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This is Going to Hurt

This is Going to Hurt by Adam Kay is a comedic, tragic, and insightful view into the life of a (junior) doctor. The book is written as a series of diary entries that Adam has kept over the six years he worked in the NHS (UK healthcare system). Since then, he’s become a writer for TV and film. He brings those skills to this book.

Read: 1x | First: January 2023


The book does a great job of describing how gruelling the hours are, the lack of compassion (and sometimes great shows of it), and the difficulties of life-threatening situations that Adam encounters. But through it all, there is a high level of comedy he inserts into the diary entries.

As there isn’t too much of an overarching point (at least not made implicitly), I’ll leave this review with one of the diary entries that showcases just how funny it can be:

Monday, 12 February 2007: Prescribing a morning-after pill in A&E. The patient says, ‘I slept with three guys last night. Will one pill be enough?’

Waarom een nier doneren een goed idee is

See the English version of this article with sources and footnotes

Het is zeven dagen geleden dat ik mijn nier heb gedoneerd, en ik voel me weer de oude. Ik heb een litteken van ongeveer 10 cm rond de broekrand. Ik loop nog geen marathon. Verder voel ik me volkomen normaal.

Ik doneerde mijn nier anoniem om iemand een tweede kans op leven gegeven. Zijn nieren lieten het afweten, dus zijn leven werd vroegtijdig afgebroken. Hoewel dialyse de functie van een nier gedeeltelijk kan vervangen, vermindert het proces van elke twee dagen aan het dialyseapparaat de kwaliteit van leven van iemand aanzienlijk.

Een nieuwe nier, van een levende donor, gaat gemiddeld 22 jaar mee. Niertransplantaties worden regelmatig gedaan en 98% van hen is succesvol. Kortom, door een nier te doneren krijgt iemand een tweede leven.

Op dit moment wachten in Nederland ruim 800 mensen op een nier gemiddeld twee jaar voordat er een beschikbaar komt. Als ze geen nier krijgen is dialyse de enige optie. Van degenen die wachten sterft 8% en 14% ziet hun toestand verslechteren tot een toestand waarin een transplantatie geen zin meer heeft.

Het doneren van een nier had ook een positieve invloed op mij. Ik voel vreugde en dankbaarheid dat ik iemand anders kan helpen, ook al ontmoet ik de ontvanger nooit.

De donatie, hoe gemakkelijk ik het ook ervoer, komt niet geheel zonder risicos. Toen ik het nieuws voor het eerst deelde met mijn moeder, was haar reactie niet precies wat ik had verwacht. In plaats van dolblij en dankbaar te zijn, was ze verrast en uitte ze haar ongemak over mijn beslissing om een nier te doneren.

“Heb je de nier zelf niet nodig?” en “Wat als iemand in je omgeving een nier nodig heeft?” waren twee typische reacties die ik kreeg toen ik anderen vertelde over mijn plan om te doneren.

Het antwoord op de eerste vraag is een volmondig nee. Nierdonoren leven gemiddeld even lang als andere mensen. Er is een verhoogd risico op terminale nierziekte, maar de kans, gemeten over 15 jaar na donatie, is lager dan 0,5%. Als het misgaat, krijg ik automatisch voorrang op de wachtlijst.

Wanneer iemand in mijn omgeving een nier nodig heeft, krijgen ze mijn resterende nier niet. Maar de kans dat een bekende van mij een niertransplantatie krijgt is 1 op 18000. Met andere woorden, er is een kleine kans dat iemand die ik persoonlijk ken een nier nodig heeft. Zelfs als ze dat deden, is de kans groot dat ik niet compatibel met ze zou zijn.

Een derde risicofactor is een kans om te overlijden tijdens de operatie zelf. De kans om te sterven op de operatietafel, is lager dan 1 op 3000. Ik zeg lager dan dit getal omdat de meest robuste data komt van meer dan 10 jaar geleden en ik mijzelf ook gezonder, of in ieder geval jonger, inschat dan de gemiddelde donateur.

Het ziekenhuis snijdt je nier niet weg zonder met zekerheid te weten dat je gezond genoeg bent om te doneren. Ik bezoek het ziekenhuis zes keer voor de operatie, twee bezoeken die meerdere uren duurden, de andere waren snel in en uit voor een bloedtest of scan. Aangezien ik in dezelfde stad woon als het ziekenhuis, is de totale duur van de bezoeken minder dan twee volle werkdagen.

De dag voor de operatie krijg ik mijn eigen privékamer met uitzicht. Er is wat nervositeit, maar voor de workaholics kan ik zeggen dat ik die middag op de laptop door kan werken. De enige onderbreking is het nemen van bloedmonsters en het inbrengen van een katheter om vloeistoffen in de bloedsomloop te pompen om de nieren gehydrateerd en actief te krijgen.

Tijdens de operatie zelf ben ik onder algehele narcose dus daar kan ik niet veel over melden. Een paar uur later, wanneer ik wakker word krijg ik een raketje en na een half uur bijkomen rijden de zusters mij weer naar mijn kamer.

Wat me het meest verbaast, is de helderheid die ik voel na de operatie. Ik krijg de eerste twee dagen morphine en mijn vriendin zegt dat ik een beetje high klink. Maar ik kan vrienden een bericht sturen dat het goed met me gaat. Na bezoek kan ik de rest van de dag Netflix kijken en naar een audioboek luisteren.

Vier keer per dag komt er een verpleegster langs om mijn vitale functies op te nemen en te vragen naar mijn pijnniveau. De eerste twee dagen bereikt het pijnniveau een acht, beide keren ‘s avonds als ik probeerde in slaap te komen. Maar dit is allemaal beheersbaar met enkele oxycodon pillen en ik slaap relatief goed. Tegen de middag van de derde dag heb ik de laatste aspirines ingenomen en had sindsdien geen pijnstillers meer nodig. Tegen de ochtend van de vierde dag zit ik in een taxi naar huis.

De ervaring van anderen kan verschillen. Ik verkeer in een uitzonderlijk goede gezondheid, sport zes dagen in de week en heb afgelopen zomer een marathon gerend. Dit is slechts mijn ervaring, die mij positief heeft verrast.

Een week na het doneren voel ik het littekenweefsel rond de taille, vooral na het lopen van langere afstanden. Ik moet voorzichtig zijn als ik mijn buikspieren belast, bijvoorbeeld bij rechtop gaan ziten, maar daar is het ook mee gezegd. Ik laat de hond alweer uit, zie veel vrienden en kan in principe weer terug naar kantoor.

