Healthcare in The Netherlands

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That query with my ´insurance´ was a joke. Closed without further notification. That´s what I learned from the ´chat´ with the ´insurance´. The day before I was told something idfferent.

 

Well, how do you get iatrogenic injury caused by medical errors in a GP´s practice properly diagnosed ? Including possible treatment?  You don´t ? There is no mystery disease, I know more or less what´s going on.

The way they learned their job , as in http://www.benzobuddies.org/forum/index.php?topic=210941.0 what would it be, all those ´vague´ complaints ? Psychiatric ?

 

The worst healthcare system in the world. It may get me killed. And sometimes I wish >censored>.

 

As a reference:

 

http://www.benzobuddies.org/forum/index.php?topic=210941.0

 

http://www.benzobuddies.org/forum/index.php?topic=188686.0

 

I had not expected anything but the way I received the emssage was a cold shower. Those GPs think they´re so great but they don´t know ANYTHING.

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As an addition, I noticed they cleaned up some of their old junk.

 

There were a number of conversion tables that stated that 4 mg clonazepam was equal to 5 mg diazepam, with some sources suggesting adding 5 mg Haldol. !

 

Librium is currently unavailable through regular channels. Uncertain if this will be permanent.

 

While often denied, rationing healthcare is a major feature of the system. The GPs controlling most of the access. Often, the worse you are the lower your ration. Guess what you get without good medical records ... The supply of doctors has been articifially limited, resulting in a historical shortage and high salaries. The bitching and moaning of GPs that they don´t make enough money ... they are so busy ! (what do you expect with a system like that). Costs are higher only in the USA. So it´s really not cheap. A dysfunctional system.

 

I was checking throught he local ´supply´of GPs. And read something about the GP I had before my last one (if you get that ...). (difficult to translate) It appears he would often start a conversation with a cordial `How are you doing ?´ People would normally answer a question like that with ´fine´. But I guess you ´d have to answer with ´What the hell do you think, I´m here for a friendly chat ?´ The ´I don´t see anything´, ´ as long as you´re here in my office you´re fine´club. Okay, some things are hard to translate.

 

You get what you pay for ? Not here, you pay lots of money and you still get monkeys (if you don´t get the reference ´if you pay peanuts, you get monkeys´).

 

 

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Side note: http://www.benzobuddies.org/forum/index.php?topic=210941.0

 

I was reading a bit today. Old Dutch source for GPs. I think the file is diagnostiek huisarts.pdf Written in Dutch. They sort of confuse prognosis with diagnosis, and offer prognosis as a substitute for diagnosis. Something like that. 4 page text, I culd offer the original in Dutch but would anyone really care ? Dutch primary care is heavily based on opinions and probabilities. Non-serious things have to pass on their own, or maybe there is a pill for the symptoms ... 'trust' is a primary feature in primary care. So what I have is not serious ?? The arrogant and irresponsible SOBs.

 

There is soemthing truly wrong when the doctor patient relationship has to be based primarily on trust.

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Basically, it seems doctors have the ability to impose the medical hierarchy on their patients. In primary care anyway, if you give them some power. And trust is power.

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More fun in Dutch healthcare: hospitals close:

 

(http://www.sin-nl.org/ijsselmeerziekenhuizen-door-rechtbank-failliet-verklaard-mc-zuiderzee-mc-emmeloord-mc-dronten-en-verloskundigenpraktijk-de-kreek/)

 

https://translate.google.com/translate?hl=en&sl=auto&tl=en&u=http%3A%2F%2Fwww.sin-nl.org%2Fijsselmeerziekenhuizen-door-rechtbank-failliet-verklaard-mc-zuiderzee-mc-emmeloord-mc-dronten-en-verloskundigenpraktijk-de-kreek%2F

 

http://www.sin-nl.org/lijst-15-zwakste-ziekenhuizen-in-nederland/

 

https://translate.google.com/translate?hl=en&sl=auto&tl=en&u=http%3A%2F%2Fwww.sin-nl.org%2Flijst-15-zwakste-ziekenhuizen-in-nederland%2F

 

The local ER has already closed due to lack of money.

 

Lots of money, but what they do with it ... 2nd most expensive healthcare system in the world.

 

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Latest experience.

 

More or less through a connection, a website/organization that was willing to provide a service I got a telephone consult with a neurologist. Normally he gives second opinions.

Prior to that I had condensed the past 5 years in a few messages on the website.

 

Basically, he was thinking of neurological diagnostics. And possibly a psychologist or psychiatrist. 'clinical thinking' Idea about the latter: they know more about medications ... no, they just label people and prescribe drugs for 'therapeutic' purposes.

The neuro is basically thinking about the therapeutic properties of the drug. As he knows it, it sedates people and getting off can people make more alert. Not my experience !

 

The GPs have been messing me up. A neurologist wouldn't have done that. So that's thinking about neurological diagnostics and treatment. For known neurological conditions.

