How to be an inFLUencer: the role of a general practitioner

Clare Taylor: 0:15

Hello and welcome to ESWI Airborne. Today we'll be talking about how to be an influencer. I'm your host, Clare Taylor, and this is where we meet the members of ESWI, the European Scientific Working Group on Influenza. Today I'm joined by Dr Van Essen, also known as Dr Ted, to his TV audiences in the Netherlands. Ted is going to take us with him on his unique journey from studying influenza to societal influencer. Ted, thank you so much for joining us here today. How are you?

Ted van Essen: 0:47

Very good, thank you.

Ted, you first qualified as a general practitioner in 1974. I find this unbelievable looking at you, but what motivated you to become a doctor?

As a matter of fact, I became a general practitioner just after medical school. There was not a specialty training at that time. So I was 25 and I quit medical school and started being a doctor right away. What I liked on that job is that I was my own boss for one thing. And secondly, I was outside of hospital because the authoritative system of hospital didn't like me so much. I didn't like that and they didn't like me either, so I had some conflicts there. So I was very grateful to be my own boss at that time. And the best thing of general practice is, of course, that you can see lots of patients with different problems and you have to start with every consultant you have. You have to start all over from the beginning because it's something new for the patient and for you as doctor.

And has it changed a lot, being a GP over the years for you?

Oh yes, of course, when I started I was as a locum, so I visited different places then. But then I had my own practice in 1976, together with my wife, who is also a GP, and we did that for 10 years with the two of us, with just one secretary as a help. Now, 40 years later, we are working in a medical center with 10 GPs, some trainees, some nurses, some psychologists, about some 25 people working in the same building and working all together for a population of 10,000 patients. And this development is something great to have been part of that.

That's wonderful, and I see that you're active on many, many committees and medical boards and you also work in media, which we're going to talk about a bit later. Do you still have the time to see patients?

Well, not anymore. I quit general practice some years ago, but now the last year I've been working on the vaccination sites for the COVID vaccination and I see patients there. Of course, lots of questions that people have I have to answer and I really enjoy seeing patients again, but that's only in that place. So, no, I don't see any patients more. I answer a lot of questions by mail and on the internet. So that's the other way. I don't see, but are active in the contact with patients.

A vaccination, and particularly influenza vaccination, has been a theme for you for a long time. It was the topic of your PhD thesis, so why did you choose this in the first place?

I think I was curious how were things managed in the practices of my colleagues? When I started my practice, my predecessor gave me a list of names and he said well, these are 200 names of patients that need a flu shot every year. And I added a few names and then in September I started writing prescriptions for the pharmacy for one flu shot and I sent that to the patient by mail and they came with the flu shot to my practice and I gave the vaccination and I was wondering how other colleagues were dealing with that, because it seemed rather awkward to do so many steps in between. And that's why I started asking all my colleagues in my society, how do you deal with that? And that was the first chapter of my thesis, as a matter of fact, because after that I started developing a program to improve that system and we rolled that out in one region and then it was quite successful. And we rolled it out all over the country. And since then I'm sort of addicted to the flu shots.

Okay, and vaccination has been a big topic for the last year, especially what's the biggest challenge now for vaccination?

I think people want to have answers on their questions. It used to be so that if the doctor said this is good for you, just take this vaccine, people said, ok, if you say so, we'll do that. But now they have questions and they want answers and they're right so to ask those questions. And the doctor or the nurse are the best professionals to give answers to the people, because they know their patients and they know all the contacts of their families and their the jobs and you know what kind of answer you should get. Because you have to answer different to elderly people compared to a young person with a young family, and that's something you can really do the best as a doctor.

And Ted, you've really been active and working a long time now. What's been the greatest breakthrough or change in your career and what are you most proud of?

I think that starting my research for my PhD was very important for my career. What I found out that having a PhD opens a lot of other doors. People think that you are a better doctor with a PhD, which is nonsense, of course. But you know how science works. That helps. But you also know how to communicate about your subject, because that's the fun of the flu shot. It's always in the news at the time of the vaccination. It's in the news because people say well, do you want to take it or don't you want to take it? When there is a flu epidemic, seasonal, then there's a lot of news. With the pandemic, there was a lot of news and you are then the expert in this field. I was the general practitioner in the Netherlands who had the most expertise in the field of influenza and that makes that you have an obligation to use that information, to use that expertise to tell the patients about it.

