Roy E. Kadel, DC
— 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.
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.
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.
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.
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
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
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.
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
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.”
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.
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.
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.
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
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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
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.
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
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
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.