 

Not my issue. To understand what I'm dealing with, you need to think at a scientific level, and abandon common diagnostics ('the way they learn their job')

 

As someone who was studying to become a specialist stated 'Dutch specialists are superspecialists, they know a lot about their field but beyond that they don't know anything' he wanted to work in Germany. I guess the rest is for the flunkies, the GPs.

 

What happend to me is NOT normal. Even for Dutch standards. Getting treatment for iatrogenic damage caused by medical errors appears to be close to impossible in this country.

 

A few aforisms 'if the doctor doesn't know, it doesn't exist', 'if the doctor doesn't see it, there is nothing', 'I am the doctor, I am God'. Freedom to choose a doctor ? Not in the real world. Certainly not if you want your insurance to pay. 'you can eat anything you want, as long as it is cheese'. Justice or help for victims of medical errors ? The medical community polices itself.

 

 

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After a recent search through the Dutch medical landscape.

 

Local GPs: likely to ´stick together´. Finding a GP elsewhere (partly against the rules, ´zoning rules´=GP has to be able to arrive at the residence of the patient in 15 minutes) and without proper medical records,  encountering distrust (why no medical records) a basic lack of knowledge, most common diagnostic pathway is trying to diagnose the 400 most common medical afflictions based on the 200 most common symptoms. Risking cherishing ignorance, long term benzodiazepine use is either ´satisfied user´, ´mental or psychiatric´, ´addiction´. The Dutch medical community considers themselves an elite , they police themselves and their collegues, mostly above the law. All sorts of dysfunctional behaviors for my situation, ´waiting till it is over´, emphasis on normalcy, restricting access to care, the Dutch GP calls on the medical hierarchy for solutions if he/she doesn´t know. Doctors think clinical, almost complete inability to think otherwise. A doc who acknowledges a medical error made by a colleague in public has his career terminated. Victims of medical errors typically run into problems. If the doctor ´fails´, you may see a psychiatrist.  Whell, that summary is bad enough. Very archaic.

 

So I´m not expecting anything from the Dutch medical community.

And as far as I know, the only country in which clonazepam is prescriebd widely is the USA.

 

I think I've been repeating myself, for the most part.

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Just reread all 14 pages in this thread. After opening that other one. It's dismal. About the true reality, you wouldn't believe how much. Primary care, anyway.

'ignorance is strength' and such. It's not looking good. I could use a 'doctor free zone' for my health and safety. After the medical errors and iatrogenic damage in 2013, 2014, 2015, the effects started to accumulate and interact in conjunction with the effects of aging. I have a fairly good grasp of what's going on, but fixing that ...

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This thread has gone on for quite a while, and I think it's time to wrap it up.

 

As I think I've stated over and over, healthcare in The Netherlands is quite abysmal. It appears that doctors (specialists in particular) can only think clinically. As in, what's the disease ? ('how they learned their job/craft') To what extent it's a complete inability, and to what extent they just want to do their job that way, I'm not sure.

Cutting corners a bit, that neurologist I talked to over the phone. Prior to that I had explained the situation in some messages over the internet. A bit about the condition I started it for, some 'surprise' of his part that no diagnostics were performed prior to prescribing anything, followed up by his suggestion to ask in primary care (!) for a neurological examination by a neurologist. Also with the suggestion (again cutting it short) to consult with a psychiatrist (he used a certain phase ... epi condal chondrial ...) if nothing was found. To put that bluntly, if the doctor does not find/see anything it must be between the ears ('mental') because God the doctor does not fail ... And drugs have only therapeutic properties ... you become more alert and energetic when you stop taking the drug ...

 

I'm not sure if it's that bad ('clinical only') in other countries ? In primary care it's a bit different, more like a free for all. But they don't know anything, except that they are so great. Of course, all of this is worse because of the 'structure of Dutch healthcare', including the legal position of the patient (or lack thereof).

 

If you ever see a Dutch 'home doctor'/huisarts (GP is a misnomer): run !

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Small 'update'.

 

Here it's still the year 1980. Likely, they have 'agreed' that benzodiazepines are safe and that they will not contradict each other. It's a national thing, something a lot like what you could experience in one city in the USA.  And it's not as if you can move to a different state like in the USA. Those 'home doctors' (association: 'doctors' who doctor a bit at home) have all had the same basic education. Common standard of care. Comment by an employee of an an 'insurance' company (not really insurance, just a tax and each insurance company offers the same basic product) 'it's not getting better'.

 

It's all better in The Netherlands. After all, if they all agree something does not exist, it does not exist !

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Just a little continuation.

 

A few stories

 

https://dutchreview.com/expat/health/healthcare-in-the-netherlands-2/

 

Not all useful, so a few selections

'David February 11, 2019 at 19:47

 

I am originally from the UK, have lived here for 28 years and am now in my early 50s. I have followed many forums over the last 20 years and have seen the many horror stories left by expats about their experiences with the Dutch health care system. Now, I have experienced it for myself:

 

In the middle of 2017, I finally went to my doctor (General Practitioner) here complaining that I could not get off the floor/out of the bath anymore. This had been getting gradually worse over a long time (I am not overweight). He told me that I just needed to do some sports. I made the mistake of listening to him and just went and did fitness for six months.

