Healthcare in The Netherlands

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A bit blog-like: the bastard (GP) just got an extension. He'll likely wait it out till his retirement.

 

Bummer. Liberty you can't seem to get a break .

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Dutch GPs have absolutely no fear of litigation. It's presented as an advantage. It's not. A slap on the wrist by their collegues ....

 

Check that UK thread about 4.4 GBP (?). Even if I would win this case, then what ? That Dutch medical care is so limited. And don't forget Dutch 'normalcy'. What happened to me in the past 4 years is something that should have been avoided at all costs.

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A bit about Dutch GPs ...

 

The way they usually work: rule ´fine´ or ´not fine´ (life threatening illness that requires a referral to a hospital), if it´s ´fine´ it´s small stuff for the GP ... who knows a little bit of everything.

Most GPs, certainly mine will then try to put you ´at ease´ (because you´re not going to die, but you may also not feel being taken seriously). They may offer lifestyle advice. If you´re older and it gets really rough, they´ll prescribe a pill ...

 

A little bit of an exageration, but that´s the bottom line.

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Liberty

 

If you want to get the REAL story about the American health care crisis I am reading a great book called: An American Sickness: How health care has become big business and how you can take it back by Dr. Elisabeth Rosenthal. It shocking and every American person who has seen a doctor or been hospitalized should read it. We have the most expensive health care with the poorest outcomes.

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This country has healthcare costs only second to those of the USA.

 

I know that your system has flaws, but I'd rather have that system. USA the poorest outcomes ? I don´t bevlieve that. I haven´t read the book, but factors like many Americans being extremely overweight, being on many prescription drugs doesn´t help ...

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You might want to read it and then decide.

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Last new about my 'case': the GP will be judged by other GPs !

 

Seems it's fixed. These GPs here, it seems they are just running a (bad) business while playing doctor. Most anxious to keep their patients, they want even more money.

 

But that's not really my point.

 

It seems I'm on my own. Local healthcare is very restrictive. Slight overstatement, everything that doesn't make the alarm bells ring is 'small stuff' for the GP. They don't do real diagnostics, even in his defense the GP uses the word 'opinion'.

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The fox watching the hen house. Sorry, Liberty, but you made the effort.

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I suspect I can't get anything done in this healthcare system. It would be difficult enough anywhere else at this point.

I've done some bloodwork, private lab. Some things are fine, some values seem to point to underlying health problems or a hormonal imbalance. A very high SHBG value twice. Nothing actionable, as of yet.

 

The dangers of K. Doctors don't want to know. And someone confirmed the issue of continuing physical stressors being bad for recovery. Pretty much my experience. It gets rough enough if you are able to get through the day smoothly prior to a taper.

 

There are plans to shift more of the workload from the hospitals to the GPs ! What a corrupt healthcare system. The GPs, the insurance 'companies' (private entities that used to be non-profit), state officals - they really have it together. There is so much money involved. Only the healthcare system in the USA is more expensive. I've heard to some bad stories about the USA, but this is NOT better !

 

Anyway, I never expected to benefit from that semi-legal action against the GP and indeed it seems that nobody cares except for the doctors ! Here, doctors are mostly above the real law.

 

And to anyone who reads this: consider that it's possible that your electronic medical records are not the same as printed versions.

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By the results of that quasi-legal procedure, he was acquitted by his collegues. What a joke.

 

He got bonus points for trying .... who the hell needs healthcare, and it´s all mental anyway, right ?

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The emergency department of the local hospital has closed ! The nearest emergency room is not exactly close by.

People are expected to go to their GP first, and if that is not possible for some reason then there is something for which I believe there is no equivalent in the English language / a local cooperative of GPs that serves people when their own GP is not available / for example, at night and in case of certain emergencies. There is no chance in hell I´ll go to one. Btw, you´d have to call first and talk to an assistent, who will decide if your issue warrants a visit and consultation with one of the GPs ! I have a certain attitude towards GPs ...

 

So I´m stuck with the local equivalent of 911. And whatever travel opportunities I may have to an ER not so near me.

