The modern hospital is a marvel of engineering and science, a place where robotic surgery, precision oncology and life-saving interventions happen every second. Yet, a provocative warning from one of the Netherlands’ leading medical experts suggests that beneath this veneer of progress, we may be sliding backward. Professor Schelto Kruijff, a renowned surgeon-oncologist, has sparked a critical conversation by suggesting that in our pursuit of treating disease, we are paradoxically regressing in our approach to actual health.
The core of the issue lies in a growing modern healthcare paradox: the more we focus on the technical ability to cure specific ailments, the less we seem to understand or address the holistic wellbeing of the patient. Kruijff argues that the current trajectory of healthcare is moving us “slowly back to the Middle Ages,” not in terms of our tools, but in our conceptual understanding of health. By isolating the biological “broken part” from the human being and their environment, medicine risks becoming a fragmented exercise in pathology rather than a practice of healing.
As a physician, I have seen this tension play out in clinics across Europe. We have reached a point where the medical system is exceptionally quality at keeping people alive, but often struggles to ensure they are truly healthy. When the hospital becomes the primary site of “health,” we ignore the social, environmental, and psychological determinants that prevent illness in the first place. This shift transforms the patient from an active participant in their own wellness into a passive recipient of technical interventions.
The Hospital as a Source of ‘Unhealthiness’
One of the most unsettling aspects of Professor Kruijff’s critique is the assertion that hospitals—institutions designed to restore health—can themselves become drivers of ill-health. This is not merely a reference to hospital-acquired infections (nosocomial infections), even though those remain a significant clinical challenge. Rather, it refers to a systemic “unhealthiness” created by the clinical environment itself.
The sterile, high-stress atmosphere of a modern medical center can strip patients of their autonomy and dignity, contributing to a state of psychological fragility. When a patient is reduced to a room number or a diagnosis, the healing process is hindered. The over-reliance on aggressive interventions can lead to iatrogenic harm—illness caused by medical treatment itself. From over-prescription to the complications of unnecessary surgeries, the drive for “more” intervention does not always equate to “better” outcomes.
According to data from the World Health Organization, the focus on curative care over preventative and primary care creates a bottleneck in healthcare systems, leading to burnout among providers and diminished quality of care for patients. When the system is designed to react to crisis rather than maintain stability, it inherently prioritizes the “sick” over the “healthy,” effectively defining health simply as the absence of detectable disease.
Understanding the ‘Middle Ages’ Metaphor
To the layperson, comparing 21st-century medicine to the Middle Ages seems absurd. We have CRISPR, MRI machines, and immunotherapy; the medieval physician had bloodletting and prayer. However, Kruijff’s metaphor is focused on the philosophy of care. In the pre-modern era, health was often viewed through a holistic lens—integrating the spirit, the body, and the community, even if the biological understanding was flawed.
Today, we have the opposite problem: we have perfect biological understanding but have lost the holistic integration. We treat the lung, the heart, or the tumor, but we often forget the person inhabiting those organs. This fragmentation is the “medieval” element—a return to a state where the human experience is secondary to the perceived “cause” of the ailment. We are treating the map (the data, the scans) rather than the territory (the living patient).
This process is known as the medicalization of health. It occurs when normal human experiences—aging, grief, sadness, or menopause—are redefined as medical conditions requiring pharmaceutical or surgical intervention. When every aspect of the human condition is viewed through a clinical lens, we lose the resilience and natural coping mechanisms that have sustained humanity for millennia.
Key Takeaways: The Crisis of Modern Medicalization
- Technical vs. Holistic: High-tech interventions are increasing, but the comprehensive understanding of patient wellbeing is declining.
- Iatrogenic Risk: Hospitals can cause “unhealthiness” through stress, loss of autonomy, and over-treatment.
- Defining Health: There is a dangerous shift toward defining health merely as the “absence of disease” rather than a state of complete physical, mental, and social wellbeing.
- Systemic Failure: A curative-heavy system ignores the social determinants of health, such as housing, nutrition, and social connection.
The Role of the Surgeon-Oncologist in a Changing Paradigm
It is particularly telling that these critiques come from a surgeon-oncologist. Oncology is perhaps the most “technical” of all medical fields, relying on cutting-edge chemotherapy, radiation, and complex surgeries. For a specialist at the University Medical Center Groningen (UMCG) to advocate for a move away from this narrow focus suggests a profound shift in professional consciousness.
The realization is that a successful surgery—removing a tumor with clean margins—is not the same as a successful recovery. A patient may be “cancer-free” but left with debilitating depression, chronic pain, or a severed connection to their community. If the medical system considers the surgery a “success” while the patient’s quality of life plummets, the system has failed in its primary mission: to make the person healthy.
This requires a transition toward patient-centered care, where the goals of treatment are defined by the patient’s values and life goals, not just by clinical markers. It means asking not just “Can we treat this?” but “Should we treat this, and how will it affect the patient’s overall life?”
Global Implications and the Path Forward
This phenomenon is not limited to the Netherlands; it is a systemic issue across the Global North. In the United States and much of Europe, healthcare spending continues to rise while population health metrics—such as life expectancy in some demographics—have stagnated or declined. This is the mathematical proof of the modern healthcare paradox: we are spending more on the “machinery” of medicine while the “product” (actual health) is diminishing.
To reverse this trend, healthcare policy must shift toward Value-Based Healthcare. This model prioritizes outcomes that matter to patients over the volume of services provided. Instead of paying a hospital for the number of tests performed or surgeries conducted, the system should reward the achievement of long-term health and the prevention of hospitalization.
we must reintegrate the social determinants of health into clinical practice. This includes:
- Community-Based Care: Moving the center of gravity from the hospital back to the community and the home.
- Preventative Integration: Treating nutrition, exercise, and social connection as “prescriptions” with the same weight as pharmaceuticals.
- Psychosocial Support: Ensuring that mental health and emotional support are not “add-ons” but core components of every treatment plan.
What This Means for the Patient
For the average person, this critique serves as a call to be a more active advocate for their own health. It is important to remember that the physician is an expert in medicine, but the patient is the expert in their own life. When navigating the healthcare system, patients should feel empowered to ask questions that move beyond the biological:
- “How will this treatment affect my daily quality of life?”
- “Are there non-clinical interventions that could improve my condition?”
- “What is the goal of this intervention—to treat a marker on a test, or to improve my overall wellbeing?”
By shifting the conversation from “cure” to “care,” we can begin to bridge the gap that Professor Kruijff warns us about. The goal of medicine should not be to turn the human body into a perfectly functioning machine, but to support the human being in living a flourishing life.
The next major checkpoint for this discourse will be the ongoing evaluations of healthcare reform across the EU, specifically regarding the integration of primary care and the reduction of unnecessary hospitalizations. As these policies are debated, the voice of practitioners like Kruijff will be essential in ensuring that “progress” is measured by the health of the people, not the sophistication of the equipment.
Do you feel that modern medicine has become too focused on the technical and not enough on the human? We invite you to share your experiences in the comments below and share this article to join the conversation on the future of global health.