by Roy E. Kadel, DC

1991 — During a recent trip to Europe, I had the opportunity to visit a chiropractor in The Netherlands. The visit was informal, pleasant and quite informational, so I made a decision to relate it here.

Many people call The Netherlands “Holland.” However, Holland is actually the name of the country’s two western-most provinces, North Holland and South Holland. The entire country is officially known as The Netherlands. The Dutch rarely use the official title themselves, so I will use writer’s license and bounce back and forth between the two terms.

The Netherlands is a country just east of Great Britain and the North Sea, west of Germany and north of Belgium. It is about 150 miles wide and 200 miles long, very small for an actual country. We have many states in the USA which are much larger than Holland. But Holland, with 14 million people, is one of the most densely populated countries in Europe.

The national capital of Holland is a city called The Hague, where I visited the chiropractor’s office. This is a large city of a half-million people. It is an elegant city, full of parks, lawns, well-tended gardens, lakes, centuries-old town houses, palaces, a few canals and four chiropractors. The city is somewhat famous for being the central point of operation for Mata Hari, the World War I sex goddess and spy.

While The Netherlands has 14 million people, there are just 60 chiropractors in the country. Many of them are graduates of Anglo-European College of Chiropractic, in England. I was given an AEC college catalogue and found it very similar to a college catalogue from Logan College, where I attended. The school was taught in English and seemed to take about 11 semesters to complete. The curriculum is very similar to Logan’s. It begins with the basic sciences and progresses to the clinical sciences. Some of Holland’s chiropractors are graduates of American schools, but I didn’t meet any.

As I first entered The Hague, one of the things that struck my eye was a sign saying “Chiropractic” on a brick building. Obviously a doctor of chiropractic was to be found inside. I proceeded to my hotel and checked in, but remained determined to return to the doctor’s office and learn what I could. I was staying at the KurHaus Hotel, about one and a half miles away.

I first called the doctor’s office from my hotel room. The doctor’s receptionist answered the phone in Dutch and when she stopped talking I asked her in English if she spoke English. We then proceeded to communicate in English once we had established the fact that I knew no Dutch. She indicated to me the doctor was very busy but could talk to me on the telephone about 12:30.

Well I knew that probably was not true, judging by what I see in my office, so I put on my walking shoes and made a hike to the office that I had passed an hour earlier.

I walked into the chiropractic office of Dr. Erik Stegeman for a visit. I stood at the reception desk with my business card out, trying to make connection with the receptionist. The four folks in the waiting room regarded me with a look I can only explain as “I bet this guy is trying to cut in front of me.”

After I got the receptionist’s attention, and she went back and told the doctor I was there, Dr. Stegeman made an appearance in the waiting room and asked me to return about 2:30 for a good visit. I could see he was busy, so I agreed to his suggestion.

When I arrived back at Dr. Stegeman’s office, I found several patients waiting and the receptionist watering the flowers. Holland is a country full of beautiful flowers and people who appreciate them.

Dr. Stegeman stepped out of his treatment room, grabbed my hand robustly, and welcomed me, introducing me to his staff and giving me a tour of the office. The staff was made up of himself, his receptionist (whose name I don’t know) and Dr. Marihe Zegelaar.

Dr. Stegeman informed me that he was a physiotherapist prior to attending chiropractic school in England at AEC. He was a student there from 1983 to 1987, and after graduating he started this practice in The Hague.

Dr. Zegelaar was a recent graduate of AEC. She had just begun practicing after completing her entrance tests, and gave me a good run-down of the examinations required to practice in Holland. She is currently practicing as an associate doctor in three Dutch cities, Amsterdam, Rotterdam and The Hague.

The office was triangular in shape, with about 1,200 feet of floor space. They had three rooms for treatment. One room held a physical therapy-type table and an X-ray machine. Another room held a spring loaded Zenith Hi-Lo table and also a flexion/distraction table. The third room held a fully equipped Zenith 560 table and a consultation desk. The office also has some physical therapy modalities, namely, ultrasound and low-volt galvanic electrical therapy.

I discovered that chiropractic treatment in The Netherlands is paid for by the government health plan and most independent insurances. The playing field among the health care providers is not completely level though, as the allopathic patients don’t have to pay an excise tax on their treatment, but chiropractic patients do.

This clinic was seeing about 200 patients a week, according to the doctors. Dutch chiropractors have great difficulty getting the thrifty Dutch patients to recognize the importance of repetitive treatment, especially in the acute stages of symptoms. Dr. Stegeman told me that Dutch patients think he is trying to treat their wallet when he recommends they have daily treatment during the acute symptom period, and most Dutch chiropractors treat patients one time a week. The average fee for a visit would be 75 Dutch guilders, or about $45 US.

The Dutch national health insurance will pay for a person to visit a chiropractor 10 times a year. They also pay for the X-rays and physical therapy necessarily adjunctive to the manipulation.

Dutch chiropractors do act as a portal of entry into the health care system. They are charged with diagnosing and referring patients to other providers. Other providers are also charged, with similar standards to meet. This balanced obligation to refer to the proper specialist gives chiropractors in Holland 50% of their new patients. It seems that 50% of the patients in chiropractic offices were referred by allopaths.

Dr. Stegeman indicated that his referrals from allopaths had been up substantially the past four weeks. It seems that they study done in Britian on the comparative effect of chiropractic and allopathic care for back problems, indicating a clear superiority for chiropractic treatment, had been released about four weeks earlier.

Dr. Stegeman was quite an interesting person. It turned out he was an extra in the 1976 movie, “A Bridge Too Far.” He is a World War II uniform collector. I was taken to the basement of his office and shown a sample of his collection.

I discovered that the Dutch allopaths manipulate patients regularly, and people in Holland are comfortable with the concept of joint manipulation. The allopaths will take a weekend seminar on manipulation if they are not taught the topic in their regular training.

There are over 2,000 physical therapists in Holland that manipulate. A physical therapist must take the regular course work to become a physical therapist licensed to practice, and then to be allowed to manipulate they need a weekend seminar in the technique. With this knowledge, I could see why patients were stacked up in Dr. Stegeman’s waiting room and offended at the notion that I would get in to see the chiropractor before they did.

Dr. Stegeman and Dr. Zegelaar told me that chiropractic practice in Holland does not seem so business-like as it does in the United States. It seems that there are no practice building organizations working in Holland now. Some Dutch doctors have traveled to a Parker seminar and returned with material and brochures for distribution.

This office was equipped with a computer for financial affairs. The device was capable of writing short reports on patients, but it did not have the capacity to do narrative reports. My inspection of the computer was hampered by the fact that I don’t speak or read Dutch and know practically nothing about computers. I did see the screen light up when the master switch was thrown and watched the office staff point to the device and in a marveling tone of voice indicate to me it was a good machine.

The doctors had good diagnostic equipment. I got the impression a good physical examination and accurate diagnosis was important to their method of practice, and that the school in Britain stressed good diagnostic ability and skills.

The licensing requirement to practice in The Netherlands makes a large change this year. They are requiring newly graduated doctors of chiropractic to work an internship of one year with an established doctor. In the past no special internship was required other than the clinic at the college. The chiropractor must take a comprehensive physical diagnosis test, comprehensive radiology test and practical test in adjusting technique, and must write a thesis before being admitted into practice.

I have been contacted by several chiropractors asking me to establish a series of interprofessional meetings with our Dutch brothers in health care. If you have any interest in attending a professional meeting in Holland, please contact me for more information.