 

I´ve been thinking about firing that idiot GP, but I wouldn´t switch to a different one. Which has its drawbacks regarding repeat prescriptions but I just hate his guts.  Also quite different from the USA, repeat prescriptions of benzos are handed out without seeing a doctor. In the past, usually by the assistent ! Even though there is the Opium Law, there is no concept like ´controlled substance´.

 

The GP is expected to handle almost EVERYTHING. Healthcare is very expensive if you look at what you get in return.

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As a note, Librium is no longer available in this country ... I don't know if it's temporary. That is, through official channels. Doesn't mean I can't get it ...

 

I asked a question on a website that's pretty much the equivalent of pharmacy.nl ... About destroying the medical crecords, leaving that GP ... Rivotril is brand (Roche) clonazepam.

 

Got this answer 'As soon as your file is destroyed on request, all medicines that are written by your practitioner (GP) will have to be reassessed. In short, GP needs an indication to prescribe it. Rivotril is used as muscle relaxants. To be able to prescribe this, the GP will search in your old file. If the GP can not find an indication in your file or there is no file, he / she will determine the indication again before you are prescribed Rivotril. Physical dependency can be reduced with, for example, Diazepam which is similar in operation only work longer so you can gradually reduce'

 

It does not always go by the book ...

 

The answer isn't that suprising but I hate keeping that GP as my dealer.

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Recently I checked the 'medical records' of mine at the GP.

 

The guy had inserted quite a few nasty and unpleasant things after I started that complaint. He's so arrogant, and underneath I think I see agression.

Yes, American doctors can kick you out and you can find a new one but here the so-called freedom of choosing your own doctor is severely limited. Those medical records are a disaster and a mess.

I'm FUBAR too. I'm thinking of having those records destroyed and firing that GP, but that would mean no more repeat prescriptions. Not as if that would be an emergency. But there could be issues if I wanted to travel abroad for something (medical?), especially by airport.

 

I have no need for another GP. Unrecognized medical errors and iatrogenic harm ? In this country, more trouble than it's worth.

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Liberty I get a lot of what you are saying in terms of the freedom to chose question. I do tend to agree with you especially when it becomes a personality conflict. however you do understand we have ' the standard of care' issue here which to me at least seems like the very type of group-think that those who support medical freedom seem to oppose. In other words if all the doctors are restricted or limited in terms of their range of practice so being able to chose within a given pool of doctors to some degree loses its meaning in terms of medical freedom if they are all required to practice the same way. There are of course good reasons for the standard of care argument, but some of those reasons are of course in terms of medical liability and other issues pertaining more to consolidation and not a diversity of opinion I find it really difficult to find any one system as better than another. I think we are still waiting for the heath system that is needed

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www.patient-safety.com

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Hardly healthcare in The Netherlands, but two times I asked  on the American website healthtap.com a question about getting help for iatrogenic harm. I'm not sure if I mentioned 'medical errors'.

 

Not a single answer. I got answers to other questions.

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Final (?) post for now.

 

With the latest copy of my 'medical records' came a 'friendly' suggestion to discuss the situation with his colleague, one that most likely works for a salary in his 'company'.

 

Seriously. Dutch doctors. Twice I asked a question about medical errors or iatrogenic harm on the American website healthtap.com. Zero responses. A local lady who commented on the way doctors treated victims of medical errors got a very different attitude. I think she posted on a website that is mostly for doctors. While a few responses were mostly neutral, more than one attacked her in a vicious or rude way. You're not supposed to critize doctors, or only do so in medical boards/trials where doctors are judged by their collegues and which basically exist to preserve the quality of the profession.  It's almost the dark ages.

 

Most Dutch people believe you 'need' a GP. Insurance will almost always demand it. What if you don't get a referral ??

They messed me up badly. They 'know' clonazepam is (mostly) safe. Of course you can get some bizarre problems if you are obstructed when you try to withdraw from clonazepam, have medical issues, untreated, incorrectly treated, treated too late or if you are treated for things you don't have etc. A new GP would want to get to know you. Now, if you're doing badly, have some bizarre problems, have unusuable medical records, restrictive medical system: how could that possibly go right ? Those doctors work within the same practice, and I'd guess pretty much anything is on the table except what that GP did (and denied in front of his collegues in the 'board') or that the clonazepam is the hardest problem and that the GP almost forced me to stay on it ...

