultants will not infrequently give actions for the GP to undertake), signing prescriptions (signing prescriptions is one of the riskiest things that GPs do – be aware of this and don’t be upset if there is a query over your medication – this might just mean that the GP is taking the trouble to check that this is safe for you and won’t kill you) and arranging the investigations and referrals from the previous surgery.  The waiting room may be empty, but that doesn’t mean the GPs are all putting their feet up.  That’s a lot of patients seen, and a lot of decisions made. If you are waiting for the results of an investigation, this can be stressful, and you quite rightly will want the results as soon as possible.  Here are some things you should consider:
    • If the test was arranged by your hospital consultant – that’s who you should go back to for the result. Ring the consultant secretary (ring the hospital switchboard and ask to be put through) and ask when the consultant is going to convey the results to you.  If they try to palm you off by saying they will send the results to your GP, explain that you want the results from the specialist who arranged them who is in by far the best place to give appropriate advice.
    • If your GP did arrange the test, the smart thing is to make sure you know from the outset when and how you should expect to get the results. Are they going to phone you, or do you need to call?  Speaking to the receptionist if you are uncertain is the way to go – explain your problem, and ask how to proceed – they will probably be able to help you.


  1. Your Doctor has entrusted their reception staff with an important job
  • And that job is not just to make things as difficult as possible to make an appointment! The receptionist’s main job is to deal with enquiries, book appointments and generally ensure all is running smoothly.  They are not medically trained, but they will have a really good understanding of the services on offer. My advice would be to entrust them with a rough idea of the problem that you have.  This way they are able to direct you to the most appropriate course of action. Don’t forget that everyone who works in the surgery is covered by the same confidentiality clauses. You can trust that the receptionist is NOT going to be talking about you to others. Increasingly doctor’s surgeries include clinics run by nurses, physios, pharmacists and more.  If you ring and insist on an appointment with a doctor, without explaining that it’s because you have a bad back, you might have missed out on seeing the physio – probably a better option for you.
  • If you are polite and friendly to reception, they will be polite and friendly to you. They are not trying to be obstructive, they are just doing their job – you might be anxious and stressed, but try to keep calm.  The receptionist can be key in getting the right help as quickly as possible – just remember, that help might not be the GP.


So, how many of these top 10 insider knowledge facts did you know?  As with all things, the more we know about how things work, the better able we are to work with the system and get what we need done.  I hope these facts and tips have been interesting and helpful to you.  If they have, why don’t you share them with a friend?!

Voedingssupplementen met rode gist rijst

Voedingssupplementen met rode gist rijst

Publicatie Geneesmiddelenbulletin – Nr. 12 – 29 december 2017
Jaargang 51
Rubriek Let op!
Auteur Mw drs L. Bogaard
Pagina’s 96

Bij de drogist en in de apotheek zijn verschillende producten te koop die rode gist rijst bevatten. Rode gist rijst bevat de stof monacoline K waarvan wordt geclaimd dat het gebruik hiervan bijdraagt aan het behoud van normale cholesterolwaarden. Omdat rode gist rijst wordt gezien als voedingsmiddel valt dit product onder het toezicht van de Nederlandse Voedsel- en Warenautoriteit (NVWA). De gezondheidsclaim dat rode gist rijst goed is voor het behoud van een verantwoord cholesterolgehalte is goedgekeurd door de Europese voedselveiligheidsautoriteit (EFSA) voor producten met een dosering van 10 mg monacoline K per dag.1

Monacoline K

Monacoline K ontstaat na fermentatie van rijst door de schimmel Monascus purpureus. Tijdens de fermentatie ontstaat een paarsrood pigment en het hoofdbestanddeel monacoline K. Monacoline K is chemisch identiek aan lovastatine. Dit is een statine die in Nederland en Europa niet, maar in de Verenigde Staten (VS) wel als geregistreerd geneesmiddel op de markt is in een sterkte van 10 tot 40 mg. Een nadeel van de natuurlijke manier van produceren van monacoline K is dat zowel de kwaliteit als de kwantiteit van het eindproduct afhankelijk is van het fermentatieproces. Tijdens dit fermentatieproces kan bijvoorbeeld ook het giftige citrinine ontstaan.2