Voor ik het vergeet, de intraveneuze katheter is niet de enige die gezet wordt. Je krijgt er ook een die door je geslachtsdelen gaat en die de volgende ochtend wordt verwijderd. En ja, dit doet een paar seconden intens pijn, maar minder dan een trap in je ballen krijgen.

Ik ben blij dat ik een nier heb gedoneerd, zoals de meeste donoren. Ik zal een normaal leven leiden zonder beperkingen. Ik krijg zelfs een jaarlijkse gezondheidscheck ervoor. Iemand anders krijgt twee decennia leven erbij. De kosten waren het waard, voor mij.

Ik kan niet door inschatten of het voor anderen ook een logische keuze is. Er zijn niet veel mensen die dezelfde berekening hebben gemaakt als ik. Jaarlijks zijn er in Nederland 500 donaties van levende donoren, 30 daarvan altruïstisch. Maar als je erover nadenkt om te doneren, aan een bekende of anoniem, dan hoop ik dat mijn verhaal je geholpen heeft om die keuze makkelijker te maken.

Voor meer informatie over het doneren van een nier, zie de informatie op de website van de Nederlandse Transplantatie Stichting.


Ingestuurde versie met minder verhaal, meer overtuiging:

Waarom een nier doneren een goed idee is.

Er staan meer mensen dan ooit op de wachtlijst voor een nierdonatie. Als gezond persoon kan je leven met één nier, dus heb ik mijn andere gedoneerd.

Ik doneerde mijn nier anoniem om iemand een tweede kans op leven gegeven. Zijn nieren lieten het afweten, dus zijn leven werd vroegtijdig afgebroken. Hoewel dialyse de functie van een nier gedeeltelijk kan vervangen, vermindert het proces van elke twee dagen aan het dialyseapparaat de kwaliteit van leven van iemand aanzienlijk.

Een nieuwe nier, van een levende donor, gaat gemiddeld 22 jaar mee. Niertransplantaties worden regelmatig gedaan en 98% van hen is succesvol. De kans op slagen is groot, maar het aanbod laat het afweten.

Op dit moment wachten in Nederland ruim 900 mensen op een nier gemiddeld twee jaar voordat er een beschikbaar komt. Als ze geen nier krijgen is dialyse de enige optie. Van degenen die wachten sterft 8% en 14% ziet hun toestand verslechteren tot een toestand waarin een transplantatie geen zin meer heeft.

Mijn operatie verloopt zonder complicaties en ik kom bij met een waterijsje. De middag, een operatie duurt vaak niet meer dan drie uur, en avond zie ik bezoek en kijk ik Netflix. Geen drie dagen later brengt een taxi mij naar huis nog voordat mijn vriendin het ontbijt heeft gemaakt.

Op dag vijf loop ik alweer het gebruikelijke rondje met de hond, hoewel iets langzamer dan voorheen. De zuster belt en deelt mee dat de nier succesvol getransplanteert is en na enkele dagen opstarten “uitmuntend” aan het werk is.

De donatie, hoe gemakkelijk ik het ook ervoer, komt niet geheel zonder risicos. Toch, op de lange termijn leven nierdonoren leven even lang als anderen. Er is een verhoogd risico op terminale nierziekte, maar de kans, gemeten over 15 jaar na donatie, is lager dan 0,5%. Als het misgaat, krijg ik automatisch voorrang op de wachtlijst.

Tenzij je iemand kent die een nier nodig gaat hebben, is de kans klein dat je die voor een kennis hoeft te bewaren. De kans hierop is vergelijkbaar met een van drie personen uit een vol voetbalstadion kiezen. Ookal wil je doneren voor een bekende, er is een grote kans dat je niet matcht met hen.

Er is een kans op overlijden tijdens de operatie zelf. Dit risico is lager dan 0,03%, aldus data uit Amerika van meer dan tien jaar geleden. Met andere woorden, als gezonde donor in een Nederlands ziekenhuis is deze kans te verwaarlozen.

Het kost wat tijd, enkele bezoeken aan het ziekenhuis en een drietal dagen na de operatie bijkomen. Daarna zit je thuis met een verplichte, geheel vergoede, vakantie van drie weken. Je doet een nierdonatie niet voor de vergoeding, maar door goede regelingen kan het ook geen excuses zijn om het niet te doen.

Doneren van een nier heeft ook een positieve invloed op de meeste donoren. Ik voel vreugde en dankbaarheid dat ik iemand anders kan helpen, ook al ontmoet ik de ontvanger nooit.

Een maand na het doneren ga ik weer rustig naar de sportschool, ben ik aan het werk. Alles is terug naar normaal. Ik voel nog de hardheid van het littekenweefsel rond de taille. Ik zal voorlopig geen marathon rennen, maar daar is het ook mee gezegd.

Ik ben blij dat ik een nier heb gedoneerd, zoals de meeste donoren. Ik zal een normaal leven leiden zonder beperkingen. Ik krijg zelfs een jaarlijkse gezondheidscheck ervoor terug. Iemand anders krijgt twee decennia leven erbij. Voor mij waren de kosten waren het waard.

Voor meer informatie over het doneren van een nier bezoek de site van de transplantatie stichting: https://www.transplantatiestichting.nl/orgaan-en-weefseldonatie/nierdonatie-bij-leven

Why Donating a Kidney is a Good Idea

See the Dutch column version of this article

It’s been seven days* since I donated my kidney, and I feel like my old self again. Sure, I have a scar of about 10cm around the waist. I’m not running a marathon yet, but I feel entirely normal besides that.

If you’re not afraid to suffer a little uncomfortableness, I’m here to convince you that donating a kidney is not a big deal – and a massive deal for someone else at the same time.

Why donate anyway?

By donating my kidney, I’ve given someone a second chance at life. His** kidneys were failing, so his life was cut short. Though dialysis can partially replace the function of a kidney, the process of being hooked to the dialysis machine every second day significantly reduces someone’s quality of life.

A new kidney, from a living donor, will last for an average of 22 years. Kidney transplants are regularly done, and 98% of them are successful.

In short, donating a kidney gives someone another lease on life.

There are currently over 800 people waiting for a kidney in the Netherlands, waiting an average of two years for one to become available. If they don’t receive a kidney, dialysis is the only option. Of those waiting, 8% die and 14% see their condition worsen to a state where a transplant doesn’t make sense anymore.