I just get a feeling of 'you have to trust me ...' a shark. What would be the point of that ? Just making sure I don't die ... ('be glad you're not dead', why ?) And yes, they want to be your 'go to' place for all your health issues ... if you're doing badly, to be in control ...

And for as far as I know, they basically cannot work without medical records ...  so what, he cannot make sense of it since the diagnosis cannot be medical errors or iatrogenic harm ... consult with his collegues ?? Maybe a psychiatric one, because I'd be stupid enough to stay in the place ?

 

I've had a few moments of desperation, shouldn't I ...? Tell tell me if I'm nuts for saying 'no'. I get the feeling that writing this post pretty much gives the answer. No proper treatment without proper diagnosis, right ?

 

Unfortunately the local Emergency Room closed this year,  there is the local equivalent of 911 and I could make appointment with specialists ... out of pocket. My view is that my health is too important to be controlled by a GP ... truly horrible system. Still no treatment for iatrogenic injury (not just CNS).

 

My options are few. One 'option' (?) that I won't mention here, otherwise if I cannot get any relevant treatment (I know pretty much what I need !) the 'get the poison out of the body treatment'. problem with that is that it wouldn't be anything like what that would have been in 2013, and the suffering, disability, duration, devastation would most likely last a very long time. Requirements basically seem to cost more money than I can afford ... you don't want to run into doctors that want to do crazy stuff. I think you know what I mean. I think I'd be in a state of almost complete disability within a few years if I continued like this, and I'd suffer major abuse at the hands of 'doctors'. That's pretty much a 'conundrum'.

 

Firing that GP would preclude some international travel (mostly by air) since I would no longer be able to get official statements that I 'need' the drug.

 

Btw, the 'treatment' by the GP started with 'I don't believe my patient, it is not possible but I will not tell him and play stupid since I know better'. 2017 'conversation'about the clonazepam 'it is not possible' 'it is not real' (w-bad.org) like so many other docs but I had wanted to hear that in 2013 !

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I asked a question on a local forum.

 

The Dutch will chant in unison: %/ just find a different GP/% Almost outraged comments about going without a GP, and how helpful theirs is ...

 

It can be a horrible culture at times. I have some really weird problems that would be much less of a problem if that clonazepam wasn't part of the problem. Can't just take a pill ...

GPs follow a three year education after studying 'medicine' (or to be precise: 'the art of healing') for 6 years, which is obviously concluded with a doctorate. But I don't have any of the things they study in those three years.

 

 

 

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I just ordered the destruction of my medical records and fired that GP. Well, I have attempted to ... Dutch doctors can be difficult.

 

No more ´fake doctors´. I can imagine some might have issues, but I despise the local healthcare system.

 

Just no way to undo what he did ?

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Benzodiazepines are safe ? The Netherlands, 1986. Official magazine for doctors.

 

https://www.ntvg.nl/artikelen/afhankelijkheid-en-abstinentieverschijnselen-bij-gebruik-van-benzodiazepinen/volledig

 

Through google translate:

 

In 1984, 8,503,800 packages of benzodiazepine preparations were sold in Belgium, and only through the pharmacist. 1 Sales to hospitals are not included in this number. However, the figures on the number of regulations, sales and actual use appear to be incompatible with each other. 2 In the western countries, 1 in 6 adults would use benzodiazepines for a short or longer period of time in the course of a year; 2 of the population she would use chronically. 3-5 These figures show that at least a fairly large group of the population regularly occupy benzodiazepines. Even if the chance of dependence and abstinence symptoms is small, a non-small group of the population will be able to deal with these problems. Previously, several aspects of this have already been pointed out in this journal. 6 7

FREQUENCY OF DEPENDENCE ON BENZODIAZEPINES

The patients who become dependent on benzodiazepines can be divided into two groups, firstly those who use alcohol or other addictive substances in addition to these drugs and secondly those to whom benzodiazepines are prescribed on a strictly medical indication. According to Marks, dependency in the latter group would not occur more often than once per 50,000,000 patient months. 8 Assuming that this figure is correct, the risk of dependence on benzodiazepines is virtually negligible. Tyrer et al., On the other hand, concluded that abstinence symptoms occurred in 27 to 45 of the cases of more or less prolonged benzodiazepine use. 9 The study concerned ambulatory patients with anxiety syndromes who had taken on average 10 mg of diazepam or 4 mg of lorazepam per day for an average of 3.5 years. Murray et al. Found difficulties in stopping it at 58 of long-term users of benzodiazepines. 10 In only 1 in 5 patients this problem was discussed with the GP. From this it can be deduced that the ease with which benzodiazepines are prescribed and obtainable can lead to masking drug-seeking behavior of many patients who have dependency.