 

During 2018, I started becoming immensely tired, would often go to a room and forget why I went there. I developed IBS/stomach problems, started to lose my balance often and felt like my arms and legs were being crushed.

 

I pleaded with him to send me to a specialist, specifically a neurologist. He finally relented although he said that he thought it a waste of time, ‘because I don’t think that they will find anything’, he said. There was a 3 month wait to see the neurologist. When I finally saw the specialist, it took almost a month for the results of the blood test to come back. It was negative.

 

The specialist said that I had to go back to my doctor to plan any further diagnosis, and advised seeing a rheumatologist.

 

I then called my doctor and asked to be referred, as the specialist has advised. He refers me, but it will be another 3 months’ wait to see the second specialist.

 

I say that I also want to be checked out for Hemochromatosis (‘The Celtic Curse’) and wanted to see a hematologist as well. His answer was that I should just ask the rheumatologist in 3 months’ time about that. He also advised that to see a hematologist would take even longer, another 3-4 months at least.

 

By this time I am feeling much worse, and am so tired some days that I just can’t function. I am having to try and diagnose myself, because no one seems to have any idea what I have, how to proceed, or what to do!

 

I know that I can go to my health insurance provider and ask them to try and get me a faster appointment with a specialist at another hospital but I have now lost all faith in the Dutch health care system. I have now been trying to get myself diagnosed over a period of EIGHTEEN MONTHS. If I hadn’t been really assertive I wouldn’t have got even this far.

 

I have the feeling that no one really cares here. Preventive medicine? You must be joking. You could die here before they find out what’s wrong with you and treat you.

 

I will now fly to London in order to get diagnosed privately (I have no idea what the bill will be, but I have no other choice).

From my experience with Dutch doctors (the General Practioners) they are all the same. It seems all to be a question of saving the insurers money by not sending you for expensive investigation/treatment. But it is MY health that they are playing with!

 

They have been removing some old nonsense and files that put Dutch GPs in a bad light. For example, one text dated around the year 2,000 that described how Dutch GPs were looking for mental causes of physical complaints of people who originated from Marocco and maybe some other countries as well. In their own country, the doctor would usually find a physical cause.

There is almost nothing as bad for a Dutch GP as 'unnecessay tests and treatment' ! The horror !

The Dutch system is private, but as everyone is using it, don’t confuse it with other countries’ private health care systems! I am absolutely appalled that now that I finally need care that the system has completely failed me. And most Dutch people just seem to accept it all because they have nothing to compare it to, and don’t know any better.

 

Oh, they do preventive medicine ... like losing weight for overweight people ...

 

Please…don’t trust this system. If you have the feeling that you are really ill, head for Schiphol before it’s too late!'

 

The system private ? Oficially 'managed competition', but those 'private insurers' all offer the same product with soem minor differences. The product is the same, and as far as doctors are concerned there is just one system ... basically a single payer system.

 

The tendency is that Dutch doctors want to avoid real diagnosis and treatment as much as possible.  It mostly depends ont he 'opinion' of the GP.

 

https://www.quora.com/Why-is-the-healthcare-system-in-Netherlands-so-poor-dysfunctional-and-callous

 

'Bogdan Vulcan

Bogdan Vulcan, former Manager at The Netherlands (2011-2015)

Answered Dec 4 2017

 

Without any medical experience, I will share my personal story.

 

The Dutch medical system is, in my view as a patient, composed of two different systems.

 

Part 1: The Void

 

The Void is composed of family Doctors in clinics (day time or huisartsenpost outside normal hours). The Void offers very little real medical service. People working in The Void scan for the obvious signs of something deeply wrong with the patient, and in the absence of those try to apply the shortest path to success. Sometimes what happens is hilariously against the objective of actually finding what’s wrong with the patient. For instance I head some nuisance that persisted over months, so I went to the doctor; he asked me if I had been moving recently (I hadn’t) and if I have a stressful life (I didn’t). Then he wrote in his report “patient has a new job, new girlfriend, new kid, new everything..which explains the symptoms” - all made up to justify his assessment.

 

I would compare The Void to a search engine - you need to know what you’re searching for, before you get any results. As a patient, you often get in The Netherlands this question from the family doctor: “What do you want me to do?”. If you have no clue, you go home. If you have some idea, you still go home, reassured that further investigation is surely not warranted.

 

The Void is a catch-all safety net deployed on the patients. Its sole purpose is to stop people from seeking treatments or further investigation, and to do so cheaply. This is motivated by the huge cost of healthcare, and the vast demand for it. It’s not fair to say that The Void is “bad healthcare”. It’s just void healthcare.

 

Part 2: The High Tech Lab

 

This is the side of Dutch medicine that is not visible to most patients - specialist doctors and their teams, or a hospital clinic. In those places you will get great investigations, pertinent communication, world class doctors. If you can get in, that is.