Donating a kidney also positively impacted me. I feel joy at being able to help someone else. I feel grateful for being able to help another person, even though I never get to meet the recipient.

The potential risks of donating a kidney

When I initially shared the news with my mother, who is retired and had been looking forward to becoming a grandmother, her reaction wasn’t exactly what I had expected. Instead of being overjoyed and grateful, she was taken aback and expressed discomfort with my decision to donate a kidney.

“Don’t you need the kidney yourself? What if someone close needs a kidney?” were two typical reactions I got when telling others about my plan to donate.

The answer to the first question is a resounding no. Kidney donors, on average, live the same length as other people. There is an increased risk of end-stage renal disease, but the chance, measured over 15 years after donating, is lower than 0.5%. And if things go wrong, I’m automatically prioritized on the waiting list.

If someone close to me needs a kidney, they are not getting my other one. But the chance of them getting a kidney transplant is 1 in 18000. In other words, there is a tiny chance that someone I know personally will need a kidney. Even if they did, there is a big chance that I wouldn’t be compatible with them.

A third cost is a chance of dying during the operation itself. The chance of dying on the operating table, from data between 1994 and 2009 is 1 in 3000 (I’m mentioning the dates as it’s probably overestimating the risk). This is roughly the same cumulative risk you would incur by riding a motorcycle for 3000 km.

The actual costs of donating a kidney

The hospital doesn’t cut out your kidney without knowing with certainty that you’re healthy enough to donate.

I visited the hospital six times before the operation, two visits which lasted multiple hours, the others being a quick in and out for a blood test or scan. As I live in the same city as the hospital, the total duration of the visits was less than two full working days.

The day before the operation, I got my own private room with a view. There was some nervousness, but for the productivity obsessed, I was able to work through the afternoon which was only interrupted by taking some blood samples and inserting an intravenous catheter (for pumping fluids into the blood circulation to get the kidneys hydrated and active).

During the operation itself, I was under general anaesthesia so I can’t report much there. When I woke up a few hours later, I got an ice cream (‘raketje’) and after half an hour of coming to, was wheeled back to my room.

What surprised me most was the lucidity I felt after the operation. I was on pain medication, and my girlfriend said I did sound a bit high. But I could voice message friends that I was doing well, and after visitations spent the rest of the day watching Netflix and listening to an audiobook.

Around four times a day, a nurse would come by and take my vitals and ask about my pain level. I received two slow-release morphine tablets (the first two days), four oxycodone tablets (lasting about six hours), and two aspirins three times a day for the first three days.

The first two days the pain level reached an eight, both times in the evening when I was trying to get to sleep. But this was all manageable with the oxycodone, and I slept relatively well. By the afternoon of the third day, I’d taken the last of the aspirins and hadn’t needed more painkillers since.

By the morning of the fourth day, I was in a taxi driving home.

The experience of others may vary. I’m in exceptionally good health, do sports most days, and deadlifted 200kg the week before the operation. This is just my experience, which was less burdensome than expected.

A week after donating, I feel the scar tissue around the waist, mainly after walking longer distances. I have to be careful when straining my core (e.g. getting out of bed), but that is about it. I’m not allowed to lift heavy weights for the first six weeks. I’m walking the dog, hanging out with friends, and back in the office again.

Before I forget, the intravenous catheter isn’t the only one set. You also get one that goes through your private parts which is removed the following morning. And yes, this hurts intensely for a few seconds, but less so than getting kicked in the balls.

Donate a kidney if you can

I’m happy that I’ve donated a kidney, as are most donors. I will live a normal life without limitations. I even get a yearly health check for free. Someone else will get two decades of life back***.

The costs were worth it, for me.

I can’t reach through the screen and tell you that the calculation makes sense to you. There aren’t many people who made the same calculation as I did. There are about 500 living donations in The Netherlands per year. But if you’re thinking about donating, to a person you know or altruistically, I hope my story has helped make that choice easier for you.

To get more information about donating a kidney, see the information on the Dutch Transplantation website.

*The first draft of this article was written seven days after the operation. Now – a few weeks later – I can report the situation is still good. I’ve caught the flu and did take a week to shake that (vs. normally never getting the flu, but no fever, only coughing). Another person I’ve spoken to had a longer recovery time (constipation for a week, feeling tired quickly for two/three weeks, but lower pain levels)

**My kidney donation was anonymous, meaning I didn’t get to meet the person who received my kidney. I do know that it’s a man who had multiple people ready to donate but who didn’t match his blood or tissue type. I didn’t match his blood type but it was a perfect match on the tissue values. Donating through the blood type means that more antibiotics must be given. On average, the success rate is the same.

***In some cases, you might be able to start a chain of donations. Meaning that you donate to someone who has a non-compatible friend/family member who will then donate to someone else who’s on the waiting list (some donation chains can be up to six people).

Sources

98% of kidney recipients are still alive after one year in the US – Temple Health

99% of kidney recipients are alive after one year in the UK. The average function of a living kidney is 20-25 years, but up to 60 years of success have been reported – NHS

Life expectancy is the same – The Lancet – Life expectancy is lower by 0.5-1 year – BMJ Open

The chance of dying on the operating table of 1 in 3000 from data of 80k donors – JAMA

The risk of dying from different activities as expressed in ‘micromorts’ – Wikipedia

About 800 people are waiting for a kidney in The Netherlands (they wait an average of 2 years for one to become available) – Nierstichting

The are about 1000 kidney transplants in The Netherlands (population 18 million) per year – Erasmus MC

Public Commitment 2023

Theme: Expansion

This year I’m focusing on expanding myself and my impact on the world in various domains. It follows from a year where a lot of groundwork was done (e.g. finishing v1 of Blossom’s database). In 2023, it’s time to build on that and expand outward.

The expansion can take many forms, from moving to a bigger house, to offering more things with Blossom. It also means improving what I’ve done in terms of fitness and ‘recovering’ from the kidney donation (by ‘expanding’ to higher numbers on the big lifts).

Another way of putting the theme, with a slightly different meaning, is ‘Big or Bust’. It’s a bit more aggressive, but also captures the pruning side of the equation. Expanding means building on what is working, but could also mean letting go of non-productive parts to make the expansion possible.

