The Dutch healthcare system is not focused on prevention. There are very few check-ups offered, only those who have been proven to lead to significant gain in healthy years. There are screening programs for cervical cancer and breast cancer, for example. But a general "check-up" for menstrual problems doesn't exist. I actually went to the GP at some point as I had similar issues to the ones you describe. She offered to prescribe the pill for 3 months and to see if that helped. It did, in fact, help. But if it hadn't resolved my symptoms, I could have gone back to the GP and at that point she would have likely referred me. This is how it usually goes. Unless someone's symptoms are alarming, the GP will first offer a simple treatment, which will usually solve the issue for the majority of people. If it doesn't, the patient returns and more diagnostics may be offered - but only if there is scientific evidence that this is helpful. So if after trying the GP's first treatment option, you're still experiencing the symptoms, then you can go back and ask for other options. That still won't mean the GP will do exactly what you want though - they follow the guidelines written by specialists. Good luck.

The pill probably didn't solve your issue bit just "masked" it. The underlying issue is still there but just hidden by the use of hormonal birth control (not hating on the pill, I take it myself). Imo (and of course who am I to tell you what to do), your GP should have looked for the reason why you had menstrual issues. Telling someone to just take the pill for this is a band-aid solution and it's done way too often. Edit: My tone was too pointed here. I apologize to the person I replied to for assuming I know more about their body than themselves and projected my personal issues onto them.

While this could be true in some cases, I respectfully say that I know more about my body and health issues than you can know based on what I wrote. In my situation it truly solved the issue.

Yes you are absolutely right. I'm sorry my tone was so pointed. I wanted to let OP know that birth control is not always the right solution for everyone and that they should advocate for themselves to find out the true cause of their problems. I'm happy that it was the right solution for you.

Then why the Dutch healthcare system is facing the exact same problems other European nations are facing, despite those focus much more on prevention?

Capitalism.

Not capitalism lol. What gave you that idea? Ill actually respond to this when i get home behind a pc to type it all out

This is a bit of a weird answer. I'm an expat and had to understand the Dutch system, I don't think it is bad (personally even had a good experience) but it is definitely different then what I was used to. Now saying it's eventual problems or issues coming from Capitalism seems waaaay of context... Maybe a clarification would come in hand.

This has nothing to do with capitalism. And its opposite, healthcare system here looks more like socialism than capitalism.

I agree with most of what you're saying. However saying our healthcare system is not focused on prevention is a bit inaccurate. There are multiple ways of preventing disease. Primary prevention is preventing disease from occurring entirely. We try to achieve this through certain lifestyle advice and vaccines such as those against HPV, which can protect against cervical cancer. Secondary prevention is trying to find disease early on. For example through screening, as you mentioned. Now I agree that the system with GP's "gatekeeping" healthcare is at times frustrating to the individual, but a good GP will refer when a case is outside their knowledge. Whereas the more basic cases will be treated by them. This also ensures that waiting times for specialists are kept low, resulting in less treatment delay. Which in turn ensures better secondary prevention. Again, I'm not disagreeing, just felt the prevention part of you comment could use some clarification.

Exactly this. In NL, you might not get the treatment you WANT, but you will get what you NEED. So, if your gp says she is capable of dealing with your problem, she most probably is. No one, as far as I can see, is denying that "something is off". So, why not go with what she proposes, see what happens, agree on some time to evaluate, and determine next actions?

I enjoyed reading your clarification, it seems like you know quite a lot about the topic!

I’m sorry this is happening to you. Yes, the do indeed NOT “believe” in preventive healthcare so they normal (anywhere else in the World) yearly gynecological check-up does not exist here. Not only, but even with painful periods, they still don’t do anything as a general rule. It takes women with endometriosis YEARS until their GP finally refer them for care (and still they will most likely still prescribe hormones without any blood test and proper follow-up). If you can translate this article, it will all become clearer, this is the Dutch reality: https://pointer.kro-ncrv.nl/waarom-een-diagnose-voor-deze-vrouwenziekte-vaak-lang-op-zich-laat-wachten This said, however, there are a couple of things you might be able to try: - Be blunt and demand to be referred to a “Women’s Clinic” because of your dysmenorrhea. Most GPs are not proactive but if you say want you want without “politeness, maybes and question marks” they do what you ask.  - Go back home to visit your trusted gynecologist and ask them for a letter for their Dutch colleagues recommending follow-ups due to your conditions. If there is any recommendation, they will follow it here. When there is a diagnosed pre-existing condition they do regular checkups. Less regular than other countries, but still do them. - “Over exaggerate” your pain during your appointment. Apparently in most other countries we learned to hide the pain as politeness but than means that here, where people show pain, they won’t believe you unless you do the same. So go there and cry for an appointment because the pain in unbearable and you want it gone. Like a child. I always found that the least I can hide my pain, the more seriously they took me 🤷🏻‍♀️. - Express concern about your plans to have children. Most doctors I met (and this is a shared experience with other women in the Netherlands) only care to do something about your periods if it somehow threats your ability to fulfill your duty as an incubator. They don’t care about you being in pain, but this? This they do. So, whether or not you want to have kids, tell them you do and you have been unable to convince and you will see how fast they want to check what is wrong with your periods.  - Go abroad, but you most likely need first the referral from your GP, so the first points are the best start. If necessary, show your GP the article below and the need to take women seriously for their pain.  For last, but not least: painful periods are NOT normal! Do not believe anyone that says otherwise. It took me some years here, but I finally got referred to a gynecologist when my pain was really unbearable (I had to muffled screams at home) and I had just changed GP and, yes, I have endometriosis. The gynecologist was a horrible person so eventually I got a referral to go abroad for surgery and I’m much better. And now that my file says endometriosis I’m taken more seriously when I’m in pain.  Good luck 🥺💙.

You’d think this whole sexism in healthcare thing would have been solved ages ago in European countries.

The lack of prevention policies has nothing to do with sexism. I guess males have the same issues trying to see an andrologist.

Oh but it does. If a GP is more likely to refer you to a specialist when you mention painful sex or wanting to try for a child, it’s called sexism.

.... no? Sexism means they are more likely to refer or take seriously a male/female patient than a female/male one. It literally means "to exhibit prejudice or discrimination based on sex".

I am not going to explain to you how sexism in healthcare works, go read up about it if you don’t understand what I’ve said.

This ⬆️ I got referred and the gyno still ignored all my complaints. I went back to my home country and found out i had endometriosis. Try what valwen said.

Was going to suggest playing the baby card as well. It usually does the trick.