PHENOMENA

Stopping treatment with benzodiazepines can evoke three forms of reaction:

1. The complaints for which the therapy was set return. In this case, the underlying problem has not changed anything or enough and, in an attempt to gradually or completely omit the medication, the problem will inevitably have to be dealt with again.

2. There are 'rebound' phenomena such as 'rebound-anxiety' and 'rebound-insomnia'. This may involve an increase in anxiety or sleep disorders because homeostatic mechanisms at the receptor level can not keep up with the rate at which benzodiazepines and their active metabolites disappear from the organism. 11

3. The real withdrawal reactions, indicating that metabolic tolerance for the product has occurred. The first two reactions are the most common; withdrawal reactions are exceptional.

Dependence symptoms can be distinguished into mild and severe symptoms.

- Among the most frequent symptoms, anxiety, insomnia, irritability, nausea, palpitations, headaches, muscle tension, tremors and dysphoria are considered. 2 These symptoms fall into the category of rebound phenomena.

- Among the serious symptoms is: hyperesthesia (reduced perception threshold for stimuli), kinesthetic perception disorders, illusionary sensory forgeries of a primarily visual nature (stationary objects seem to move), deerealisation, depersonalization, character change, myoclony, epileptic seizures, confusion states with disorientation and real psychotic episodes with delusions and hallucinations (delirium). 2 These symptoms fall into the category of real withdrawal reactions. Its emergence presupposes a tolerance, which is rare for benzodiazepines. Of course, these symptoms never occur simultaneously and the most serious are also the rarest.

In the event of sudden discontinuation of benzodiazepines, these effects may occur after a latency period of 1 to 10 days, depending on the half-life of the drug, and last for 1 to 4 weeks. Then the serious symptoms disappear; however, the mild symptoms can continue to exist for a very long time (weeks or even months). 2 12

There are reasons to believe that prolonged benzodiazepine use undermines normal stress tolerance and the efficiency of coping mechanisms. In laboratory animals it has been shown that long-term intake of benzodiazepines easily causes panic attacks when confronted with new stimuli. 13 Something similar could also occur in man.

FACTORS THAT PROMOTE DEVELOPMENT PHENOMENA

- In the first place, the origin of withdrawal symptoms is related to the duration of use. In general, the risk of withdrawal symptoms increases with the longer use of the benzodiazepines. A minimum duration of 3 months seems to be required, but in most cases it is chronic use for months or even years.

- In the second place, metabolic and pharmacokinetic elements play a role. The benzodiazepines are distinguished mainly by their different half-lives, on the basis of which they can be divided into 3 classes:

1. Long-acting benzodiazepines, with a half-life of 24 hours or longer. These are generally converted to active metabolites in the liver, the half-life of which is often very long. Some examples are diazepam (Valium), chlordiazepoxide (Librium), prazepam (Reapam), clorazepate (Tranxene) and ketazolam (Unakalm). Of all these agents desmethyldiazepam, with a half-life of more than 100 hours, is the central active metabolite.

2. Short-acting benzodiazepines, with a half-life of between 5 and 24 hours. These are mainly eliminated by conjugation, have virtually no active metabolites and are virtually non-accumulated. Some examples are lorazepam (Temesta), lormetazepam (Loramet), oxazepam (Seresta) and temazepam (Euhypnos, Normison).