House

Objective (O): Live in the dream house

Key Result (KR1): Get financial information from the accountant by <5 Feb

KR2: Get ‘inkomensverklaring’ info and/or check for financing from ABN AMRO

KR3: After the above, look seriously on Funda and refine the criteria once more

I want to live in my dream house* when possible. It looks like it should be financially possible to buy the dream house, so why wait? I’ve listed the first steps to making it happen here. This area would best be captured by the ‘big or bust’ framing. I don’t want to settle for an ‘ok’ house.

*Dream house: 500m2 ground, 150m2 house, no neighbours, space for sports outside, space for the vegetable garden outside, preferably near woods, can be old (do lots of work self) or new, preferably place where you can throw a party and not think about the neighbours.

Finances

O: Make 10k p/m

KR1: Keep track of finances p/w

KR2: Spend <50% of income on normal living expenses

I’ve built a good foundation with Queal, and now the first signs of income are starting for Blossom too. Over the last year, I’ve been bad at keeping track of my expenses, though it takes one hour per month. Therefore I’m changing it to once a week (<30min) to be more on top (shorter feedback loop).

I should be around spending <50% of my income on living expenses, and as my income (could) increase, I might raise this number further. The living expenses include things like groceries and mortgage payments, the latter of which could rise substantially if the dream house is acquired.

Flotte

O: Strengthen the relationship

KR1: Have 1+ deep conversation per week that doesn’t side-step challenging parts

KR2: Follow our habits such as Tuesday date night, meditate evenings (3+ p/w), check-in monthly

It’s always, for me, difficult to fit a relationship with the OKR framework, though the goals here should reflect the ‘new’ things relatively well. The most challenging part, again for me, is to stay with discomfort and seek out deepening conversations that aren’t always fun.

Relationships

O: Maintain a diverse set of relationships, and meet (expand) new friends in my interest areas

KR1: Call friends when walking Max 3+ p/w

KR2: Meet 2+ new people in Q1 outside work (>100min)

I have amazing friends and have (a) diverse friend group(s). One thing I can do more, which unfortunately others also don’t do, is to call friends more. I walk with Max every day and instead of listening to podcasts can call friends.

Outside the current groups, there is still room to meet others who share my interests, from EA to mindfulness. Possibly through Twitter, or via friends I already have, I would want to meet others who I can share interesting ideas with.

FW.com

O: Have a lively (>1 post p/m) personal website

KR1: Finish update of design site & personal brand

KR2: Post updates on what I’ve written on social media

KR3: Write one large (>1000w) post p/m

KR4: Write a post about kidney donation in Jan

KR5: Post major updates (~1 p/m) in personal newsletter

I’ve found new inspiration to start writing again on my personal website. This time, I want to focus on making a few excellent posts (no more than 1 p/m) that showcase things I’m thinking about. This can be related to these areas, a large review of an impactful book, or even some fiction I’ve written (e.g. update to Spero).

Part of why I write is to strengthen my thinking (making it clearer by writing it out), partly to remember things better, and partly to promote the ideas (and myself) I consider helpful.

Blossom

O: Expand the impact of psychedelics as medicine

KR1: (re)Launch PsychedelicsCourses <15 Jan

KR2: Have ~2 calls with new people p/w

KR3: Launch own (60-75min) course in Q1

KR4: Reach >$1000 p/m income from non-consultancy work

KR5: Reach >$3000 p/m income from non-consultancy work

This year, I want to expand the reach of Blossom and the income I can generate from that. Part of this plan is the overhaul of the courses website. Another part is getting more money from memberships, for instance, corporate memberships to Blossom, or more personal memberships.

I also want to expand the luck ‘surface area’ by connecting with more people. For that cause, I will start reaching out again for calls (I have some incoming, but would also do well by doing more outreach myself).

Queal

O: Maingain with a focus on customer satisfaction

KR1: Launch QQ offering each quarter

KR2: Relaunch go bars (<15 Feb)

KR3: Post blogs 3x p/w

Queal is still going strong, and I eat one to two meals per day myself (Cool Chocolate Athletic and Ready Berry Good most days). We’ve remade the big (40 meals) offering and will focus on providing more value to our customers.

The adjunct products are being revamped, with the bars taking much longer than expected, but a relaunch is getting closer.

Flo Coaching

O: Help 20+ people experience psychedelics to expand their minds

KR1: Relaunch Flo Coaching in Q1 but after relaunching PC

KR2: Remake customer flow including coaching talks

KR3: Retest workflow with 2+ acquaintances in Q1/2

I’ll be doing Flo Coaching together with Lotte. It’s something that will take away time from the other goals, so I have to be conscious of that. But if possible, I want to relaunch it and coach people one-on-one. My focus would be on self-development and professional creativity (e.g. helping an entrepreneur find new inspiration). Lotte would focus on self-development and women.

Sports

O: Expand my all-round fitness to exceed that of 2022

KR1: Do sports 6x p/w (3x cardio & 3x gym), after kidney recovery

KR2: Lift more than 440kg on big 3 (squat, bench, deadlift)

KR3 (uncertain): Incorporate stretching goals later in the year

This year, I will expand my all-around fitness without doing any specific races (I must prepare for, anti-goal). Last year, I did 440kg so it will be a good challenge to go bigger than that. I will also have to build back my cardio, which I will do with three cardio sessions per week of different sports (swimming, running, biking, etc.).

Health

O: Be in the best shape ever

KR1: Do 3 experiments (1x in Q1) with standard meals (2 meals x 5-7 days)

KR2: Track 3+ health metrics (e.g. free test)

KR3: Walk >15k steps p/d

Health-wise things are going great. I did donate my kidney (still have the other one), so will have to recover from this. I intend to track some health metrics, but haven’t done much and might want to talk to others to know what is smart to track. One person who invested a lot of money into improving his health found out that walking was great for him, and I plan to walk more than I’m currently doing.

Mindfulness

O: Improve the state of my mind, and expand it

KR1: Meditate >3650 minutes (60 hours)

KR2: Investigate & find 1+ meditative path to explore

KR3: Take psychedelics for exploration 4+ times, including 1 new compound

I’ve been blessed with an exceptionally calm (and rational) mind. Overall, I’m super content with how things are going, and my stress levels are miniature. I’ve read about others who’ve explored meditation more (e.g. jhanas) and would be very interested in following a meditative path beyond what I’m currently doing (10min meditation daily).