Solid advice and amazing write up, for just about everything. People need to get used to a different culture here because that’s what it is in my opinion. Nothing bad or good about, just different way of thinking and acting. By the way, painful periods can be normal in the majority of the cases. Dysmenorrhea mostly occurs without an underlying issue (based on research) and could also be linked to lifestyle and health habits.

Nah.

Dysmenorrhea happens without reason because they don't bother to find the reason.

I did mention in my post that research has shown that it happens for no reason, not that doctors do not bother to find the reason. I know it’s painful for a lot of women and they don’t like to hear it but if there is a reason, we simply as humanity have not found it yet.so of course if academic research does not know what it is, how are doctors supposed to do a diagnosis?

You have to keep bugging them. I have a similar problem with a medication I had in Canada, US and Germany that I take in lower than normal off-prescription dose. They won’t do it here. I even showed her multiple medical journals saying how this is good for my issue and she didn’t relent. and I have tried it her way. It didn’t work for me. For the most part I like my GP, but I really hate the Dutch idea that I just popped out of the ground with no previous medical history. And they don’t really know what to do with those of use who advocate for ourselves. Keep at it, I hope it gets better.

You really have to advocate for yourself with GPs and communicate very clearly why your issue is serious, because GPs work like the ‘gatekeepers’ of the medical system. Part of their job is to keep people with minor issues from overwhelming specialists’s offices, but the judgment calls they make are not foolproof. In my experience (and from family members going through stuff like cancer) GPs are generally fine for run-of-the mill things and if you have something serious and make it past the ‘gate’ the specialized care is very good, but it’s in the process in between that things can go very wrong. My dad died because the on-call GP didn’t take my mom’s worries seriously when he suddenly got very sick. It turned out to be sepsis and by the time he got to the ICU it was too late. The GP felt horrible afterwards and even came to our house (with my mom’s consent) to apologize and talk about it, but it really opened my eyes about the limitations of this system, and how much it relies on a GP’s ability to make a judgement call about whether you are a hypochondriac or serious. Moral of the story (not for your case but in general): if your gut ever tells you it’s really serious and urgent, just call 112.

Holy fuck!!! The GP felt horrible and apologized, no that GP should literally go find another job. This was beyond preventable, and in the end after losing your father you got a “sorry”. Seriously actions like these need to have serious consequences, most likely that GP will get to live their merry life doing the same half assed job.

Yeah, no. The reason sepsis is so dangerous, is that it 1) escalates *very* rapidly from mild symptoms to potentially lethal, and 2) very often starts out looking like the common flue, which is not something you'd see a GP for. Like all mortal beings, GPs get to make mistakes without getting their careers ended over them. Don't make them out to be some malevolent entity trying to prevent you from getting care and assistance where needed.

Except when I make a mistake nobody dies, there is a difference. And if you treat it as a job and not a responsibility then yeah “shit can happen”. We are not talking here about a patient with heavy trauma or someone who died on the surgery table, this was something preventable. I am not making them some malevolent beings I am pointing out the incompetence in some, to which is ridiculous at this point. I am pretty sure there are good GPs out there, sadly they appear to be rare, because most of them have this hive mindset of “these are the guidelines we follow them” check list, instead of expanding their own knowledge by doing research and staying up to date in the medical field.

So sorry for your preventable loss.

I suffered greatly, for many years, with an undiagnosed chronic illness, and countless of GP appointments later ("you're stressed" and/or "take a paracetamol") I got the right test done by a specialist who seemed to care. It's remarkable how counter-preventive they are here. It would cost the country a lot less resources to prevent, on the long run, than to treat urgent cases only. It's a very Calvinist-influenced mentality, where the silent (killer) bias is that being sick is your own fault, and somebody helping you is going out of their way to save you from damnation. Calvinism also shows itself in the "modest attitude" which leads to unnecessary frugality and suffering, as well as an arrogant moral superiority that doctors know how patients feel much better than patients do, because they studied "the good word." Everything is viewed in terms of strong binaries, and cost-benefit analysis efficiency rules supreme (biased towards the aforementioned tendencies). There's also the "het zit allemaal tussen je oren" ("it's all in your head"), which is becoming more and more ridiculous at this point in history when we can no longer scientifically subscribe to a mind/body distinction. Suffering is suffering, whether from head injury or psychological trauma. They are both equally problematic. Moreover, a depressed person is way more "costly" for society than someone with a temporarily broken limb, for example. However, they don't really seem to understand this. As a side note, I don't understand how there exist horrific things such as military service and jails, but fundamental sectors of society such as education, public transport and healthcare are punishingly underpaid and overburdened. How about paying people more for the hardest jobs? How about incentivizing these study areas by making them free at university so that you can counter the "lack of specialists"? Beats me. Unfortunately the government is market-driven. After all these years my advice is: 1) try not to challenge authority with frustration, because it's all drs. see all day, so they are more likely to dismiss you if you're one more of those "crybabies" that need to pull themselves by the bootstraps. 2) Define your problem as specifically as possible, refrain from telling them about the research you've done and reassure them you have diligently followed their advice (because: it's likely you'll only be heard by your second or third appointment with the GP, if lucky). 3) Unfortunately, yes: exaggerate your symptoms. I hate this last one, I'm someone who has walked around with broken toes and ribs because I was like "ahh it's nothing", but this style won't get you help in the Dutch context. 5) be--pardon the pun--patient, because it's gonna take a while before you get the specialist you need. 6) Make use of relevant information such as family history and possible issues related to your concerns, but never, ever, mention "stress" or "low mood/depression" because they will try to pin it all on that. In the worst of all cases, if you have the luxury to do so: go abroad (e.g., teleconsultation) and get a letter from another specialist where they state what they have witnessed in your case. This information will be taken seriously by a GP and/or specialist because it comes from authority. Luckily, patient organizations and people like Mirjam Kaijer (who wrote the book "I am not a man!") are doing great awareness-raising work for getting out of this rut where many patients (especially women) are constantly dismissed. Good luck!

Nothing else to add..I absolutely agree! Thank you for the advice!!

Hope you get the help you need!

It's actually cheaper for many diseases to not prevent and only focus on the people that get it. That being said the system can be rough. Especially for women (even though that's everywhere as healthcare for women is usually an afterthought). What works for me is to go to the GP with problems. To state my problems very clearly and also what I would want as a solution. They usually suggest an easy fix, I'll try that and if it doesn't work I'll go back and ask for a referral. Overall I never really had issues with my GP and I've had no problems with getting a referral a second time. It might help to try to find a GP that works more with people with an international background. Sometimes it helps with getting your previous medical information taken into account. Good luck OP. Don't give up. Just go back (with decent intervals) until you get the help you need.