Op verkoopwebsites worden geen bijwerkingen van rode gist rijst gemeld. Op diverse gezondheidswebsites wordt aangegeven dat het minder bijwerkingen zou hebben dan de statinen. In de productinformatie bij het in de Verenigde Staten geregistreerde lovastatine wordt echter wel degelijk gewaarschuwd voor bijwerkingen zoals rhabdomyolyse (afbraak van spieren, gewrichten en urinewegen) en leverfunctiestoornissen. Lovastatine wordt bovendien in de lever gemetaboliseerd door CYP3A4. Gelijktijdig gebruik met sterke CYP3A4-remmers kan de spiegel van lovastatine dan ook verhogen.3 Uit twee meta-analysen naar de werking van rode gist rijst blijkt dat de bijwerkingen nog onvoldoende zijn onderzocht.4 5
Bijwerkingencentrum Lareb heeft echter in juli een rapport uitgebracht over meldingen van bijwerkingen na gebruik van rode gist rijst (RGR)- supplementen.6 Gezien de overeenkomst met lovastatine is het niet vreemd dat hieruit blijkt dat het gebruik van RGR wel degelijk de bekende statine-achtige bijwerkingen zoals spierpijn kan veroorzaken. Het Lareb heeft de Voedsel- en Warenautoriteit en de Inspectie voor Volksgezondheid hierover geïnformeerd. In Duitsland heeft het geneesmiddelenagentschap Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), als enige binnen Europa, sinds begin 2016 producten die meer dan 5 mg Monacoline K bevatten geclassificeerd als geneesmiddel.

Zelfzorgstatus van statinen

Sinds 1999 heeft de FDA drie aanvragen gehad om lovastatine om te zetten van een receptgeneesmiddel naar een zelfzorgproduct.7 Deze aanvragen zijn alle afgewezen. Hieruit blijkt dat de FDA lovastatine niet veilig en effectief genoeg acht om te gebruiken als zelfmedicatie. Eén van de leden van de FDA adviescommissie Non-Prescription Drugs, heeft hierover een artikel geschreven.8 Hierin wordt opgemerkt dat geneesmiddelen voor asymptomatische indicaties zoals lovastatine onder controle van de arts moeten worden voorgeschreven.


  • Door de term ‘natuurlijk’ denken veel patiënten een product zonder risico’s te gebruiken. Rode gist rijst bevat echter het statine lovastatine en mogelijk ook andere schadelijke inhoudsstoffen zoals citrinine die bij de fermentatie van rijst tot rode gist rijst ontstaan.
  • Er is onvoldoende bekend over de bijwerkingen van rode gist rijst. Uit meldingen bij bijwerkingencentrum Lareb blijkt dat het middel niet zonder bijwerkingen is. Ook zou rode gist rijst niet moeten worden gebruikt tijdens de zwangerschap, en kunnen interacties optreden met sterke CYP3A4 remmers.
  • Monacoline K is het in de Verenigde Staten geregistreerde geneesmiddel lovastatine, en ook in Duitsland is het inmiddels als  geneesmiddel geclassificeerd.  De FDA vindt lovastatine bovendien niet veilig genoeg als zelfzorggeneesmiddel. Het is onterecht dat het in Nederland als voedingsmiddel vrij te verkrijgen is. De Europese registratieautoriteit EMA en de nationale registratieautoriteiten zouden actie moeten ondernemen en rode gist rijst, net als de registratieautoriteit in Duitsland, als geneesmiddel moeten classificeren.


  1. European Food Safety Authority, Scientific Opinion on the substantiation of health claims related to monacolin K from red yeast rice and maintenance of normal blood LDL-cholesterol concentrations (ID 1648,1700) pursuant to Article 13(1) of Regulation EC No 1924/2006. EFSA Journal 2011; 9: 2304.
  2. Gordon RY, et al. Marked variability of monacolin levels in commercial red yeast rice products: Buyer beware! Arch Intern Med 2010; 170: 1722–1727.
  3. Center for Drug Evaluation and Research. Approval package lovastatine USP tablets 10,20 and 40 mg, December 2001. Via:
  4. Gerards MC, et al. Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain – A systematic review and meta-analysis. Atherosclerosis 2015; 240: 415-423.
  5. Li Y, et al. A meta-analysis of red yeast rice: an effective and relatively safe alternative approach for dyslipidemia. PLoS ONE 2014; 9: e98611.
  6. Bijwerkingencentrum Lareb. Red yeast rice – an overview of the reported ADRs. 2017. Via:
  7. Food and Drug Administration. Briefing document: Joint Session of the Nonprescription Drugs Advisory Committee and the Endocrinologic and Metabolic Drugs Advisory Committee, December 13, 2007. Via:
  8. Tinetti M. Over-the-counter sales of statins and other drugs for asymptomatic conditions. N Engl J Med. 2008; 358: 2728-2732.