The Perfect Day

6 – wake up

7-12 – deep work

12-14 sport

14-17 communicate/various work

17-21 relax/write more/game

Habits of Note

The goals above include some new habits that I’m forming or strengthening. Other notable habits that I have include:

  • Daily flashcard training (Thought Saver)
  • Reading (no specific goal anymore, but average about a book per 2 weeks at the moment)

Notes

Two things came up that I haven’t incorporated yet into the goals. The first is that I would want to seek out coaching again. I did so last year and found it helpful. This was in regard to life/work but also have had positive experiences with coaching for sports. I want to do more research (talk to multiple coaches) beforehand this time around. The second is that I probably want to define my hobbies better. There is already a lot here, but I might benefit from a passive/relaxed hobby like watching movies with intent. In other words, have something high-quality to do when relaxing.

Public Commitment 2022 – Recap

I’ve discussed my goals with my coach (Chris) each month. But I failed to update the website here.

I will do a short recap to still have something in writing. Expect more recaps every quarter in 2023.

The theme of last year was ‘living fully’, and I can say that I’ve lived up to that. I went on many vacations, from Vietnam to Bulgaria and Norway. I’ve enjoyed the work that I’m doing and generally am very content.

Here is a short recap on the goals/mood for each ‘project’ of my life.

House

No major updates. Looked at redoing the kitchen, but there isn’t enough space to do it properly (add things). Did look at moving houses, and if it works will do so in 2023.

Finances

Had no specific goals, but did manage to bring in revenue for Blossom, though I also spent a lot on a full-time employee.

Flotte

Made more time to do fun things together (remember: Covid restrictions only ended somewhere in January).

Relationships

No specific goals, but I enjoyed a lot of time together with friends.

FW.com

I spent nearly no time on this site, which I hope to counter very much this year.

Blossom

I didn’t get to $3k revenue per month from recurring revenue. I did do consultancy work and helped organise ICPR. I’ve learned a great deal and will keep applying this in 2023.

Flo Coaching

I’ve made a website that features Lotte and me, but I’ve not actively worked on client acquisition. This is something that will change in 2023 unless other significant opportunities present themselves.

Sports

I trained for and had a lot of fun doing a 42km obstacle run. The run went great, and it was fantastic training for it. The day itself was hot, but luckily it was the water edition. I did the run with my brother Tom, a friend Maikel and a few of his friends.

After completing the run, I focussed on weightlifting (powerlifting) and finished the year with a 140kg squat, a 100kg bench press, and a 200kg deadlift.

Health

Healthwise, I have nothing to complain but did do something radical in December of 2022. I donated my kidney to a stranger. I will write more on this in January 2023. Overall, super happy with the decision and nearly fully recovered within a week.

Mindfulness

I started exploring mindfulness by reading a few books and doing a mini-course. I’ve also picked back up the daily 10-minute meditation from Sam Harris (Waking Up).

Public Commitment 2021 – Recap

The last year didn’t go well with regard to my goals.

Because of a lot of different circumstances, I spent very little time reflecting on the goals I made and working towards them.

Though covid didn’t have a personal impact on me per se (I did catch it, but next to the loss of smell for a few days, had no other negative consequences), the time of being at home the whole time didn’t positively influence me.

I won’t bore you, the reader, with too much detail, here is a mini recap of the goals I set.

Goal 1: Write something every day

I’ve kept up with writing and actually produced a report of 200 pages in the summer, I didn’t write each day. It’s something that I do want to do most days and hopefully will get to in another form with my 2022 public commitment.

Goal 2: Promote my work

This is something I haven’t done enough of when I look back. Still, something that I aspire to do and could take more action on. For Blossom, there will be a lot of promotional activities coming up, and there is much to read and learn about this process.

Seen differently, it’s being proud of what you’ve made and sharing this with a wider audience so they can benefit (and possibly buy some services from you).

Goal 3: Meditate daily

I might have dropped off somewhere, but for the last 3-4 months, I’ve been meditating each morning.

Goal 5: Learn three songs on the harmonica

Alas, I let this one go and don’t foresee myself picking it up again soon.

Goal 6: Add 2 features to this website

The dark mode is here; no other features were implemented.

Goal 7: Improve my learning process

Here is also room for improvement.

I have updated my work-day scheduling and end of the work day process.

Goal 8: Move more money towards effective charities

Not something I actively accomplished. I did donate quite a bit, and the final number should be on the EA page.

Goal 9 (new): Achieve the elusive six-pack

I did work on this and did a photoshoot at the end of September/beginning of October.

Feel free to ask me about the pictures.

Public Commitment 2022

This year’s theme is Living Fully.

Last year (2021), I was less happy/satisfied/fulfilled than I thought I could be.

So this year, living fully is the underlying theme.

One example of where I plan to improve is to be better at stopping work at 6 pm. This will give me more room to enjoy things in the evening, but also more energy and focus on getting work done before that time. As Cal Newport (also featured in last year’s update) would say, we are working 20% too much (number of tasks/commitments). By cutting out some of that, also next to work (e.g. voorzitter VvE, EA Rotterdam meetups), I think I can be more fulfilled and produce better results.

Here is the preliminary Q1 2022 plan

  • Blossom: get (average) revenue >€3000
  • Flo Coaching: Book 10 clients
  • Sport: Finish 19km obstacle run (start of April)
  • Relationships: Stop working after 18:00 on most days
  • Life: Read in the evenings (vs YT etc)
  • House: Plan new kitchen

Power to the People

Power to the People by Pavel Tsatsouline is one of the classic books on strength training. Here are my notes.

Wired for power

  • We already have more power in our muscles than we’re using (20-30%)
    • Part of training is getting more ‘neurological efficiency’
    • We won’t completely overcome this ‘strength deficit’ as otherwise you would tear your muscles
    • (as seen with bodybuilders who gain more strength than their tendons can hold)

Tension, what force is made of

  • Tension = force, we want to increase tension
  • High tension training has five key conditions
    1. Slow exercise performance
    2. Maximizing muscle tension (flexing) regardless of weight
    3. Heavy (85-95%) weights some of the time
      1. Lifting heavy is needed for spine, joints, tendons to get accustomed to pressure
    4. Minimizing fatigue
      1. “High values of fatigue and tension are mutually exclusive”
      2. So program should focus on having (and inducing) low fatigue
    5. Taking advantage of various neurological phenomena

Training to failure or to success?

  • “[Y]ou must push your limits of weight/tension, and not reps/exhaustion if you want to get stronger.”
  • Hebbian rule (Cells that wire together, fire together)
  • If you are training to failure, you are training to fail”

Don’t water down your strength with reps and fatigue

  • How to minimize fatigue
    1. limit reps to five or fewer
    2. increase rest between sets to 3 to 5 min
    3. limit sets to 2
    4. pause and relax between reps
    5. don’t practice a lift more than 5x per week

(check back later how this contradicts with building muscle?)