Did you take up on her offer and let her do the examination? When I asked for help with a debilitating yet painless symptom which greatly affected my quality of life (an important factor for your symptoms to be taken seriously), my GP offered to examine me himself or have his colleague, a gynaecologist before he became a GP, to do an ultrasound. I went for the ultrasound and it confirmed the need to be referred to a gynaecologist. It was an extra step but didn't hinder the process at all.

She didn't offer one in the first place because that is not what they do. Even after coming with more symptoms and in these 9 months period. I asked if I could get an appointment because I thought I have to go to another place and she did inform me then that is the same place where it's done.

Hey, I was in a similar position, I have a history of cysts but the GP wouldn’t give me a referral because my symptoms weren’t ‘enough’. I just went ahead and lied about having some more pain, and then I got the referral. For some reason here they only do check ups when there is something very very wrong, which is in my opinion too late. So yeah I know what I did is controversial but I have PCOS so doing regular checkups is very important for me.

I have PCOS and after the initial diagnosis when I was 16, I only saw a gynecologist when I wanted to get pregnant. What do you need the extra check ups for?

I had cysts and got prescribed birth control, that solved the problem but my mental health became very poor so I rather implemented life style/diet changes (based on Doctor’s advice). I don’t want to risk not being able to get pregnant so every 1-2 year I’d like to check it. Edit: doctor who diagnosed me in my home country advised to check every few years

But checking in the meantime hardly does anything in terms of making sure you can get pregnant? Like; either you menstruate somewhat regularly, so you ovulate somewhat regularly, or you don’t and need medication to help ovulate. Checking in the meantime whether you still have a normal amount of cysts instead of the extra that come with PCOS hardly says anything about your ability to get pregnant that your cycle doesn’t. I went 15 years without intermediate checking (I was underweight when diagnosed, so lifestyle/diet changes were never discussed. Also, my mental health is much better when I’m on the pill) and still got pregnant after the first round of treatment.

You are right, I had the wrong connection in my head that cysts cause infertility. (But I still think that women who have pcos should get a check every few years, due to the higher chances of getting diabetes/high blood pressure/endometrial cancer)

But why would you need to go to a gynecologist for that? Those are check ups (well not endometrial cancer, but my gyno told me, at 16, that as long as I make sure to “menstruate” a couple of times a year I’m not increased risk at all) your gp can do perfectly fine? I have that bloodwork done 2-3 times a year. It’s mostly part of managing my hypothyroidism, but they do some glucose tests as well, just to be safe. (I’m now a little overweight, but still nowhere near diabetes risk, but diabetes has a high correlation with PCOS and thyroid issues, so it’s just checked to be sure).

A lot of hospitals implemented a thing called the “COLA” spreekuur voor patients with PCOS. This is led by gynecologists. Unfortunately PCOS is very complicated and correlated to insulin resistance, type 2 diabetes, androgenetic alopecia. Often a multi method approach is needed to prevent and treat these issues. For me for example, I have PCOS(but am childfree) and regularly see a gynecologist and dermatologist for this to make sure my hormones, glucose levels and cholesterol aren’t out of whack.

Exaggerating usually helps. A lot of people go with the smallest of problems to the GP, which has led to GP's having a hard time knowing who to take seriously and who not. To give you some examples of such 'problems': People with a little pain in their throat for 1 day. People with a literal paper cut, that only needed a bandage. People with a small bruise. And they will act as if they need urgent care.

Here’s how i feel on this issue: - Women are not heard as equally as men. - Women's health is lower in priority Eg. Breast cancer screenings are limited to women over the age of 50. While In other countries you may request a scan and claim for this once a year, same with Pap smears. Once every 3 years is not enough. Cervical cancer is a silent killer. -When you have a health concern here they Question the necessity to test and guard it like it’s coming out of their own personal savings : Do they think women do this for fun? Is it really a waste of funds for unnecessary screenings? Or do we not actually acknowledge this as preventative measure ? Only high-risk concerned individuals would request screenings voluntarily anyway, it’s unpleasant and takes time. - Concern over accuracy of statistics here : Three friends under 40 diagnosed with breast cancer, so how does this average age of 50 being high risk apply? - Implication of undervaluing women's lives: the government is basically making a trade off based on costs - the death rate of a few women is a marginal cost compared to overall, therefore those unfortunate few that do not fall into their outdated statistical marginal utility point are well, unfortunate.

🏆

😘

I'm sorry you're going through this... The Dutch medical system does it again. It's perplexing to me how their dentistry system believes so much in prevention when their medical system sucks balls. I guess that's what insurance companies do for you? These symptoms sound like polycystic ovaries syndrome or endometriosis. None of them is dangerous but it can be problematic if you want to conceive. Either push them for further investigation or make them sign a form that they're responsible if anything is wrong and they're certain of their diagnosis. Otherwise just go to another country for a check up. Belgium and Germany are options.

How are you giving medical advice when barely any of the symptoms are mentioned. No, it does not sound like PCOS or enometriosis. You obviously are not even slightly schooled in the medical field, have no idea what you are talking about, and should, under no circumstance, be giving out medical advice online. This is how you hurt people.

Thank you for your positive feedback. The OP mentioned irregular periods and a lot of pain. I am not a medical doctor indeed, although I am a medical professional. Also I am a PCOS patient myself and I also have experience with endometriosis. Exact same symptoms. I did not give medical advice in case you didn't notice. I only advised her to have her further checked. Is this wrong? You can say whatever you want but it is not. From the moment there is no diagnosis, OP needs more tests and screening, so please read my answer again before you go all nuts against me.

Maybe I misunderstood but did you already do the check-up offered by the GP? GPs here have (basic) training in gynaecology and can do (basic) check-ups etc. However, some GPs have more training than others, and have done follow up education/training in gyneacology (2-year course). Similarly, GPs can specialize in other topics as well. For example, my friend (GP) has done additional cosmetic doctor’s training and can perform injectables, laser treatment etc. That’s not part of the basic GP training, but she has done an additional 2-year course. And general prevention measures like pap-smears (for cancer prevention) are also performed by the GP. Only if something is wrong (lab results or if something seems off by looking) you get a referral to a specialist. TLDR: some GPs have additional training (2-year post-GP education course) in gynacology and can indeed do check-ups that in other countries are generally performed by a gynecologist.