So how you used your influenza in fact, which brings us to the fact that you are a TV doctor in the Netherlands, going by the very cozy name, if I may say so, is Dr Ted. Tell me, Ted, or Dr Ted. How did you get started with the media work?

Well, after my PhD, I was asked sometimes about flu, but then this talk show started in 2009 and they were looking for a doctor to tell everything about all kinds of medical problems and GPs know everything about all problems. And I had a lot of experience because that was the year that the Mexican flu did go around. I was the spokesperson for the Dutch College of General Practitioners on the Mexican flu and that lasted a lot shorter than this COVID pandemic and after three months it was all over almost. But there was a lot of interest on TV and on radio, what can we expect of this pandemic? And so I had a lot of experience talking in news programmes and that was the reason they asked me for this programme. I'm still on the same programmes since that time.

Well, that's obviously working. And what do you enjoy about it?

It is sort of an extension of my surgery. Having a patient in front of you with a problem. You try to find out what the problem is, but then you try to give an explanation of the complaints and tell about what the patient could do about it, or just wait, which is usually the best to do. So that's what I do with patients in front of me, and now I could do it with a million patients in their own houses in front of their TV sets. And that's the fun of it, to make it personal, although you're just talking to a camera.

How do they respond to this? Do you get a lot of messages from your audience, and what are they asking about?

Oh yes, I sure do, because at the end of the programme there's always a link shown where people can ask questions, and it depends, of course, on the subject, but on flu shot, there usually are hundreds of questions in the mail on this link, on this site where the programme is announced. And what we also do is that we give us a short text there about what I've said in the programme. As a matter of fact, the text which I use to prepare myself is also in prints on the website and under that people can ask questions on all kinds of things. And sometimes there are less questions. Sometimes it's well, you're talking about the menopause, but you're a man, what do you know about the menopause? And sometimes, of course, people start really saying not too nice things to me. Well, usually people have good questions, I can answer them.

Do you hear the same questions again and again? Are there topics that are very common that come again and again?

Yeah, that's absolutely so, and it's not only with the patients that are the people that ask me questions, but also journalists always start with the same questions and that is what are the side effects of the flu shot, what can I expect of the effectiveness of the flu shot and how come I did get the flu anyway, even after my flu shot? And that's the things that you have to answer again and again and to tell them that, of course, the flu shot has some side effects, but not that many, and it's not always working because the effectiveness is not 100%. And, yes, you can have other viruses which look like the flu but are completely different, so the flu shot will not work against them.

And do you think it's important for medical experts and scientists to be active in the media and to be public figures?

I think we really should do it, because when you see the communication about any medical problem, when it comes from the government or from public health, people sort of think it might be influenced by the government. But when the doctor tells them they believe it's the best, I think. So we should really use that position we have, to give them the answers on the questions they have. Doctors are best suited for that.

And is there anyone that you would look to as a role model, as in this TV doctor

Yeah, there's always been TV doctors in most countries there are, and I've seen them all. I tried to see what I could copy of them and what you see is that in the beginning of TV there was this doctor that said well, this is a problem that you should do, and that's something I changed. Now I try to tell people that the problem is this and that might be serious or not that serious and they could discuss this with their own doctor to get personal answers, etc. etc. So you try to give the patient or the listener the idea that he or she should work on it together with their own doctor, but that they best come there with some pre-information.

So, Ted, in relation to scientists, medical experts in the public domain, as media figures, do you see how the tone or the role of this expert has changed over the years?

Absolutely. I think that in the past there was the authority that told the audience what is good for them, and now it is the person on the table that discusses with the journalist what are the ins and outs of the situation at that moment and what could be the best way to get out of this situation. Of course, you still have different characters between virologists and other experts, and some are still in the way that say, well, we know the best, but usually that doesn't work.