 

Once, a young doctor in The Void thought there is a risk that the kid had a serious condition - and instead of just brushing us off with paracetamol as his previous two colleagues did (and as it’s the case most of the time), he decided to sent us to a hospital for urgent investigation. Turns out the kid had contracted some original stomach flu which was treated in the hospital for 3 days. The doctors paid a lot of attention to all symptoms and investigated everything thoroughly - for example there was a team of 2 surgeons that came every 2 hours to evaluate possible appendicitis.

 

I know people that were not referred to such a hospital or a specialist unit in time, because of how The Void works. In one case, this resulted in an aggravated disease as the doctor waited too long, despite patient complaints, before making a specialist referral (and no, to my knowledge you can’t just skip the referral and go directly to the specialist). In another case, a child died because a family doctor did not send him to hospital despite high fever and multiple visits and complaints, because there haven’t been symptoms for the number of days written in the procedure.

 

In my personal case, for a persistent knee pain of 6+ months, I was not prescribed investigation (radiography or MRI) unless “it gets worse”. I switched countries and doctors, and in Luxembourg the doctor said that such recommendation should not have been made because of the pattern and length of the symptoms, and ordered an urgent MRI. Turns out it was an aggressive local and very serious disease (immediately spotted on the MRI), which I then treated successfully in Luxembourg. If it had been caught earlier, I would have possibly needed less treatment.

 

In my opinion, in The Void it’s the system, the “procedure”, that determines the patient’s fate, rather than the doctors or the patient themselves. You are the owner of your health; but I think the system should cooperate more to help you have and keep your health, rather than push you until it may be too late.

2.7k Views · View 27 Upvoters'

 

https://www.delta.tudelft.nl/article/dutch-doctors-and-their-magic-powder

 

Somehow I lost part of the post I was writing. I'll leave it at this.

 

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Skipping a few things,

 

An old article (2001) Dutch primary care: https://www.henw.org/artikelen/de-helende-werking-van-het-arts-patientcontact

 

google translate:

'The healing effect of the doctor-patient contact

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By

 

    S van Dulmen

 

Published

October 10, 2001

 

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Item info

Edition

2001, number 11

First page number

490

Last page number

494

Resume

 

There is no one-to-one relationship between a medical intervention and its therapeutic effects. All kinds of patient and doctor-related factors as well as doctor-patient interaction contribute to a greater or lesser extent to the effect of the intervention. Understanding the nature of these factors can lead to a better understanding of the patient and ultimately benefit his health. Based on a literature study, a long-term doctor-patient relationship appears to yield important health benefits. In addition, attention from the general practitioner for the emotions, expectations and information needs of the patient appears to be beneficial for health. Patient health therefore still benefits from personal, integrated and continuous care as traditionally provided by the general practitioner.

preface

 

A doctor can influence the health of a patient through his way of communication. That health appears to be of particular benefit from providing comprehensible information in an empathetic, that is, a warm, friendly and reassuring way. 1 This knowledge can easily be used in practice. After all, it does not seem too difficult to give a patient encouraging approval, to pay attention to the perception of his complaints and to provide support at the right time. In addition to empathic consultation, other factors, such as the expectations and experiences of doctors and patients, also appear to influence health and illness. 2 There is therefore a certain healing effect from these so-called context factors, which play a role in every doctor-patient contact. Attention from the doctor for this can lead to a better understanding of and by the patient and ultimately also to his / her health.

 

Traditionally, family medicine has been characterized by continuity of care, availability, accessibility, familiarity with the patient and his environment and an integral approach to the patient. 3 This distinguishes general practice medicine from specialized clinical medicine, which generally involves short-term relationships with the patient. As a result, a number of context factors are expected to have particular significance for the organization and structure of general practice medicine. Little attention is paid in the literature to a possible difference in meaning of the context within primary and secondary healthcare. In this article I discuss the most important context factors that contribute to the effectiveness of a medical intervention in general and a general practitioner medical intervention in particular. It is not an exhaustive literature report, but a reflection on the results of a recently conducted literature study of context factors in the doctor's office. 2

Context effect within the doctor-patient contact

 

There is no one-to-one relationship between a medical intervention and its therapeutic effects. The effect of a medical-technical action appears to be partly dependent on the interpersonal context in which that action takes place. This therefore does not concern the broader context of general practice medical care, but what is taking place within the actual contact between doctor and patient. This interpersonal context is not only determined by the physician, but also by patient-related factors and the physician-patient interaction. Context working also involves more than place work based on the actions of the care provider. All kinds of factors in the contact between doctor and patient can both strengthen and weaken the effect of the medical intervention. The success of a medical operation also depends on the meaning and expectations that arise from the way the medical operation takes place. The use of guidelines by the doctor also has added value. The use of guidelines offers him guidance and structure. These aspects are (unconsciously) transferred to the patient independently of the actual content of the guidelines, increase confidence in the doctor and treatment and thus contribute to the effectiveness of the protocoled intervention. In addition, the meaning that a patient attaches to the words of a doctor can also influence a healing process. The interaction with a patient can therefore be interpreted as a therapeutic instrument that can be used by a doctor in accordance with Balint 4 . The way in which this interaction takes place is determined by a number of context factors that can be influenced by a doctor. I briefly discuss the most important factors below.