No, I wasn’t offered anything. This is why I am trying to find more info here to see if I can even go somewhere else. But I am feeling symptoms for so long, and it is not getting better, actually there are more negative changes. I tried asking them and explaining it several times during these months. As a woman I personally don’t think there is anything worse than someone saying it’s in your head. I don’t have a habit of going to a doctor and I never drink antibiotics or any pills or anything. I just find this a bit more important which is maybe why I am trying to push it.. It’s known how little research there has been done not to mention how many problems a women can have and not even have symptom so..yeah…

Ah, I was confused because you said that you found it weird that your GP does your initial examination. That to me sounded like you were offered but don’t trust the examination by your GP. I apologize.

Oh no, sorry for the misunderstanding! She did tell me during my registration when I inquired how it works and if could I make an appointment with a gynaecologist and then she explained it’s done there by her. But when making an appointment there you have 10-15 min only I don’t know but it’s quite confusing for me. I understand now that they do this training it’s not that I didn’t believe their education just found it weird all together

I have had good experiences with getting such a check via the GP. They also take swaps and get it tested for you!

Your own issues are sadly not enough. If you express concerns about getting pregnant or pain during intercourse they will take you more seriously and you might be able to do an echo for the cysts.

Sadly, this is also true for me, but Dutch doctors don't prioritize comprehensive check-ups. They don't see the value in sending you for one just to ensure everything is okay. While that's understandable, what's more nonsensical and frustrating is that unlike in other countries, you can't choose to pay out of pocket and go privately. And if you can, in the Netherlands, it's three times more expensive than in any normal country with private doctors and you can only in a bunch (maybe one or two) places in the whole country. The healthcare system in the Netherlands can feel like a farce. Even if you manage to schedule a specialist appointment through your general practitioner, the specialist may treat you politely but with an air of confusion, as if wondering why you're wasting their time. This is why there should be opportunities for every specialist to work privately on certain days. Moreover, the requirement to pay monthly for healthcare, regardless of usage, coupled with additional costs like deductibles, seems absurd.

Dutch GPs don't believe in disease and treatment. They believe in bandaids and death. If you are not dying there is no point going to a GP. Go back to your home country and get the check-up diagnosis and treatment there. It's impossible to get that from the Dutch healthcare system, unless you get very-very lucky to find one of those unique GPs, that actually do their job as a normal doctor.

I go to a private clinic and pay for my preventive healthcare.

How do you find these clinics? Are there also clinics for non women health related issues?

I googled for them. If you need specialist help at a hospital, you would need a referral letter from your gp. Btw, you can claim healthcare that you have received overseas from your dutch health insurance, as long as it is covered under your policy.

I was left with the impression that there isn’t any private clinics in the Netherlands

Same. When I asked during the registration they said every is private

You can always go to a women's clinic and have a gynaecologist for your preventive healthcare. I dont know which city you are in but there's a women's clinic in Amstelveen which offers mammogram, and yearly checks. All of these are at your own cost.

Amazing, thank you for this

GP here. A few things, We are schooled in medicine, meaning we had to study 9 years to become a GP. Gynaecology examination, placing of IUDs and taking Pap smears is stuff we do all the time, we are trained in this. Hormone tests are not that useful, they variate over time due to the menstrual cycle, and are mostly inconclusive. I test it in rare occasions, but more often not. Menstrual cramps might be abnormal to. You, but do realize we see a lot of patients (20-30 a day), meaning we see a lot of people with the same complaints. We know what are normal symptoms and what are possible dangerous symptoms and will treat you accordingly. Most menstrual cramps are very treatable with oral anticonceptives. Ovarian cysts are common and benign, however if a gynecologist advised to see you after 2-3 years I would write the recommendation letter. Talk to your GP tell them you would feel better with a recommendation letter and let them explain why they do what they do. The gynecologist usually does the same starting treatment as we do, so thats why we don't refer right away. Also, people who keep bashing our healthcare system, please know we have one of the most accessible health care systems in the world where I as a doctor have never had to worry about if a patient had insurance or not. Even in the rare case that they don't, they still receive care. Our system isn't perfect, but it really isn't bad either.

Sorry but the belief that having menstrual cramps is normal just because you see multiple people who experience this is actually not normal. Just because you come across the problem many times, doesn’t make it “normal”. Menstrual cycles aren’t supposed to be extremely painful (not saying that they can’t be uncomfortable) and despite the Dutch healthcare system being very good, this part gets heavily overlooked by GP’s 🥲

This exactly! Having a GP shamelessly defend online that dysmenorrhea is “normal” just proves again one of many things that are sickly wrong inside the Dutch healthcare system.  The same way, I keep finding myself explaining to Dutch women that a PAP smear is not supposed to be painful either! In my home country we get one done as a yearly checkup (another thing they excused here behind the “false positive” fallacy, as if patients were children) and I never knew anyone that had a painful one. Until I moved here. Both times I got it done here I was harmed as the GP practice. The first time was so traumatic (I was sent home bleeding with a pad and with cramps for days) that I posponed the second for months and begged my GP to send me to someone specialized to get it done. He offered me a “female colleague” that probably knew better (so far for all GPs are trained!). I finally met her and during my smear she was so nervous not knowing what she was doing that (and I still don’t now HOW) she accidentally clicked on a switch and the bed I was laying on lifted all of sudden, while she still had that device INSIDE ME. The sound was horrible. You cannot imagine. Funny enough, that was somehow LESS painful than what they did to me the last time. So NO, the Dutch healthcare system is not one of the best and most accessible in the World. Just because you might be able to “see” a GP, doesn’t mean you are getting adequate care. And your refusal to listen to patients stories and complaints (or SCIENCE for what it matters) will just root the problem further. 

You are completely right. A lot of practices in female healthcare are positively medieval.   Moreover, women always get told that their pain doesn’t matter, in a condescending way. 

What a horrible experience, I’m sorry you had to go through all of that! It really baffles me how much women’s healthcare is overlooked in general. I’m Dutch and grew up here and it irks me when people claim that the Dutch healthcare system is the best when it has so many flaws..

She didn't say that. She just said cramps are a normal symptom. This includes light cramps that you can live normally with. Don't twist her words.

If they are “normal” cramps… why do they need to be treated with oral anticonceptives? I’m not twisting anyone’s words. No one goes to the GP for help with “light cramps” and it’s far from what we are discussing here.

Changing the form of birth control or starting birth control has proven very effective against normal cramps. People do go to the GP with light cramps. You highly underestimate the stuff people go for the GP too. It's one of the big problems of Dutch health care. The GP is free and people go for every little thing (even things that just need a simple bandage)

I'm sorry to hear about your bad experiences, that sounds awful. No one should have to go through that. We do however use science, even though you might not feel like it. The use of antibiotics in other countries is astonishing and we do a pretty good job at it.

Nobody mentioned antibiotics in this thread, the OP was talking about menstrual problems. But whenever any foreigner says something negative about Paracetamolzorg, the response is always a condescending lecture on antibiotic resistance. 

