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Culture Surprise at the Doctor’s Office

image (cc) takomabibelot via Flickr.

image (cc) takomabibelot via Flickr.

As someone who suffers from a variety of chronic, but not debilitating medical woes, you’d think I’d be better about getting my medical care set up. Not so much. My general dislike for going to see the doctor and the learning curve of a new system gave me ample excuse to take my time. Still, after procrastinating for several months, my chronic wrist problems finally forced me to finish filling out paperwork and make an appointment.

Finding a Doctor
I’ve written a little bit before about medical insurance in the Netherlands and how it operates somewhat like an HMO. One of the key components is finding your primary care physician (huisart) since this is the person who will handle all your medical care from now on. Even when you are in an emergency situation, you are supposed to call your huisart’s office first and they arrange an ambulance to pick you up (there is the 112 number if you’re in a really dire situation; a la 911 in the States).

It is generally suggested that you ask a friend or neighbor to recommend a huisartspraktijk (doctor’s office) or huisart to you. You’ll want someone near by and insurances are universally accepted, making other people who live in your area the best source of information. This is tricky for an expat who hasn’t marrying into a Dutch family and may not have made many friends yet. Most of the people we’ve met don’t live in the area, but we asked around and got suggestions. I also found that our insurance company has an online database of doctors that we could search by location and that is ultimately where I found the office I applied to. They have several doctors, which increased my chance of finding a woman.

It was recommended to me by a Dutch neighbor that I should walk into the huisartpraktijk to become a new patient. Many doctors already have full dockets, so they may be more receptive to a face-to-face request rather than a phone call. It also meant I got to scope out the waiting room and pick up the starter paperwork: a couple of contact forms with a few medical questions. I filled out the paperwork, dropped off copies of my US records and made my first appointment.
The First Appointment
The first appointment is really a consultation with your new huisart before you are added to the system. That way you can meet and decide if you’re comfortable with your physician before taking your clothes off. It also provided my new doctor with the chance to discuss my medical history a little and to talk about my chronic issues.

I really appreciated this appointment. I’ve never had a consulting appointment with a primary care physician before and it helped to set me at ease a little. I was surprised that unlike in the US, and even at our Netherland’s dental office, I did not have to fill out a form with 50 questions about my medical history. The doctor just asked about the health of my direct relatives and if cardiovascular problems, diabetes, and breast cancer had ever cropped up in my immediate family. She also inquired as to the age of the person who suffered from these ailments. My questions were answered and while the meeting was certainly formal, I didn’t feel rushed.

I was a little surprised to find that I would have to make a separate appointment to have my wrist looked at. I guess there will be no making an appointment for one thing and then discussing other problems here. The receptionist also told me that I would have to call them this afternoon to make my appointment because I wasn’t in their system yet. When I called I was able to get an appointment lined up quickly; less than a week from today.

Non-Intervention Medicine
There is clearly a non-interventionist attitude towards medical care here in the Netherlands, or at least here in Maastricht. My doctor told me that there is no regular exam necessary until age 30 for women. At age 45 is when they start watching your risk factors for things such as cancer or cardiovascular disease (unless you have some really strong risk-factors at a younger age of course). This is so very different from the US where risk factors are frequently monitored quite close and at an early age. My expected interaction with my huisart appears to boil down to one thing: “Only when you are sick.”

There is less of a tendency to prescribe medicines here unless absolutely necessary as well. When I spoke to my new huisart today regarding my eczema, which I’ve been prescribed copious amounts of cortisone for in the past, she said she’d write a prescription but “only if absolutely necessary”. This is a huge change from my last doctor who would give me anything at the drop of a hat. And probably a change for the better. There is no point in getting antibiotics or something else that won’t help. On the other hand, I will probably be slower to see my doctor for ailments since I won’t want to visit just to be told to sleep and drink lots of fluids. We will see.

Most of my questions actually stemmed from a gynecological angle, as I am accustomed to having a regular, separate gynecologist for my annual exams and other treatments. Gynecologic concerns are, in fact, my number one reason to have a female doctor. I learned that women in the Netherlands only have an annual pap smear every 5 years (provided that their previous one was normal I assume), and that I am not expected to start them until I am 30 years old. Also, nurses rather than doctors usually do pap smears. That never happens in the US expect maybe at a free clinic.

Talk about a huge change from the yearly exams I’ve had ever since my period started. I was very surprised. I suppose the Netherlands does not see higher rates of cancer than the US, but the attitude feels a little too casual to me. Perhaps more frequent exams are considered invasive or a hassle relative to their perceived benefit in younger women. Fortunately, I’ve always had normal annual exams, so I’m not too worried.

I am calling this culture surprise rather than shock because the differences are significant but not necessarily negative. I can get behind less frequent use of drugs and medication when not necessary. It remains to be seen how well I handle a less intensive gynecology program and having direct access to only my huisart.

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