Patient trust

 

A visit to the doctor leaves no patient untouched. For example, uncertainty about what is going to happen can make patients anxious and thereby aggravate symptoms. In addition, the information provided by a doctor during the consultation can also increase patient anxiety. 5 On the other hand it is also true that any form of assistance, regardless of the nature of the medical intervention, is reassuring due to its symbolic meaning. 6 Just offering a solution in the form of medical treatment reduces anxiety and physical complaints. Positive experiences with counseling not only have a reassuring effect, but also increase the feeling of trust in the doctor. Continuity of care and a long-term doctor-patient relationship also have a positive influence on the patient's confidence 7 and thereby increase the chance of improving the patient's health condition. 8 , 9 A health-promoting effect therefore appears to be inherent in the continuity of care provided by a general practitioner. Working with patients' fixed lists, as is the case in Dutch general practice, does not appear to be necessary to guarantee continuity; Patients also strive for continuity in countries without fixed lists. 7 The importance of continuity has also been demonstrated in the second line: patients who visit the same doctor at an outpatient clinic use fewer medicines, are reassured and satisfied earlier and report a reduction in their symptoms. 10 The confidence generated by continuity of care can therefore not only be health-promoting but also cost-efficient. However, trust in a doctor also has a downside. Namely, it can lead to a decrease in the patient's need to exercise control while in contact with the doctor. 11 Too much trust can therefore result in a patient being passive and taking less responsibility. That will ultimately not benefit his health. A patient who tends to put his fate in the hands of a doctor may therefore benefit less from a long-term relationship with the same doctor.

Patient expectations

 

The confidence that a patient has in his doctor is expressed in positive expectations of the effect of a treatment. Positive expectations contribute to the effect of the treatment. This effect is less when there is no long-term, positive relationship between a doctor and a patient or when a patient is dissatisfied with the contact with the doctor. Because of the long-term relationship with their doctor, patients usually know what they can and cannot expect from him. This is an important advantage of general practice medical care, because the expectations that patients already have prior to a visit to a doctor are more decisive for the outcome of a contact than the expectations that arise during a visit to a doctor. 12 13 14 Because of his role as gatekeeper for the second line, a general practitioner can ensure realistic expectations for the patient if they do end up with the specialist.

Conditioning of treatment effects

 

The conditioning theory provides an explanation for the healing effect of positive expectations. This theory assumes that context effects are conditioned responses to stimuli that are present in the consultation room. Neutral treatment-related factors such as the presence of a doctor, physical examination or certain medication (the unconditioned stimuli) are associated with a decrease in health problems and are therefore positively conditioned for recovery and anxiety reduction. The association reduces the symptoms alone. A certain treatment will therefore have less effect for someone with bad experiences than for someone with good experiences. 15 , 16 In order to increase therapeutic effects, it is therefore important for a doctor to become acquainted with and use the experiences of a patient with previous conditions and treatments. Bügel and Van Everdingen talk in this connection about taking a treatment history. 17 Due to the nature of their relationship with the patient, GPs automatically have insight into the patient's history and can use it more easily than a medical specialist. Positive experiences with a certain treatment can, for example, reduce the dosage of (accompanied by serious side effects) medication. Moreover, many therapeutic effects that patients attribute to a specific intervention can be explained by spontaneous recovery or regression to the average. After all, patients consult a doctor when their complaints are most severe, while most complaints also decrease without medical intervention. They will nevertheless attribute these spontaneous effects to the visit to the doctor and be conditioned by them. Given that GPs are more often confronted with transient conditions compared to medical specialists, interventions in general practice are likely to have more of such positive context effects.

Expectations with the doctor

 

A doctor influences the effect of that treatment by the way in which he introduces a treatment to a patient. For example, as a doctor expects more relief from pain medication for a patient, the pain also appears to decrease more. 18 A doctor can apparently subtly communicate his expectations to the patient. Expectations of the doctor appear to be even more decisive for health effects than the expectations of the patient himself. 19 This is probably due to the patient's need to be liked and thereby meet the expectations of the other. Due to the generally long-term relationship between a general practitioner and a patient, a general practitioner has ample opportunity to 'educate' a patient in the direction of his own expectations.

The core

 

    The effect of a medical intervention also depends on the interpersonal context in which that action takes place.

    Insight into the factors responsible for this benefits the health of the patient.

    Personal, integral and continuous care still has therapeutic value.