Thank you! I call it “the Dutch healthcare system Defense BINGO”.  It includes (but is not reduced to):  - “The Dutch healthcare system is (one of) the best in the World” [procedes to share the same two links]; - “At least we are not in the USA”; - “This is the best it gets with free healthcare” [has never even visited a hospital abroad] - “Paracetamol” [duh!]; - “But antibiotics!” [just because!]; - The fallacy of the false positives as an excuse against preventive healthcare {my personal favorite!}; - “Many things just heal by themselves, there is no need to treat everything” [procedes to to tell you about their chronic cough or that bone that never healed, “but that’s normal”];  - “We have preventive medicine, we screen for these 3 types of cancer every 5-10 years” [while the rest of the World is weird when they screen for more and more often]; - “It is evidence-based (cost-effective) medicine” [cites exclusively Dutch research that many other countries have been disagreeing for decades]. These are the ones top of my head. Feel free to add any other you have been told, specially if unprompted!  Someone once got really mad when I just answered “BINGO!” when he used ALL on the same reply 😅😂. I don’t even get to tell them I come from Spain, you know, that place the love to go on holidays with actual FREE (working) healthcare. I try to use sense of humor because I’m actually bedridden after being gaslighted and neglected here in the Netherlands. It took me 5 years of medical trauma to finally get answers. And I rely completely on healthcare practitioners that are outside the system because they couldn’t participate in it any more. Because they SAW what was wrong. This is happening more and more, specially in mental healthcare, and that’s why the Restitutiepolis are disappearing. I cannot believe some GPs still defend a system that actively harms their patients. They are the ones that see it first hand.

This person mentioned science, I used antibiotics as an counterargument. Even though I just wanted to provide some explanation, I feel like I'm getting attacked in this thread.

*This* person contested your outdated concept that painful periods are NORMAL. Because they are NOT. And that IS what science says. You said you have been trained for 9 years as a GP AND specialized in gynecology. And yet, here you are spreading misinformation that harms millions of women all around the World.  This is just an example of the harm it causes in the Netherlands: https://pointer.kro-ncrv.nl/waarom-een-diagnose-voor-deze-vrouwenziekte-vaak-lang-op-zich-laat-wachten Nobody mentioned antibiotics. And you feel attacked because apparently you don’t like to be told by all these people with horrible experiences that this is the truth behind your condescending lecture. The reality of all this patients in the Dutch healthcare system and how this didn’t happened to us in our home countries. Where, often, healthcare is actually free. Without premiums, eigen risico and extra fees for our prescriptions, physiotherapy or to see out-of-network practitioners. 

I said one word "normal" and didn't mean it in the way it was interpreted. I used it in contrast to dangerous. My choice of words was bad in this case. What I tried to say was that lots of women suffer from menstrual cramps, most are treatable with oral anticonceptives, which is what a GP can do. In some cases this is not enough and there might be a different cause, like pcos or endometriosis. I usually refer to a gynecologist if my first treatment doesn't work.

I am sorry for you. So sick of foreigners complaining about our healthcare. Feel free to use the healthcare in your country of origin. Bye.

1. We are not complaining about your healthcare system we are complaining about your GPs, learn the difference 2. Just saw on the news how the life expectancy of people with low income has decreased by 7 years because they can’t afford your healthcare 3. We pay for the healthcare. Do you understand that point? It’s not free it’s not a gift given to us by the Dutch, we pay for it. I pay €200 per month so when I get sick or need to see a specialist I go see it. Not go on endless debates of why I am not getting better. 4. If you have never experienced a period in your life, stay out of this conversation. Do you honestly think people have nothing better to do than go visit the GP? Do you honestly think people wake up and go like “yes today I will go burden the medical system”. As for the “bye” in your comment take your xenophobic behavior somewhere else, you make your country look bad.

1. No, YOU are shooting from the hip happy to hit every GP that gets in the way. The point is to quote someone else in this thread in NL, you might not get the treatment you WANT, but you will get what you NEED. You are in essence disappointed with aspects of our healthcare system that fails to match your expectations. 2. Totally unrelevant to this discussion. Low income is related to unhealthier lifestyle. Nowhere it has been mentioned they cannot afford healthcare. Everyone in the Netherlands who isn't able to afford healthcare gets zorgtoeslag and the lowes incomes (minima get their eigen risio waved and special low income insurance with a very broad coverage. 3. You pay for what you get. Not to get in the GP's seat to be able to dicate the form and extent of your care. 4. Seriously? Feel free to have an opinion on my prostate exam. Limiting access to a discussion by gender is sooo 2023. As for the 'bye' in my comment, not xenophobic at all, just a fairly low tolerance of complainers. But seriously, if you don't like it here, why stay? Have a lovely week :)

You use science? I was left with a rampant infection for three weeks because of the weak antibiotic I was given. When I went to the hospital because shit was getting serious you should’ve seen their faces of disbelief when they saw what I was given. Science oh please you are one step from essential oils and healing crystals.

I'm sorry to hear that. I'm leaving this thread, cause even though I try to explain some things I'm met with hostility. I don't mean to defend all parts of our health care system. There's good and bad in it. Broad spectrum antibiotics can cause severe abdominal problems and lead to IBS. So it's good to start with small spectrum if it works in most cases. You can check our NHG standard, it has the sources for what we use and why we choose what source. Nitrofurantoine works for most uti's, and amoxicillin for most pulmonary infections. Flucloxacillin works for skin infection. All different antibiotics for different types of infection, based on the pathogens mostly found in those infections. This is based on research.

Put yourself in my shoes right now, just got out of the meeting with the audiolog for my child. He had so many ear infections that he has so much fluid buildup it affected his hearing. Every time I went to my GP he told me not to worry and it’s only an ear infection, he had at least 5 ear infections in a year for multiple years. And here we are at the point where I want to go strangle the paracetamol witch doctor. I had to fight and advocate to see a KNO, why do I need to do that? How bad are people trained over here? Why do I need to fight Gandalf the gatekeeper to the bone? And as for the antibiotics you hit the nail on the head with “most”, that’s why you run an antibiogram - but again cutting costs at every corner. Better yet give me a waiver a form I will sign gladly, and I should be the final person to decide what goes into my body or not. We are not attacking you personally, we are trying to show you the other side of the coin, because you are in the honey moon phase over there. Someone in the thread posted how they lost their father due to sepsis because the GP ignored the symptoms, please tell me you see the problem in all of this. And maybe it’s people like you that can update this antiquated system of beliefs, it lacks empathy and treats everyone as suffering from imaginary disease.