3. Very short-acting benzodiazepines, with a half-life of less than 5 hours, eg triazolam (Halcion).

According to several researchers, mainly the benzodiazepines with a short half-life lead to the rebound and withdrawal symptoms. 2 9 11 15 Triazolam, for example, would easily give rise to rebound insomnia and lorazepam would more often give rise to withdrawal symptoms than, for example, clorazepate. 16 17 An explanation could be that the sooner these products are eliminated, the faster they also disappear from the benzodiazepine receptors. Moreover, the short-acting products have virtually no active metabolites. Because benzodiazepines have an α-aminobutyric acid (GABA) -ergic effect, it is assumed that after long-term use and at rapid elimination the balance is disturbed because the GABA-ergic tone becomes too weak with an increased excitability of certain neuron groups as a result. 18

Not only withdrawal symptoms bring people back to their medicines, but also the so-called onset and offset phenomenon has an influence on this. 11 The onset phenomenon is the speed with which the anxiolytic effects occur after the intake of the medicament. The duration and intensity of these are directly related to the liposolubility of the product. Of diazepam, for example, it is high and oxazepam is low. The offset phenomenon is the speed at which the anxiolytic effect disappears, which is related to the half-life. In the case of drugs with a short half-life, a rapid and abrupt breakdown of sedative and anxiolytic effects is experienced. It is understandable that drugs with pronounced onset (flash) and an equally pronounced and abrupt offset effect will more likely result in the patient tending to resume their use more quickly. This can explain the commercial success of resources such as lorazepam and bromazepam.

- Thirdly, the personality of the patient plays a role, 19 which is just as important as that of the two aforementioned factors together. The clinic teaches us that some patients, even after very long use, can stop relatively easily, while others, even after short-term and low-dose use, still have all the trouble in the world to reduce or omit the use. While on the one hand the patients whose benzodiazepine levels fall the fastest in the blood relatively more problems, 9 it is also noted that some people are particularly sensitive to these changes. Especially people of the passive-dependent type, with a 'histrionic personality', or with an asthene personality, alcoholics or patients with other addictions, even if they occur in the family, patients who somatize strongly and finally depressive patients tend to form dependence or getting withdrawal symptoms. When these symptoms occur, these people also have a reduced tolerance for them.

However, these statements are put into perspective by Mendelson, 20 who concluded, inter alia on the basis of a study by Clift, 21 that long-term use of sedatives in an important part of the cases originated in a hospitalization, whether or not psychiatrically reasons. Often systematically, patients receive hypnotics, usually benzodiazepines, which are simply prescribed after discharge. This rule is sometimes extended for years without any criticism. Furthermore, Mendelson states that patients with clear psychiatric illnesses in their history are no more likely to become dependent than patients without a psychiatric history. However, this risk was increased in apparently normal people who clearly achieved high scores on questionnaires on the subjective experience of stress symptoms (eg the personal disturbance scale of Foulds). Ashton also describes the majority of patients who experienced major dependency problems as 'normal' before starting to use benzodiazepines. 12 Somatic complaints or symptoms were often the reason to use benzodiazepines. Possibly, however, these were anxiety equivalents. Furthermore, dependence on benzodiazepines appears to occur more frequently when they are prescribed by general practitioners, orthopedists and gynecologists to patients with insomnia of somatic origin. Patients who increase the dose themselves also form a risk group.

POLICY AND TREATMENT

Benzodiazepines are prescribed too easily, too often and for too long. It is advisable to prescribe benzodiazepines as a 'cure', as is the case with antibiotics. Therefore, a benzodiazepine was given in a well-defined dose for a well-defined period, under very regular control. It is difficult to draw up general rules, but preferably benzodiazepines should not be prescribed for more than 4 months. 2 If this period is to be exceeded, consideration should be given to the possibility that dependency may arise, or that there are other or underlying problems that are not adequately addressed, so that psychiatric assistance must be considered.

Furthermore, the previously mentioned risk categories should be kept in mind when prescribing benzodiazepines. With these people, one should be cautious about prescribing a benzodiazepine. In general it is also advisable to enter into a 'contract' with the patient, in which one clearly determines the dose, the frequency of intake and the overall duration of the treatment. In addition, frequent contact with the patient must be ensured, in which case one also tries to help in other ways through supportive conversations, advice for healthy living habits, relaxation of the type of autogenic training, insightful psychotherapy, behavioral therapy, etc. A clear agreement with the patient. patient - especially when it comes to psychopharmaceuticals - prevents and manipulates at a later stage of the therapy.