 

Status of the doctor

 

In general, the symbolic significance of a doctor-patient contact is great. Equipment, needles, a white coat and pills have an important context effect. The status of a doctor also contributes to the effect of medical treatment. Research into the status of the regular doctor has mainly focused on measuring blood pressure. Blood pressure measured by nurses appears to be lower than that measured by doctors. 20 , 21 It is possible that a difference in responsibility between the care providers plays a role in this. 22 When a doctor measures too high a blood pressure, this has rather immediate therapeutic consequences. This phenomenon is also referred to as the white coat phenomenon, that is, a higher blood pressure or blood glucose level is measured by a doctor than when that measurement is performed at home by the patient himself. A possible explanation for this is that just the awareness of being observed can give subtle physiological responses. 23 Due to the absence of the white coat and impressive equipment, such effects are less common in general practice than in clinical practice.

Expressing emotions during the consultation

 

In addition to being observed, talking to a doctor about symptoms and especially about their perception has an effect on a person's health condition. After all, it is known that the hiding of thoughts and feelings is accompanied by physiological responses. In the short term, this can result in an increase in autonomous activity; in the long term, it can act as a stressor, which increases the chance of physical complaints. 24 The expression of stressful experiences therefore has beneficial effects on health. Moreover, there are several studies that show that it improves immune function and can decrease both anxiety, HbA1c, blood pressure and rheumatic complaints. 24 25 26 27 28 29 30 Talking about the perception of a disorder therefore appears to be largely responsible for the therapeutic effects in somatic health care. However, a patient does not just tell his personal story, he must know himself in a familiar environment and be encouraged to do so. 31 A longer-existing doctor-patient relationship is essential for this.

Empathy

 

In addition to a safe and familiar environment, the patient's empathetic treatment also contributes to the reduction of anxiety, pain and blood pressure. 1 , 32 33 34 A patient not only needs information and advice, but also needs reassurance, attention and recognition. 35 As female doctors are generally more empathetic than men, 36 consultations with female doctors may have more context effect. In any case - contrary to what is often assumed - patients are not more satisfied or more quickly reassured by more research but by more attention to the significance of the complaints for them. Patients with nervous functional complaints may even become more worried by additional research. It is not the research that reassures patients, but the doctor. It therefore appears to be effective not only from an ethical point of view but also from the point of view of health promotion when a doctor makes sure that a patient feels comfortable during the consultation.

Provision of information

 

The oral information from the doctor to the patient will influence his expectations and thus the symptom experience. Simply naming the symptoms or making a diagnosis can have a therapeutic effect because it gives meaning to the symptoms and provides a sense of control. 37 The diagnosis must then fit within the patient's frame of reference. 14 Meeting the information needs of the patient will therefore have a beneficial effect regardless of the actual content. However, the stress associated with a visit to a doctor can lead to patients having difficulty withholding information 38 and thus poorly following a doctor's advice. If a doctor has known a patient for a long time, he can better assess whether the degree of anxiety and stress he has observed is common to the patient or requires more attention. The way of giving information appears to be crucial. For example, it appears that the anxiety of patients from doctors who are trained to provide information is decreasing more than that of patients from doctors who had not attended training for this. 39 Finally, in the case of disorders for which there is no effective medical treatment (chronic benign pain, CFS, IBS), the waiver of therapeutic intervention can be regarded as a recognized therapeutic. Incidentally, not being able to find a physical explanation gives meaning to the complaints, something that GPs have to deal with more often than medical specialists.

Conclusion

 

In addition to the nature of a medical act, the way in which and in which environment that act takes place has therapeutic value. There are all sorts of factors in doctor-patient contact, such as expressing emotions and giving attention, empathy and information that have a healing effect on health. There is therefore a range of possibilities within the doctor-patient contact to promote the health of the patient. A different approach is effective for each patient, because it is precisely the interaction between the specific intervention and the characteristics of the individual patient and doctor that contributes to recovery. Conditioning appears to play an important role in general practice, not only because a patient with good experiences will always return to the same general practitioner, but also because contact with the same physician will eventually become health-promoting as a result of conditioning effects. This underlines the importance of continuity. With a view to increasing therapeutic effects, it is advisable for a doctor to pay explicit attention to a patient's experiences with previous treatments and conditions. Consultation skills of a doctor can thus increase the effectiveness of medical treatment. This also means that an intervention can have less effect if a doctor does not empathize with the patient. Compared to medical specialists, consultation skills with general practitioners are better developed. Moreover, general practitioner medical care is less medico-technical, so that more positive context effects will occur in general practice.

 

More than 40 years ago, general practice medical care was defined as continuous, integral and personal care for the health of the patient. 3 The therapeutic value of these concepts is still undeniable today. Nevertheless, this magazine recently seriously questioned whether GP care in this form is still feasible. 40 In my opinion, recognition of the favorable effect of the context in the doctor's office automatically implies recognition of the value of 'traditional' family medicine for the Dutch health care system. '

 

Written in the year 2001. Can it be that bad ? Yes, some GPs learned their job before that time. The original Dutch text is actually worse. For example, paragraph 'expectations with the doctor'

' Due to the generally long-term relationship between a general practitioner and a patient, a general practitioner has ample opportunity to 'educate' a patient in the direction of his own expectations.' The Dutch word that is used in the original text which is translated as 'educate' is closer to the phrase that is used to raise a child ...