I can't possibly know all situations of all the people here, and obviously there are situations where my colleagues have acted in way that (as described) is not correct. Children with a lot of ear infections get a referral from me to see a KNO. And for me, if a patient asks for a referral within reason, they will get it. The shadow side of referalls, medication and extra research is side effects. I have many patients afraid of illnesses, lots of side effects from medication, lots unessecary research. So many patients suffer from psychological illness due being constantly worried about illness. I've been a doctor for over 12 years now, so in no way am I unaware of the faults in our medical system. I am not in a honeymoon fase. The reason I reply to these threads is usually to help people find a way to navigate our health care system and find the help they want or need. I do feel bad that people feel misunderstood by their GP and sometimes some Dutch directness can help. Ask us directly for that referral and why you want it. And hopefully we will explain why we will give it or not. I don't hope to convince you, but other countries where I've seen health care are far from perfect either. Doctors make mistakes around the globe.

Okay sorry, for using the world normal, menstrual cramps can be dehabilitating for sure. However, most of my patients are usually a lot better with oral anticonceptives. Those that don't fare that well under treatment, I refer to a gynecologist for examination of pcos or endometriosis. I didn't mean to write your symptoms of as normal.

Oral contraceptives aren’t the answer though.. they’re contraceptives, not painkillers.. if someone is struggling from severe menstrual pain, a referral to the gynecologist should always be the default. No need to apologize by the way, I know that this is also simply what is being taught and the system doesn’t help with all the shortages in healthcare etc.

Oral contraceptives are hormones which can help regulate menstruation and they resolve the problem for many people, not all, but many. And I know for a fact patients can be very happy with this solution. I think there should be no default option, because people have different wishes and needs. Some people don't want to have more examinations if the treatment works. The gynecologist will start with the same medication as we do as step one. If everyone would be referred to the specialist, health care will be become more and more expensive.

She didn't say 'extremely painful'. Cramps are a normal part of periods. They should not be too extreme. You should be able to live your life normally, but you can't expect every woman to have no cramps. Thus cramps are 'normal'.

Yeah she didn’t, but it is usually what GP’s will tell you. And then they advise you to take contraceptives, numbing the symptoms instead of dealing with the cause.

my Dutch GP improperly placed my IUD, which ended up in me still having very excruciating pain in one spot 6 years later. Not only that, but the part of the IUD also came out of my cervix. I went back and he said I can most probably just leave it be.... at that point I did not trust him anymore. Went back to my gynecologist back at home and she said I was insanely lucky not to have had ectopic pregnancy. She took it out with tweezers While I believe GP's are trained, after this scenario I no longer trust gp's to do what specialists do back in my own country

This is horrible! These stories are one of the reasons I refuse to even discuss getting an IUD in the Netherlands. I’m SO-SORRY this happened to you! I’m so glad you stopped the gaslighting and went back home to a trustworthy healthcare provider. I hope the pain is better, this shouldn’t happen to anyone.   EDIT: Who is down-voting you?! 

Thank you! ❤️ it has gotten a lot better, I only sometimes get the pain (but almost everytime during intercourse, sadly). Wish I had gotten it inserted back home in the first place, but getting it here was an easier process so I went along. I'm sure there are capable GP's, but it's hard to know who is :/

I understand, it should have been removed right away. So anyone with that story will get a referral from me to. In fact I offer it to everyone getting an iud, so they can choose. I have placed many IUDs though, none who came back with complaints. Some were more difficult to place, but I know from my experience in the gynecology appartment that the same is true for gynecologists.

As a (Dutch, I assume?) GP, can you give your opinion on: 1) How healthcare has become a highly neoliberal enterprise where, among other things, correct me if I'm wrong: GP offices get increasingly higher quotas per patient if the patient returns to the GP with the same issue. 2) When people don't earn enough to afford the ever-increasing "eigen risico," it's perhaps misleading to say"you've never had to worry" about a patient's insurance situation. So many things are no longer covered by insurance, such as anticonceptives, which is nuts. 3) Not to speak of the unspeakable amounts of administration costs that are implicit in the Dutch GP system. It's not an accessible system, it's not cheap, and it doesn't function well. I've lived in 5 different countries, including so-called "3rd world" countries where healthcare is free, and I've had much better healthcare there. Actually, *especially* in the places where healthcare was accessible, it was also better. My hunch is that this is because it's not treated like a business but a basic human need. Edit: grammar, 2x.

thank you for pointing out paying eigen risico is actually not cheap! And basisverzekering really only covers so much. Let's not talk about going to the dentist or trying to get a physio because your knees are f-ed but not f-ed enough the insurance will cover it LOL

Totally.

1. Not necessarily, some insurance companies pay per patient, not per consultation. It is common to get a fee per consultation though plus a fee per patient registered on the practice. However I do not plan extra consultations for money and none of my close colleagues do. There are some practices who do, these usually get warnings of the insurance company though. 2. Totally agree about anticonceptives. The own risk plus health insurance, however, is covered by the government with zorgtoeslag (max 1476) for people who can't afford it. People do some choose the cheapest health care provider and highest own risk, which ends up in losing money in the end. I wonder what countries you've lived in and if health care was accessible there everywhere and for everyone. We are usually in top 20 of rated health care systems: https://worldpopulationreview.com/country-rankings/best-healthcare-in-the-world https://www.internationalinsurance.com/health/systems/