If it is difficult for a patient to reduce the use of medication, whether or not because rebound or withdrawal symptoms occur, one proceeds as follows: one replaces the preparation with another, long-acting benzodiazepine preparation in a comparable dose. The latter is then phased out very gradually, preferably in accordance with a predetermined schedule. Especially with long-term use of benzodiazepines, the last few "weighs the heaviest". For example, 50 to 100 mg of clorazepate can be administered, the dose reduced to, for example, 20 to 30 mg in the course of 1 to 2 weeks and then further reduced gradually over 2 to 4 weeks.

However, Ashton advocates stopping quickly - especially with hospitalized patients - in order not to stretch the process unnecessarily. 12 After replacing the agent used with a long-acting preparation (in this case diazepam), it ceases it in the course of 2 weeks. During this phase, a supportive attitude, with frequent contacts, is very important.

Optionally, propranolol (Inderal) can be administered in a dose of 40 to 80 mg per day. Propranolol may reduce, but not prevent, the severity of certain vegetative symptoms, such as palpitations. 9 If the patient nonetheless fails to omit his medication, or significantly reduces it in doses, hospitalization may be considered to clinically discontinue discontinuation.

CONCLUSION

Severe addiction to benzodiazepines is likely to be rare, but rebound symptoms in discontinuing therapy are not. Taking a tranquillizer has almost become part of our culture. A very large number of people use benzodiazepine preparations every day, sometimes for years. With which stubbornness people stick to their tranquilizers, they often only see when they try to get rid of them. This task is certainly not facilitated if abstinence symptoms occur when the medication is stopped. Benzodiazepines may be easily prescribed from a sense of impotence in order to do something about the psychological suffering of patients. Furthermore, it is also true that patients come too easily to ask. However, it is our job as a physician to prevent our evolving to a sedated society through clear agreements with our patients.

Literature

1. IMS-AG. Market research data. Zug (Switzerland): IMS-AG, 1985.

2. Owen RT, Tyrer P. Benzodiazepine dependence, a review of the evidence. Review articles. Drugs 1983; 25: 385-98.

3. Charger MJ, Petursson H. Benzodiazepine derivatives -side effects and dangers. Biol Psychiatry 1981; 16: 1195-201.

4. Balter MB, Levine J, Manheimer DI. Cross-national study ofthe extent of anti-anxietysedative drug use. N Engl J Med 1974; 290: 769-74.

5. Charger M. Benzodiazepines - the opium of the masses Neuroscience 1978; 3: 1159-65.

6. Laan JW van der. Dependency on benzodiazepines, size, risks and any differences between the means. Ned Tijdschr Geneeskd 1984; 128: 809-14.

7. Offerhaus L. Benzodiazepines; a pharmacological hangover. Ned Tijdschr Geneeskd 1984; 128: 817-9.

8. Marks J. The benzodiazepines. Use, overuse, misuse, abuse.Lancaster: MPT Press, 1978.

9. Tyrer P, Rutherford D, Huggett T. Benzodiazepinewithdrawal symptoms and propranolol. Lancet 1981; i: 520-2.

10. Murray J, Dunn G, Williams P, et al. Factors affecting the consumption of psychotropic drugs. Psychol Med 1981; 11: 551-60.

11. DiGregory GJ, O'Brien CP, Boisse NR. Clinical focus: problem avoidance with benzodiazepine therapy. Princeton, New Jersey: Abbott Laboratories, 1982.

12. Ashton H. Benzodiazepine withdrawal: an unfinished story.Br Med J 1984; 288: 1135-40.

13. Gray JA, Holt L., McNaughton N. Clinical implications of the experimental pharmacology of the benzodiazepines. In: Costa E, ed. Thebenzodiazepines, from molecular biology to clinical practice. New York: RavenPress, 1983.

14. Schöpf J. Withdrawal phenomena after long term administration or benzodiazepines. A review of recent investigations.Pharmacopsychiatria 1983; 16: 1-8.

15. Hollister LE. Pharmacology and pharmacokinetics of theminor tranquillizers. Psych Ann 1981; 11: 26-31.

16. Poser W, Kemper N, Poser S. Benzodiazepine dependenceamong psychiatric in-patients. (Royal Society of Medicine International Convention and Symposium Series and The Royal Society of Medicine, no 43.) London: Academic Press, 1981: 185-9.