Combined with the GPs 'owning' patients (for real or in the mind of doctors) it's just an example of a horrible and dysfunctional primary care system.

[[cs...]]

Just a little continuation.

 

A few stories

 

https://dutchreview.com/expat/health/healthcare-in-the-netherlands-2/

 

Not all useful, so a few selections

'David February 11, 2019 at 19:47

 

I am originally from the UK, have lived here for 28 years and am now in my early 50s. I have followed many forums over the last 20 years and have seen the many horror stories left by expats about their experiences with the Dutch health care system. Now, I have experienced it for myself:

 

In the middle of 2017, I finally went to my doctor (General Practitioner) here complaining that I could not get off the floor/out of the bath anymore. This had been getting gradually worse over a long time (I am not overweight). He told me that I just needed to do some sports. I made the mistake of listening to him and just went and did fitness for six months.

 

During 2018, I started becoming immensely tired, would often go to a room and forget why I went there. I developed IBS/stomach problems, started to lose my balance often and felt like my arms and legs were being crushed.

 

I pleaded with him to send me to a specialist, specifically a neurologist. He finally relented although he said that he thought it a waste of time, ‘because I don’t think that they will find anything’, he said. There was a 3 month wait to see the neurologist. When I finally saw the specialist, it took almost a month for the results of the blood test to come back. It was negative.

 

The specialist said that I had to go back to my doctor to plan any further diagnosis, and advised seeing a rheumatologist.

 

I then called my doctor and asked to be referred, as the specialist has advised. He refers me, but it will be another 3 months’ wait to see the second specialist.

 

I say that I also want to be checked out for Hemochromatosis (‘The Celtic Curse’) and wanted to see a hematologist as well. His answer was that I should just ask the rheumatologist in 3 months’ time about that. He also advised that to see a hematologist would take even longer, another 3-4 months at least.

 

By this time I am feeling much worse, and am so tired some days that I just can’t function. I am having to try and diagnose myself, because no one seems to have any idea what I have, how to proceed, or what to do!

 

I know that I can go to my health insurance provider and ask them to try and get me a faster appointment with a specialist at another hospital but I have now lost all faith in the Dutch health care system. I have now been trying to get myself diagnosed over a period of EIGHTEEN MONTHS. If I hadn’t been really assertive I wouldn’t have got even this far.

 

I have the feeling that no one really cares here. Preventive medicine? You must be joking. You could die here before they find out what’s wrong with you and treat you.

 

I will now fly to London in order to get diagnosed privately (I have no idea what the bill will be, but I have no other choice).

From my experience with Dutch doctors (the General Practioners) they are all the same. It seems all to be a question of saving the insurers money by not sending you for expensive investigation/treatment. But it is MY health that they are playing with!

 

They have been removing some old nonsense and files that put Dutch GPs in a bad light. For example, one text dated around the year 2,000 that described how Dutch GPs were looking for mental causes of physical complaints of people who originated from Marocco and maybe some other countries as well. In their own country, the doctor would usually find a physical cause.

There is almost nothing as bad for a Dutch GP as 'unnecessay tests and treatment' ! The horror !

The Dutch system is private, but as everyone is using it, don’t confuse it with other countries’ private health care systems! I am absolutely appalled that now that I finally need care that the system has completely failed me. And most Dutch people just seem to accept it all because they have nothing to compare it to, and don’t know any better.

 

Oh, they do preventive medicine ... like losing weight for overweight people ...

 

Please…don’t trust this system. If you have the feeling that you are really ill, head for Schiphol before it’s too late!'

 

The system private ? Oficially 'managed competition', but those 'private insurers' all offer the same product with soem minor differences. The product is the same, and as far as doctors are concerned there is just one system ... basically a single payer system.

 

The tendency is that Dutch doctors want to avoid real diagnosis and treatment as much as possible.  It mostly depends ont he 'opinion' of the GP.

 

https://www.quora.com/Why-is-the-healthcare-system-in-Netherlands-so-poor-dysfunctional-and-callous

 

'Bogdan Vulcan

Bogdan Vulcan, former Manager at The Netherlands (2011-2015)

Answered Dec 4 2017

 

Without any medical experience, I will share my personal story.

 

The Dutch medical system is, in my view as a patient, composed of two different systems.

 

Part 1: The Void

 

The Void is composed of family Doctors in clinics (day time or huisartsenpost outside normal hours). The Void offers very little real medical service. People working in The Void scan for the obvious signs of something deeply wrong with the patient, and in the absence of those try to apply the shortest path to success. Sometimes what happens is hilariously against the objective of actually finding what’s wrong with the patient. For instance I head some nuisance that persisted over months, so I went to the doctor; he asked me if I had been moving recently (I hadn’t) and if I have a stressful life (I didn’t). Then he wrote in his report “patient has a new job, new girlfriend, new kid, new everything..which explains the symptoms” - all made up to justify his assessment.