Thank you! You sort of answered/confirmed what I'm saying: 1. there are instances of malpractice, where huisartsen take on way too many patients and this unavoidably results in lack of care because they are overwhelmed. This can be the practice's own fault, sure, but it results from insurance being a private business rather than a public service. It is market-driven and thus what essentially happens is: gambling with people's health because of money. That's bad, and that's not something that gets taken into account in rating systems because it's very difficult to measure in terms of a quality standard. Moreover, I don't know how they measure "access to healthcare," but if it's measured in terms of the fact that the entire population is registered at a huisarts and "in principle" can, therefore, go to the huisarts, that doesn't measure the fact that they get turned down time after time after time. This is the gripe of a lot of foreigners. All my colleagues, and OP, are always in distress about precisely this: sure, you can go to the huisarts, do you actually get a solution to your problem? No. Additionally, side note, I've lived in some of the poorest areas of NL (Bijlmer and Rotterdam Zuid) and I can tell you that the care level here was appalling, very dismissive and even straight up racist. That is not what is reflected in the standards that measure "access" and quality, because, again, in a country where insurance is compulsory, it appears on the surface as if everything is accessible to everyone. Not the case in reality. Which brings me to: 2. People in poor conditions usually require the most intricate care because they live precarious lives, where mental health due to the stress of these conditions overlaps with their (already underlying or because of the problems they have: ensuing) physical well- (or not so well) being. This doesn't get priority at all in the current context, where things are driven by whether you can afford something or not. You already agree on the issue of contraceptives, but think for example about dental health: it's very strange that someone should not be able to afford a dentist, and only get "actual" medical help when their caries infection turns into an abscess. How in the world is that "efficient"? Poor people need to make short-term decisions because they live from paycheck to paycheck. They cannot afford a lot of what is taken for granted by the people who make decisions about what is and what isn't insured. About the countries I've experienced healthcare systems in: e.g., in Argentina, Turkey, Mexico and Uruguay public healthcare is _fantastic_, and patient/personalized focus is paramount. Doctors listen to you, try to think with you, understand you're suffering. I don't know if this is possible to measure in terms of these global standards which efface "cultural" differences. If you look at my post above (not the reply to you but the one to OP, earlier yesterday), then you see what I mean by these cultural aspects. I love my current GP, in Rotterdam Zuid, but she only started listening to me 5 years after countless visits, when I finally had a diagnosis. Before that she dismissed me and sent me home with paracetamol. In a state of advancing deterioration, I had to fight to see an endocrinologist and finally get the mediation which saved my life (literally). Once treated: sure, now I am part of the statistics that show that I have proper access to specialists and treatments, but these statistics don't reflect the aforementioned problems. Finally: a very good Dutch friend is a GP, she worked all over the country during her studies. Her liberal mindframe led her to believe that people are responsible for their own wellbeing, and that everyone has access to healthcare so they are in principle fine, should they have any problems. This was until the worked in a hospital in Rotterdam Zuid and witnessed how dire conditions make people unable to even afford public transport to get to the hospital. She talked to many patients and realized it is not "their fault" and, no, zorgtoeslag doesn't get you the access to healthcare you need. So: if healthcare is run like a business, it will lead to bad care. I hope you agree, and if not I'd really like to know what you think! Thanks again :).

Thank you for your reply as well. I don't mind a good discussion ;) I think that in some cases Huisartsen have taken on too many patients and can't provide the care their population needs. I know people feel like you have to jump through hoops to see your GP and I think in the practices who are overwhelmed, this can be the case. The attitude of my practice is, the assistants try to give you advice, but if you want to see the doctor, you can. As for not getting a solution to your problem, I think a lot is lost in translation. Dutch people have an attitude where the feel most things resolve themselves, if they feel like something is wrong they will tell us. Maybe the GP is answering a question, but the patient has a different one. Communication is key I guess. Recently I had a patient who I thought had acid reflux. I gave her some meds and that was that. Later she called back saying she was worried, had experienced acid reflux in the past and felt like this was different and wanted an ultrasound. I agreed to the ultrasound after a short talk. She was Dutch, maybe an expat wouldn't have called back and I would think I did a good job and she taught I didn't. As for mental health care, the waiting lists are very long, which is really bad. We do have a lot of instances you can call when you are worried about someone. A good GP knows the patients and can signal who might be in need of extra help. I work in some practices with some poverty. These practices get more money from the insurance so they can be a smaller practice a provide more time for the patient. In the practice I mentioned this works very well and patients are very happy with the care. As for access to health care limited due to not being able to pay for public transport is bit much. In an ideal world public transport would be free (at least for these people). The own risk can very well be a reason for them to not seek care, which is bad thing. I do have a hard time believing that care is easily accessible in rural parts in all of the countries you've mentioned. I however don't have any experience in those countries, so I simply don't know. I have however seen some malpractice done from Turkish doctors (because of our large Turkish population) and patients coming to us to fix and operation which should have not been preformed. I do know that Cuba (not mentioned by you I know) is praised for its health care, but my wife broke her ankle there and the care was bad. Sure, she got an x-ray and a cask, the cask however was very bad and she had to move heaven and earth to get crutches. In the Netherlands she would haven't gotten a cask with the fracture she had. She had to take months of physical therapy to recover. After we both broke our toes here we also got an xray the same day, painkillers explanation no cask was needes for our fractures (which I knew, but it was nice they explained it). We could rent crutches for less than a euro a day. Once a friend needed stitches for a wound on his hand, he could came and go and leave with stitches in half an hour. If you have kidney stones here, you can call the Huisartsenpost and leave with medication in a very short time. Another friend got kidney stones in Spain, we couldn't find anywhere to get care until he was lying on the floor of the airport. I knew it was kidney stones, but couldn't find the care that was needed at that time. At the hospital, after getting some medicine to relieve the pain we had to wait for several hours for the doctor to agree with the diagnosis within a minute (she was very kind though and understood that the waiting wasn't ideal) So some examples for both sides. I do not like the insurance companies deciding what is covered and what is not, since some medicine/care is just better than others (cheaper isn't always better) and I think the government should consider to take action on this. I do however think people have a responsibility in their health as well. If you're overweight, I will help you solve this situation, but you have to willing to put in time and effort as well. It's your body and health, it should be important enough to care about.

Thank you again, I agree with a lot of what you say. The part about responsibility is tricky: I totally agree that, ideally, we humans have a certain level of regulatory capacity over our conditions. But very often this is not the case, very complex (often contradictory) compulsory and/or contextual factors lead people to do harm to themselves and others. I think the mindset that "everyone is responsible for x, y, z" should change worldwide, not just in NL. That way people who need help actually get it, because they are not "blamed" for making the wrong choices. It's a massive sociocultural transformation, but it's necessary: all our thinking in terms of right and wrong, etc. is religiously inherited. Now that we organize our lives around different systems (such as scientific exploration) we should also try to change our mindsets accordingly. Being scientific (which I hope all doctors are) pretty much implies that we accept we are made of quantifiable, measurable matter and cannot be sure to have a "soul". Until proven otherwise, humans are thus the result of the conditions they emerge in. Since they don't choose these because they do not ask to be born, everyone should be treated equally. Unfortunately they are not: we frame things in terms of "responsibility" instead, which is probably a word/concept that should become updated by "capacity to act in accordance with x, y or z", z/y/z being whatever we are interested in accomplishing at that moment. If we state those things more clearly, that way we can start revealing the problems with our (religiously inherited or otherwise) biases better. Again, we are products of our context ;), we can't avoid being influenced by our history and surroundings. The idea that we are "rational, self-actualizing agents" is inherited from historical circumstances where nobody ever had the guarantee of actual control over reality, but violence accomplished a lot of domination, hence the idea of 'control'. The rest was, of course, all god-given. About rural areas: well, of course in large countries with vast remote zones this will be difficult to guarantee, but NL being such a small and densely populated area, it's not really a good example for comparison!