Advice is to train almost every day, but breaks are ok, taking more than one day off reduces effectiveness by 50%

More low rep advantages

  • Why it’s safe
    1. The stabilizing muscles are not fatigued yet
    2. You are (forced to) concentrate(d)
    3. Can develop strength without training to failure

The idea is that these types of workouts will give you energy (vs draining it after more reps)

Rigor mortis, or why high reps failed to tone you up

  • You feel the ‘burn’ after high reps because you run out of ATP (as a dead body does too)
  • Strength = tension = tone (i.e. get muscle tone by residual tension over active/energy exhaustion)

But I don’t want to bulk up

  • Lifting heavy weights will not necessarily build big muscles

Machines are the wusses’ way out

  • Learn with free weights, better to have stability before going to heavy (free) weights
  • “The more fixed the object, the more likely you are to develop a pattern overload,” explains Paul Chek

Isolation exercises, Frankenstein’s choice

  • Instead, do movements that involve more than one joint to form a ‘kinetic chain’

Irradiation: Getting strong and hard with only two exercises

  • “It’s not daily increase, but daily decrease – hack away the unessential” – Bruce Lee
  • E.g. tense your fist, now tense harder, more… then you feel other muscles up to chest contrasting
    • Law of Irradiation
  • The deadlift & pside press (over bench) as the two exercises
    • Deadlift being the 80% important (Pareto)

Emphasize your problem areas without adding exercises

  • Change up the variation of the big two exercises (to focus in on muscle that is lacking)
  • But, probably also not necessary, as building up load on basic exercises will recruit the lazy muscles

How to become a bear: A Societ commando’s secret

  • What if you did want to build ‘show’ muscles?
    • Longer time muscle under tension, so more reps
  • The method
    1. reduce reps to 4-6 per set (so still relatively heavy weights)
    2. perform 10-20 sets
    3. stop a few reps before failure, so you can keep doing same reps/sets
  • e.g. instead of 100×5 (and 90×5 for second set), do 80×5, 30-90sec rest, stop when you can’t do 80×5 anymore
  • reducing rest time promotes HGH production(?)
    • and reduced rest time allows for the best training total time of 45min for testosterone release (?)
  • do workouts less often but still 3x per week for each muscle group

Last three pieces of the big biceps puzzle

  • Eat a lot of protein
  • Note on health: no, having a lot of big muscles is also straining the body
  • Book on diet: Anabolic Diet (Mauro Di Pasquale)
  • REST
    • “Don’t run if you can walk, don’t walk if you can stand, don’t stand if you can sit, and if you sat, might as well lie down and take a nap.”
  • Calm mind = big body (i.e. less stress is good for muscle building)

Virtual Masculinity

  • (some critique of building muscles by pumping them full of blood)
    • Sarcoplasmic hypertrophy
  • This is in contrast to ‘myofibrillar hypertrophy’ which is a result of heavy weight training
  • Building with high reps does both, but leads to ’empty’ muscles

On variety, soreness, and keeping things in focus

  • Your body reacts the same to exercise as to smell, not smelling something again unless intensity or taste is changed
  • (notes on ‘plateau’ as just being the level where someone has started to get accustomed to an exercise)
  • So, do the same exercises, but change the routine’s load (cycling)
  • There is no correlation between your level of soreness and progress

Cycling: The Russian breakthrough for continuous improvement

  • Don’t max out; you won’t get improved results over time
  • Do periodization, build up weight over time, take breaks after intense periods (competition)
  • Three types of periodization
    1. Linear Cycle
      • Start with 80% of 5RM, e.g. weight you can do 10x
      • At least 8 workouts in cycle
      • Stop if you can’t make the set
    2. Wave Cycle
      • Go back in weight during the cycle
    3. Step Cycle
      • Stay flat for a while, then go up a bigger step
      • Or a small step, so good program if doing lighter weight exercises
  • If you have been ill or otherwise away from the gym for 7 days or more
    • Then go back 2 to 3 workouts and pick it back up again
    • Or even if you’re feeling shitty
  • A cycle is about 8-16 workouts

Hyperirradiation: How to boost strength and safety

  • Next few chapters about ‘neural programs’ and how to use them in training
  • Hyperirradiation: tense all your muscles when doing the lifts, as to activate/recruit them and gain strength
    1. Squeeze the weight as if you are trying to crush it
    2. Squeeze your glutes as if pincing a coin
    3. Tighten your abs as if bracing for a punch

Hyperirradiation: “Cheering” not “Cheating”

  • Brace yourself against the ground (for Olympic lifting)
  • Slack muscles absorb the ‘recoil’ of the muscles that are at work
  • Benefits
    1. Increased strength through additional neural stimulation of the target muscles by the impulses from working ‘extra’ muscles
    2. Increased strength through providing a solid and efficiently aligned foundation to lift from
    3. Improved workout safety through dramatically improved body stability

Hard abs + strong hands = Powerful body

  • Training grip can help with deadlift
  • When training with heavy weights, the core muscles take on a significant part of the load (abs included)

Power breathing: The Karate secret of superstrength

  • Tensing the abdominal muscles helps with strength (so karate also employs this with screaming at the end of a punch)
    • This included contracting the rectal sphincter
  • Alternative is to breathe out, but with tension in the stomach still
  • A belt does something similar, though it should be avoided (as it creates a weak link in the midsection)
  • A way to exercise this is to do concentrated/contracted breathing (8 reps, 8 sets?)
  • More in Beyond Crunches: Hard Science. Hard Abs.
  • Breathing tips
    1. Inhale 75-100% before loading muscles
    2. Hold your breath, breathe out at the end or right after
    3. Take a breath (if exercise allows) between reps
    4. Don’t expel all of your air, to not lose tension
    5. Can take more breaths between reps (e.g. with deadlifts)
    6. Keep your midsection rock hard but do not let your stomach bulge out
    7. Always use the anal lock (contract your rectal sphincter)

Slow and steady wins the race

  • Lift heavy weights slowly
  • Three to five seconds up & then three to five seconds down
  • You will not be able to lift more weight if you go quick

Feed-forward tension

  • “Because your strength generally does not exceed 30% of your tendon structural strength, the strength governor mechanism is set up way too conservatively”
  • Feed-forward tension
    • Maximally contract your muscles with a submaximal weight
    • Or even without weight, done with dynamic tension
    • This (may) break(s) the feedback loop and allows for more tension also under heavy loads
  • Feed-forward tension is not the same thing as ‘feeling the muscle’ either. Feeling your entire body cease to be a carbon based life form and get compressed to the density of a black hole is more like it!