 

I would compare The Void to a search engine - you need to know what you’re searching for, before you get any results. As a patient, you often get in The Netherlands this question from the family doctor: “What do you want me to do?”. If you have no clue, you go home. If you have some idea, you still go home, reassured that further investigation is surely not warranted.

 

The Void is a catch-all safety net deployed on the patients. Its sole purpose is to stop people from seeking treatments or further investigation, and to do so cheaply. This is motivated by the huge cost of healthcare, and the vast demand for it. It’s not fair to say that The Void is “bad healthcare”. It’s just void healthcare.

 

Part 2: The High Tech Lab

 

This is the side of Dutch medicine that is not visible to most patients - specialist doctors and their teams, or a hospital clinic. In those places you will get great investigations, pertinent communication, world class doctors. If you can get in, that is.

 

Once, a young doctor in The Void thought there is a risk that the kid had a serious condition - and instead of just brushing us off with paracetamol as his previous two colleagues did (and as it’s the case most of the time), he decided to sent us to a hospital for urgent investigation. Turns out the kid had contracted some original stomach flu which was treated in the hospital for 3 days. The doctors paid a lot of attention to all symptoms and investigated everything thoroughly - for example there was a team of 2 surgeons that came every 2 hours to evaluate possible appendicitis.

 

I know people that were not referred to such a hospital or a specialist unit in time, because of how The Void works. In one case, this resulted in an aggravated disease as the doctor waited too long, despite patient complaints, before making a specialist referral (and no, to my knowledge you can’t just skip the referral and go directly to the specialist). In another case, a child died because a family doctor did not send him to hospital despite high fever and multiple visits and complaints, because there haven’t been symptoms for the number of days written in the procedure.

 

In my personal case, for a persistent knee pain of 6+ months, I was not prescribed investigation (radiography or MRI) unless “it gets worse”. I switched countries and doctors, and in Luxembourg the doctor said that such recommendation should not have been made because of the pattern and length of the symptoms, and ordered an urgent MRI. Turns out it was an aggressive local and very serious disease (immediately spotted on the MRI), which I then treated successfully in Luxembourg. If it had been caught earlier, I would have possibly needed less treatment.

 

In my opinion, in The Void it’s the system, the “procedure”, that determines the patient’s fate, rather than the doctors or the patient themselves. You are the owner of your health; but I think the system should cooperate more to help you have and keep your health, rather than push you until it may be too late.

2.7k Views · View 27 Upvoters'

 

https://www.delta.tudelft.nl/article/dutch-doctors-and-their-magic-powder

 

Somehow I lost part of the post I was writing. I'll leave it at this.

 

This is horrible.

[[li...]]

Today I read a book 'De huisarts als poortwachter' by Frans Rampen, retired dermatologist.

 

The title translates as ' The home doctor as gatekeeper' or if you prefer 'The GP as gatekeeper'.

You can't really read it if you can't read Dutch.

 

He writes a reasonably but not completely comprehensive picture of the effects of gatekeeping in the NL. Some new things I was't aware of.

The gist is that it's a completely perverted system, with the presumption that GP gatekeeping allows for better and cheaper care. One dimension he touches is the 'regie' function (how to translate? control, management, supervisory ?) of a patient's healthcare. He rightly mentions that some people want to manage their own healthcare !

 

The suggestion that primary care is cheaper is debunked. He basically describes a rotten system, in which the GPs 'home doctors' rationalize their own actions. They do a lot of things because they learned their job that way. He describes the relationship between the GPs and money and power. The results of this system are horrible. From oncology and other medical fields, comparisons with 16 to 17 other EU countries.  The results are abysmal. Examples: life expectancy at birth at the 10th place, life expectancy from the age of 65 years 11th place, infant mortality 13/14 (page 223) etc.

 

In some ways it was worse than I had expected. Many specialists dislike it, but they have given up. The position of the GPs and the 'insurers' is very strong, and their marketing excellent. Who cares about facts ! And you don't have any rights in primary care anyway. It's just 'an opinion'. Beware.

[[Ma...]]

Wow. Just got done reading all 14 pages. Just wow. Note to self - never ever get sick in Europe, especially the NL. Not as bad here, but we have our quirks. The medical system here in the US is set up to benefit 3 entities - the allopathic medical profession, the pharmaceutical companies, and the insurance companies. You could probably throw the politicians in as a 4th. Our doctors could stand a little more in the way of giving "lifestyle" advice, if they knew anything about it. "Here's a pill, go take it like a good little camper, and get out of my office. And I don't want to see your face again til the next check up, and don't you dare complain about side effects."

 

Well, after the past year's medical disasters, I decided to jump ship and take care of my own self. Can't take most of their pills anyway, without getting sicker. And I've suspected for a while now that the clonazapam/zolpidem may be responsible for a number of my other issues. So I just went CT. Seems "health care" is anything but now days, no matter where you are in the world. And the socialists here tout how great health care is in Europe. Lying bastards.

 

I'm sorry you lost your battle. While I was reading, I was really hoping you'd be in the 14%. Hope things get better for you. Don't let the bastards hold you down.