And then, assuming that you know, we have this increasing number of scientific experts and medical experts in the public realm, how do you see the interaction between science and policymaking?

I see the policymakers as part of the general public. As a matter of fact, their knowledge about, for instance, flu is not that much more. There's a big problem that people in policymaking change all the time, governments change all the time and that makes that you have to tell them also what is the current science in this field. So talking to patients is the same as talking to listeners to TV shows, as talking to policymakers, just explaining them what is the best for you and for the population.

You're the chair of the Dutch Influenza Society and you also co-founded this society. Why did you start this and what is it that you hope to achieve with it?

Well, as a matter of fact, I didn't start it because it was there in the 90s. At that time, the chair was the later director of the ECDC, Sprenger, but at the time they were so successful because the vaccination rate did go up to 75% of the patients at risk. So they decided to stop with society, and then in the beginning of the century, it still was great, but then in the 10th of this century, like in 2018, the vaccination rate was down to 50%, and then I decided, together with a few other flu experts, to re-erect the foundation again and starting to influence the people through our society. As a matter of fact, we're not a big society, but if you are a foundation, journalists always come and ask you questions about flu because they think you are an expert. So why not ask the flu foundation?

Ted, when people come to you looking for advice, and what is your advice to people who are just afraid of having a vaccine? If I said to you, Ted, I just don't know and I'm nervous and I'm scared, what would you say to me?

I would say well, let's talk about it, because you can be afraid of just about any aspect of the vaccination you're getting. Some people are afraid of needles, for instance, and then you can discuss that and tell them that it sometimes starts with a very bad start in life, where they had needles as a baby, for instance, or in the hospital. And when they recognise that, then this might be the start of a therapy for them to get rid of this needle fear. But it can also be that they have ideas about the vaccine that they are going to receive and then you can try to answer questions about that. Or they say well, I have a very strong immune system, so I don't need all this stuff in my body. Then you can give them an explanation about their immune system. So you have to listen first to the people that ask questions and try to find with them what kind of answer they really need, and then try to give them an answer and ask them again is this the answer for your question or do you have more questions? So you should talk with the patient and it's not enough to only send.

So to identify a very specific fear, what the particular kind of fear is.

Because there's a difference between people. Of course, you have the robust anti-vaxxers. You don't have to try that to influence them, because they will not listen to you. But there are still a lot of people that have their questions and just want answers and do the best for their children, for instance. They read a lot of things on the internet or in newspapers and they have questions and they want the answers, and I think you should listen to them and try to give them the answer on their own question.

What level of vaccination do you aim for? What do you think you referred to previously? 75% of the at-risk were vaccinated against flu. What's your objective? What is an acceptable level?

Well, that's the WHO goal. Target is 75% of the at-risk population. I think that's a very good target which we did reach in the beginning of this century. And what I do not tell you right now is the vaccination rate of the health workers, because that's very low in the Netherlands. That's a subject we really have to address the coming years because that's awful that the vaccination rate is very low in health care workers. So there's a lot to do still.

How low is the vaccination rate in health workers?

Oh, it's only about 30, 40%, so that's not what we want. I think health care workers' vaccination rates should be almost 100%.

A worthy aim indeed. Well, I could talk with you, Dr Ted, all day. I can understand why you are an influencer, but that's all we've got time for today. Dear listeners, keep on tuning in to the podcast series ESWI Airborne, and until next time stay safe.

Aida Bakri: 20:27

ESWI Airborne is brought to you by ESWI, the European Scientific Working Group on Influenza and Other Acute Respiratory Viruses. These episodes would not be possible without the team's efforts and I would like to extend special thanks to our ESWI Secretariat, our technical and IT teams, our arts team and our host, Clare Taylor. The podcasts are recorded virtually and we thank our guests for their participation in this inspiring and educational series. Talks are adapted to a global audience and are intended as recommendations and guiding principles. For any specific medical questions you may have, these should be addressed to your local general practitioner. Many thanks to our sponsoring partners and thank you for listening.

How to be an inFLUencer: the role of a general practitioner

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ESWI Airborne: Meet the Members