17. Stewart RB, Salem RB, Springer PK. A case report oflorazepam withdrawal. Am J Psychiatry 1980; 137: 1113-5.

18. Cowen PJ, Nutt DJ. Abstinence symptoms after withdrawal of tranquillizing drugs: Is there a common neurochemical mechanism? Lancet1982; ii: 360-2.

19. Tyrer P, Owen R, Dawling S. Gradual withdrawal ofdiazepam after long-term therapy. Lancet 1983; i: 1402-6.

20. Mendelson W. Hypnotic dependence. In: Mendelson W. Theuse and misuse of sleeping pills. New York: Plenum Press, 1980: 127-39.

21. Clift AD, ed. Sleep disturbance and hypnotic drug dependence. New York: Excerpta Medica, 1973.

 

 

MEDIEVAL, they all know it's mental !

 

Those Dutch doctors. They are in a position of power (no free choice of doctors, for the most part) and they think they know that and therefore it's true. 'I am the doctor, I am God'.

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A few comments made by GPs, to me and other people:

 

´it´s not so bad´, ´be glad you are not dead´ (classic), ´just stop taking the clonazepam´, ´be glad you´re not taking diazepam, clonazepam is easier´, ´you´re physically dependent, but that dependence is mental´, ´what do you mean ?´ ´you may think about that´,  20th century phrase ´it´s mental´, March 2017 (!) ´that´s not possible, that´s not real´ (as in w-bad.org), ´I did not make any medical errors´ when I confronted the latest GP with his violations of the WGBO (Dutch law)

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Apparently, the GP was cheering when I told him to 'burn' the medical records and it was my intention to formally leave his practice. I got a response in writing in about 5 days, a record.

 

It just doesn't like like I'll be getting a different GP. Seriously, they want to be in charge of your healthcare but in a case like this they wouldn't have a clue about what to do. The mentality is all wrong. I would have to pay for any visits to specialists out of pocket though. Why would I need insurance ? GPs, they don't know anything.

 

Supposedly, we have the freedom to choose our own doctors. As long as it´s a GP !  You can eat anything you like, as long as it´s cheese. And even that can be difficult.

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So in this country we have a system where doctors form a hierarchical layer above the general population. Most of the time they are able to hide that.

 

Now, a GP royally ****** me up by making numerous medical mistakes, showing a callous disregards for my legal rights and the subsequent iatrogenic damage that followed.

So now I´m supposed to go to one of his colleagues (GPs) for medical treatment while they obviously want to ´hold the line´ (not accusing their colleague), and practice their proclivity for restricting access to hospitals and the insistance on ´normalcy´ ? This country likely is one of the worst for getting iatrogenic injuries treated. And you won´t find a single doc who knows what this drug does (I do, but they can only learn from their colleagues, right ?).

 

Excluding someone from relevant medical care. I´m in no shape for CT and the situation is as messed up as it can be. Even daily functioning is horrible.

 

I recall reading somewhere that before the advent of the internet patients and their doctors often recognized that something was wrong while on a benzodiazepine, usually (not always) patients would follow their doctors suggestion that it was anxiety, mental or psychiatric. Things have changed. That GP is an anachronism. Soon to retire.

 

Right now I wish I´d been born in the USA, Ghana or Nigeria ... Moving the a different country like the USA and paying for medical costs without insurance would cost a few hundred thousand USD ...

 

People have been writing posts ´My GP has been trying to get me killed´ for less.

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Today I formally fired my GP (for as far that´s possible in this country). They really like to exercise power over others. People without a GP ? No no, that´s not possible ...

It is, I got a call back from my ´insurance´ (hardly worth the name) and I got a confirmation, sort of. Can´t visit a specialist without a referral if you want the insurance to pay. There is a lousy loophole by allowing you to contact a GP for evaluation and a possible one time referral. That´s pretty much for emergency issues. The medical need must be obvious. Such as an eye infection that can be ´seen´.

 

There is a national database (ION) abused by GPs to transfer the medical records and name of the doctors when you switch GPs. I wrote that GP to get me out of that database, which is my right. But GPs really want you to switch to a different GP ... maybe when I´m younger and healthier ... GPs pretty  much determine your healthcare ´ration´.