Denk je na over kinderen? ‘Ga eerst langs de huisarts’Zwangere buik

NOS Nieuws

Dat roken en drinken tijdens de zwangerschap niet goed is voor het ongeboren kind, weten de meesten wel. Maar dat roken vóór de zwangerschap een spontane vroeggeboorte bijna twee keer zo waarschijnlijk maakt, of dat het gebruik van ibuprofen voor de zwangerschap schadelijk kan zijn, is veel minder bekend.

“Van dit soort risico’s zijn mensen zich amper bewust”, zegt Marjolein Poels, onderzoeker bij het UMC Utrecht, in het NOS Radio 1 Journaal. Zij promoveert donderdag op haar onderzoek naar het effect van leefstijl voorafgaand aan de zwangerschap. Stellen zouden zich volgens haar vanaf het moment dat ze nadenken over het krijgen van een kind, moeten melden bij een huisarts, gynaecoloog of verloskundige.


Tijdens zo’n gesprek moet dan besproken worden hoe een gezondere levenswijze allerlei zwangerschapscomplicaties kan voorkomen. “We zien vaak dat vrouwen pas een eerste gesprek met een verloskundige plannen als zij tussen de acht en tien weken zwanger zijn. Maar juist die eerste weken zijn heel belangrijk”, zegt Poels.

In Nederland is het gebruikelijk dat we pas na twaalf weken vertellen dat we in verwachting zijn.

Marjolein Poels

Ze verklaart dit late melden vanuit de gewoonte om pas na drie maanden de zwangerschap wereldkundig te maken. Na die periode is de kans op een miskraam over het algemeen kleiner. “Dan mag iedereen het pas weten, is de gedachte in Nederland. Maar dan is het kind al flink op weg in de ontwikkeling.”


Zo vroeg mogelijk starten met het corrigeren van een ongezonde leefstijl, is essentieel voor het tegengaan van zwangerschapscomplicaties. Poels: “Denk aan vroeggeboorte, een te laag geboortegewicht, een te hoge bloeddruk of zwangerschapsdiabetes. Bij overgewicht is de kans op zwangerschapsdiabetes meer dan zes keer zo hoog.”

Heel simpele adviezen, ook gericht op de vader, kunnen de kans op zwanger worden vergroten.

Marjolein Poels

Poels deed haar promotieonderzoek in Zeist. Onderdeel van haar onderzoek was een voorlichtingscampagne. “We zagen dat door die campagne vrouwen vaker hun voedingspatroon veranderden, eerder een gesprek aangingen met een zorgverlener, sneller stopten met roken of drinken en eerder begonnen met foliumzuur slikken.” Dat laatste verkleint de kans op geboorteafwijkingen als een open ruggetje, open gehemelte of hazenlip.

Rol van de man

“Hele simpele adviezen, ook gericht op de vader, kunnen de kans op zwanger worden vergroten. Het kan bijvoorbeeld langer duren voordat een vrouw zwanger wordt als hun man alcohol drinkt.”

Volgens Poels moet het een vaste gewoonte worden om bij een kinderwens onmiddellijk de huisarts of verloskundige te informeren. “Dan is er voldoende tijd om te werken aan een topconditie van de toekomstige ouders.”

Facebook pagina

Facebook pagina

Facebook joinVanaf heden is er ook een Facebook pagina van Huisartspraktijk Neeteson. Ook u kunt hier lid van worden. De bedoeling is dat hier met enige regelmaat nieuwtjes op gedeeld gaan worden.

De Grote Geboorte Gids

De Grote Geboorte Gids

De Grote Geboorte GidsVanaf heden bieden wij alle zwangeren die bij ons onder begeleiding zijn het boek “De Grote Geboorte Gids” aan. Een mooi en nuttig boek om je in te leven in alles rondom de zwangerschap en met nuttige tips aangaande de bevalling en kraambedperiode. Wij hopen dat je hier veel plezier aan zult beleven!