Pre-tension for max power and safety

  • Build tension first (before load is touched) to lift maximally

Successive induction

  • Successive induction: if you tense one muscle group, the opposite one (e.g. triceps and biceps) will be disinhibited as they are expecting the other side to hold the tension
  • E.g. doing bicep curls, but on the way down, push with the triceps

On shoes, gloves, and mirrors

  • Running shoes bad for lifting
  • Shoes with least support/spring are best (deadlift shoes)
    • e.g. Chuck Taylors
  • Also, no gloves (less feedback/pressure)
  • No mirrors, means better internal feel for muscles
    • So lifting with eyes closed could help in some regard

Power Stretching

  • “[A] muscle that can easily relax into an extreme stretch is a muscle that can do things”
  • More in Beyond Stretching
  • Do only light stretches before a workout
  • Stretching may lead to muscle damage that leads to muscle splitting, hyperplasia
  • Possibly this is the yin and yang of strength training, contracting and stretching (=better results)

The Drills

  • The Deadlift
    • Keep weight on heels
    • Eyes forward/ceiling (don’t look at bar when picking it up)
    • Knees backwards (not over bar, as vertical as possible)
    • Push butt backward
    • Recommends alternating grip (mwah, hook grip ftw)
    • Flex triceps as this ensures arms are straight
    • Knees straight forward (cue may be to push them out)
    • Core tight
  • The Side Press
    • Why it’s good
      1. Full body action, also for stability of core
      2. Also good for grip
      3. Easier to learn than miilitary press (hmm)
      4. Teaches good overhead lifting skills
      5. Shoulder in external rotation, better for safety
      6. Uses lats
      7. No spotters necessary (nor rack)
    • Brace core (etc)
    • Press working shoulder and elbow down
    • Push yourself away from the barbell (instead of barbell up)
    • When going down, actively pull the bar down (induction)

The Power to the People! Manifesto

  • Scientists who study non-linear dynamics know that complexity on one level implies simplicity on another. They even have a term, simplexity, which refers to the emergence of simple rules from underlying disorder and complexity. In Power to the People! I have attempted to deliver a ‘simplex’ approach to strength training, decades of scientific research and hundreds of years of lifting and martial arts experience distilled into a no frills power formula anyone, from a recent couch potato to a world class athlete, can use.

Amazon Unbounded

Amazon Unbounded by Brad Stone recounts the recent history of Amazon and is a follow-up to his previous book The Everything Store. The book details the meteoric rise in the valuation of the company, the many new services offered, and the demanding management style of Jeff Bezos and colleagues. The outsider perspective is critical but fair, curious and critical. A light read that will leave you more informed about what goes on inside the everything store.

Read: 1x | First: July 2021

Summary Review of Amazon Unbounded

Part I: Innovation

The first part of the book describes the rise of Amazon starting in 2010. It is crazy, from our vantage point now, to think that about 10 years ago Amazon was worth around $80 billion, less than 5% of the current $1.7 trillion it’s worth now. The same goes for the number of employees, which has risen from 33k to 950k (1 in 153 employees in the US are working for Amazon). If nothing else, this book is a story about how to scale a business through constant innovation.

‘Do more with less’ and ‘think big’ are two of Amazon’s leadership principles. Amazon is constantly trying to reinvent products that the customer wants and doing this at a scale and pace that others are not trying it at. What stood out from these pages is that even though a product fails (e.g. the Fire Phone), the lessons and technology from the product production are taken into account.

Innovation is still a hard thing to pull off. The company has had many misses and for several projects, the pay-off is years away. The intuition that Jeff Bezos has developed over the years (coupled with data) is what sometimes has moved unprofitable projects forward that in the end might turn out to be winners (e.g. cashier-less shops). The same can be said for the development of Alexa, which took many iterations before it became a product that did its job well enough.

Being a strong leader did have its downsides, as many in the Fire Phone group had their doubts about the viability but didn’t dare speak up to Bezos. Thus a balance between vision (top-down) and ground-level feedback (bottom-up) was possibly skewed too much in favour of the former.

The focus on customers is what has made Amazon successful. Throughout this book, you will see that this principle supersedes other concerns such as the quality of life of employees (using a ranked-firing/stack-ranking system such as Netflix also has) or the sellers on Amazon marketplace. The former did possibly improve, for white-collar workers that is, as the forced firing was abandoned later on.

Jeff Bezos personally buys the Washington Post and through instilling some good lessons from Amazon turns the paper profitable. It seems that the move is both altruistic (preserving good reporting) and in the end a great business decision. Later chapters do point out how the association of him and the paper, and the battle with Donald Trump, might have had negative externalities. A government contract that was awarded to Microsoft (worth more than $10 billion) might have been theirs be it not for the feud between Bezos and Trump (but who knows, this is a counterfactual after all).

Amazon Studios tried to be as scientific (data-driven) as the engineers at Amazon had been, but soon they would find out that the creativity needed to make hits didn’t match their formulas. Going with experienced script/plot-writers did solve this later on. Though, now that I’m writing this, I do remember that House of Cards was something that Netflix had conceived based on a lot of data from what customers wanted/liked. So I guess both ways can work.

The biggest needle movers will be things that customers don’t know to ask for” – Jeff Bezos, in a letter to shareholders

Mini notes

  • Minimum lovable product – as an alternative to minimable viable product
  • Single-threaded leader – each team needs to have someone who is responsible for this task, and this task only
    • For a start-up (as I’m running) this does ring true, but I think also needs to be adjusted to you yourself having one task/hat on for a period of time and then switching task/thread/hat for another part of the day
    • Chapter four also mentions that Prime day needs to mean one thing, something I have to remind myself of a lot of times, you can only be one thing in the minds of customers
  • Start with the needs of the customers and work backwards from that – e.g. people don’t want to wait in line at the supermarket so remove the checkout part (through cameras that track what you take of the shelves)
  • “Stubborn on vision, flexible on details” – Jeff Bezos
  • Amazon spent more than $22 billion on R&D in 2017, eclipsing Google and the other tech companies (and cleverly, but I would say justifiable, the tax system)
  • Keep trying things” – Jeff Bezos, on their India expansion, and the need to go fast and try, try again
  • Two-way door decisions – a mental model of decisions that they could make that were reverseable (vs one-way doors), making it (mentally) easier to make a choice to do something as it could still be reversed later on
  • Amazon was very secretive about their financials and hid the profits they made from AWS for a long time to not give competitors ideas

Part II: Leverage

Amazon’s flywheel (also see Turning the Flywheel) is the virtuous cycle that guides their business. It consists of offering lower prices, which lead to the loyalty of (Prime) customers, which leads to more sales, which leads to more sellers, that offer lower prices (or better quality products/wider selection), repeat. Whilst growing, Amazon also had a focus on growing the revenue faster than the expenses. The question they have repeatedly asked themselves is as follows: “How could they reduce costs in their operations while maintaining sales growth?” (note that this excludes R&D costs, which are a huge part of the business).