 

They don´t have a clue anyway. And I´m dealing with the consequences of serious iatrogenic injury, caused by numerous medical errors. I don´t want the local club of GPs to have control over my healthcare !! How to get myself properly diagnosed ? Gut feeling: impossible.

 

That GP will be in denial till his last breath, I figure. The clonazepam ? Rarely prescribed in this country. They don´t know the consequences. Even in the USA, in settings where GPs have 50 people on clonazepam and they see that half of them do rather badly on this drug, I guess at least 9 out of 10 don´t really ´see´ the problem. And they have to ´see´ it ! Or learn from their collegues.

 

I´m pondering writing a short story ´Dutch healthcare: a killer !´. But I wouldn´t know where to publish that ! Primary care in NL, likely the worst in Western Europe.

 

In practice, in primary care you have no real (enforceble) legal rights in this country. You are at the mercy of the GP. If you ever want to live here, beware !

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In some ways I´m likely blacklisted. There is a database ´ION´ that registers and connects patients to GPs. Originally developed for sending invoices. It´s common practice that GPs refuse to remove of of their patients/victims from that database and continue to collect money from ´insurance´. They only want to transfer a patient to a ´colleague´. I´m working on getting myself removed from that database anyway.

 

It´s obvious that especially local GPs will stick together. Did a colleague mess you up/make medical mistakes or errors ? It´s bad enough if they don´t know each other ! Basically, the GPs perform a ´triage´ function, for the serious illnesses they are supposed to refer you to a specialist. Everything else, GP stuff ! They are expected to deal with the ´small stuff´, which presumable includes my issues ? But they don´t know anything !

 

I´ve mentioned it in previous posts, the mentality. Recently I read an old article about interactions between GPs and ´islamic people´. Complaints of the latter group were that GPs were looking for mental causes for physical issues ! The arrogance ! Depending on some variables, they are proud not to refer you to a hospital ! ´putting you at ease´ or ´being dismissive´ ? Gatekeepers, in most likely the most fanatical gatekeeping system in the world. Heavily opinion based, they prefer to rely on their eyes and ears without performing actual diagnostics. Unworthy of a first world country in the early 21st century.

 

Secondary care is strictly evidence based and rigid. If you have a physical problem that is not a ´disease´ (with of course some exceptions like hip replacements) the GP is supposed to handle it.

Primary care is free for all, a bunch of flunkies for the most part who see themselves as elevated above the general population. Perhaps an exagerration, but with a lot of truth.

I´m dealing with physical problems caused by incorrect treatment, treatment that happened too late and lack of proper treatment. Doesn´t fit neatly in the ´disease´ diagnostics of an internist, for example. Note: in The Netherlands, internists are part of secondary care unlike in the USA. Paternalism abounds, no free choice of doctors (or the equivalent is: you can eat anything you like, as long as it is cheese). If your problem can be handled ´by the book´ the GPs can be bypassed, but you have to pay out of pocket , know the healthcare system and know how to play the game, be ´street smart´ !

 

It´s not as if it´s cheap. Healthcare costs are high, only the USA is more expensive. A lot of this might be due to the so/called ´numerus fixus´ (how is your Latin ?) Basically, restrictions on the number of students allowed to medical school. Results: high salaries, shortage of doctors, doctors don´t have to work hard to get new clients, the patients will come anyway since there is nowehere else to go unless you go abroad. But the latter is not covered by insurance.

 

Well, so much for stealing my life. While I still have an open query with my ´insurance´ (more like the German ´Krankenkasse´than true insurance I´m not expecting anything.

My access for what´s really wrong with me is blocked. The question is, is it not too late for anything anyway ?!? I dread joining a new GP´s practice and having them perform diagnostics on my health issues ... ´symptoms and complaints´ ? It would confuse the hell out of them, and not in a way that´s good for me. Here, healthcare is a cost not a service. And forget about legal rights. It´s not as if all of this is cheap, if they mess you up it can cause the medical system and society a lot of money.

 

They don´t know anything about clonazepam. Basically, the only thing they could deal with is a benzodiazepine (sleeping, calming tablets) in a single daily dose.

 

Apologies for the perhaps somewhat messy post.