The company has been accused of using profits from some parts of the business (AWS) to fund other parts of the empire (Amazon marketplace). And in a way this is true, and possibly anti-competitive. At the same time, the S-team and Bezos, in particular, were aware that every part of the business should carry itself. One example is that when advertising showed to be hugely profitable on their website, they still hammered that the marketplace should be profitable without this part. Automating many pieces of the business is what marked this era of Amazon.

ROBOTS

Mini notes:

  • Many changes at this time led to disgruntled sellers, who were being outsmarted by other sellers with fake reviews and knock-off products
  • Amazon expanded into unprofitable, but staple, products (CRaP) to become even a bigger part of someones life/shopping habits

Part III: Invincibility

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Het Tekort van het Teveel

Het Tekort van het Teveel (The shortcomings of too much) by Damiaan Denys offers a critical perspective on mental healthcare. The main thesis is that we want to do too much, for too many people. We should focus our efforts on those who are suffering the most, whilst limiting the public investments into helping people who are doing so-so. Going broader than this, Damiaan (or at least my interpretation) argues that we shouldn’t try and solve everything, we should be able to sit with our pain and live with discomfort.

Read: 1x | First: June 2021

We were in the jungle. There were too many of us. We had access to too much money, too much equipment. And little by little we went insane.” – Francis Ford Coppola (quoted at the start of the book, director of Apocalypse Now, describing the situation in Vietnam

Summary Review of ‘Het Tekort van het Teveel’

1. The Paradox

  • One in four people will develop mental health issues during their lifetime (WHO, 2001)
  • Those suffering from mental health issues have double the chance of dying from cardiovascular diseases
  • 90% of suicides are accompanied by mental health issues
  • 60% of those in need don’t receive mental healthcare, leading to 13,5 million deaths per year (The Lancet, 2018)
  • The estimated lost productivity and Disability-Adjusted Life-Years (DALY’s) lost between 2011 and 2030 is estimated at 16.300 billion
  • The investment, per person, on mental health care is but 2,5 dollar per year (between 0,1 to 21,7 dollar, Knapp & Wong, 2020)
  • Many experts are calling this a ‘global mental health crisis’

Damiaan identifies three problems underlying the crisis:

  1. The incompetence of governments
    • More than 40% has no mental health care policy, 30% no program, 25% no laws on this (WHO, 2001)
    • No government is able to provide adequate funding (though, see his later points on this, Andrews & Henderson, 2000)
    • In developing countries, there is a severe lack of access to mental health care (The Lancet, 2018)
  2. The inability of current science
    • Psychiatry itself is in crisis (Gardner & Kleinman, 2019)
    • There haven’t yet been much progress in the understanding of mental health disorders
    • (me: I would say that some therapies including those with psychedelics are paving a way forward here)
  3. The immense scale of psychological suffering
    • It’s estimated that 1 billion people are suffering from mental health issues (alas no source given)
    • 14% of lost (happy) years is due to mental health issues (no source)
      • From Rehm & Schield (2019);
      • 1 billion people living with mental and addictive disorders in 2016
      • 7% of global burden of disease as measured in DALYs
      • 19% of all years lived with disability
    • Since 1990, there have been no improvements in mental health globally (The Lancet, 2019)
    • Although there is the same prevalence (number of people with X), the need/demands on care keeps rising (MHF and other sources)
    • Those living in wealthy (WEIRD) countries are impacted more and are more vulnerable for psychological suffering

The subtitle of the book is ‘The Paradox of Mental Health Care’ and it’s explained as follows:

  1. The first paradox is that you would expect richer countries to do better, not worse
  2. The second paradox is that (in the current system) it’s unsolveable as the actions taken have the opposite effect of what is wanted

The Netherlands

  • 5th place on world happiness ranking (39)
  • 89% thinks they are psychologically health (40)
    • 95% of kids between 12 and 16
  • 40% will develop a mental health issue during their lifetime (42)
  • In each year (year incidence) this is 20%
    • 21% mood disorders
    • 20% anxiety disorders
    • 19% addiction
    • 9% attention & behaviour issues
  • The Netherlands spends 7,3 billion euros on health care (43)
    • 4 billion of this on curative (to cure)
    • 1,7 billion on protected living
    • 1 billion on youth mental health care (‘jeugd-GGZ)
    • 0,6 billion on long-term care (44)
  • The percentage of the budget going to mental health care is the highest in the EU (45)
  • This care is being done by 19.000 professionals (49)
    • 3.500 psychiatrists
    • 15.000 psychologists
    • 24.000 nurses
  • The Netherlands is the best place to go crazy.”
  • Between 1980 and 1997, there was a doubling in the number of intakes (51)
  • Between 2000 and 2010, the costs rose from 2,9 billion to 6,1 billion (57)
  • Between 2003 and 2018, the number of psychiatrists rose from 2400 to 3700 (59)
  • Or in other words, the number of personell or the abundance of money aren’t the problems here
    • More health care institutes are filing for bankruptcy (61) WHY?
    • Waiting lists are becoming longer and work pressure is rising (FIND SOURCE)
    • At the moment of writing, more than 90.000 people each year are on waiting lists (per year or at any moment???)
    • It takes about 8 weeks to be referred somewhere
    • The work pressure is leading to many health care professionals wanting to leave the field

The rest of the book will dissect this paradox by looking at the three components in this system, 1) the health care system, 2) the care offer, and 3) the care demand.

2. The Health Care System

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3. Care Offer

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4. Care Demand

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5. The (ab)Normality

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6. The Paradox

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7. The Shortcomings of Too Much

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8. Epilogue

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