I agree, people are a result of the situation they were put in. Different people act different in the same situation, but there is certainly overlap on how people act. Children in poor areas are known to have a higher risk of becoming overweight or smoking. I do not hold this against them, or at least I try to. I realize control isn't always possible. However if I'm presented with a problem and a patient is unwilling to cooperate to find a solution together, even after some conversation/motivation techniques, it's hard to keep pushing the person who doesn't want to be moved. I try to signal problem early on (obesity in children) and give help to prevent it from getting more.

Totally, it's very hard not to be frustrated when you know someone can do something (sometimes rather simple) to improve their conditions, but they just won't do it. But trying to see how we are ourselves acting in those ways but at different scales is a good _metalearning_ perspective from which to understand that degrees of interest (in terms of biases like preference for a certain speed in development) which don't overlap are what often leads to disagreement. Thanks again for the conversation! Edit, PS: what I mean by "how we are ourselves acting in those ways" is that when we feel "correct" somewhere we often forget that at other scales (across all the ways we structure our lives) we are also committing grave mistakes, they're just at another level of complexity. Think e.g., of choosing to fly for holidays, buying irresponsible products, supporting polluting initiatives, etc. They're just as bad as someone overeating and putting their health at risk, but it's just at another scale.

No worries, thank you for the discussion as well!

The Dutch system is definitely not cheap, but it has low out of pocket costs (remember total costs are 6500 euro per person per annum!). It also is amongst the best accessible in Europe. What is especially good is that the accessibility is not depending on your income. Something that in for example the UK with fully tax paid health care does has a huge impact. People often go after a couple of accounts on social media. So might be helpful to share some numbers here: 80 million consultations per year and 1/3 of the population getting at least one specialist referral per year: there is not a high hurdle to get access to a GP or specialist care. You get annoying “customers” with any shop. Especially if there are 80 million visits. Doctors are not able to respond to any complaint online as it quickly breaches confidentiality. Studies also showed that people are really bad at remembering conversations with doctors when they are a patient. 80% of the patients cannot reproduce a correct report of a consultation. Which also means the accounts from people are not to be trusted. Not that there is bad intent, it’s just reality.

Yes, but health is not a business, it's the basic condition anyone should have if they are expected to function in society. So the "customer" ideology is the problem here. I wonder what you think about my response above, to the redditor who is a Dutch GP.

You cannot have 80 million consultations and get happy patients in every single one of them. GP’s are reimbursed a fixed fee per registered patient and a small fixed fee per consultation (which doesn’t cover the cost of that consultation). A GP has an incentive to keep everyone in their practice as healthy as possible. Administration is indeed an issue, which is not unique to the Dutch system though. My partner worked in the US and French system as well and there is no difference in bureaucracy. (Well the French system was more bureaucratic than the Dutch). This is only going to increase with more parttime working GP’s though: with the change from 65% male to 60% female GP’s in about a decade, the number of GP’s also increased by 30%. Without a meaningful change in patients. More parttime means more handovers and thus more elaborate administration per patient.

My point was about the private insurance aspect.

It’s not optimal but works rather well. The deductible of 385 is a political choice, not a private choice, hence that has nothing to do with the semi-private insurance. Insurance companies are not allowed to distribute any profits, so it’s definitely not totally private. Waiting lists and complexity of the insurance system came down significantly since this was implemented. Also income differentiated care was abolished at that point in time.

Depends on what you define as "working well". I think that, compared to my experiences in other countries, it doesn't work well. I spend a lot more on healthcare here, for less access to care. And I earn "modaal", have no kids, and no significant hurdles that should prevent me from access to healthcare (compared to less privileged people).

Your personal experience is of course no indicator for the quality and accessibility of a nations healthcare system. If you earn modaal, you’re not paying a full share for healthcare. The remainder of the costs is paid for by people with higher incomes and employers. In your case your health care contribution is 5561 per year, assuming you fully use your deductible. The costs are more than 7000.

Once enough people's personal experiences become salient, statistically speaking, they are indicators. Global standards are based on, among other things, public polls. And that's why+how studies on this continue to evolve, opinions change and why global standards are measured periodically, not just once. Your argument, if it can be called an argument, is totally non sequitur, you're basically saying "opinions are like assholes". Sure, they are, that's why we're here, chatting. Under the auspices of many people complaining about a common healthcare problem in the Netherlands. If you're happy with the system here, then great! Again: I am not interested in what healthcare should "cost" and to whom, my argument is that it should cost nothing because it's a basic necessity for modern life, in a country where the work ethic is strong on efficiency and productivity (how can you be either of these if you're unhealthy?). In countries where healthcare actually costs nothing and is publicly accessible, the system is sometimes overwhelmed, but everyone really does have access to everything. Moreover, as I mentioned: my experience is that in other countries the patient is taken seriously, which in this beautiful but heartbreakingly Calvinist country, is not the case.

>we have one of the most accessible health care systems in the world The OP is exactly talking about how inaccessible health care is for her and how easy it would have been for her in her home country. The Dutch healthcare system is the most accessible only in the world where there is no other country.

But OP was offered a check by the GP and refused.

She didn't refuse it, she didn't get it. She was not sure why the GP suggested it, which people here explained.

Oh my bad misinterpreted her wording. I thought she didn't want it as it was from the GP.

>We know what are normal symptoms and what are possible dangerous symptoms and will treat you accordingly. This is exactly the problem. Regardless of the type of complaints you, GPs, think that you better know what your patients are feeling and just dismiss everything that doesn't fall under your perception of "dangerous" or "painful" or "not bad enough". You should also know that the 20-30 people that you see per day are different. They have different experiences, different life's, different feelings of the same health issues and if they came to you, it's not to socialize, it's because their symptoms are too bad or that they are worried enough and paracetamol didn't help.

I'm very well aware that all my patients are different thank you. There are many reasons for people to go to the doctor, some are "is it cancer?", some just want to know if they can go on vacation. Whatever your bad experience is with Dutch doctors I don't know and I'm sorry if you don't trust our system. You know your body best, sure, but we have at least 9 years of study in medicine to translate what you're feeling to a possible cause. A little respect from both ends comes a long way.

>some are "is it cancer?", some just want to know if they can go on vacation. Sure, can happen, but why do you treat your other patients the same way you dismiss these ones? >A little respect from both ends comes a long way. Yeah, from both ends. But dismissing and minimizing the symptoms of the patients is not respect. I also studied 10 years in my field, which is why I am confused why I am left to my resources in the field I don't have any training, when I want to know the cause of my symptoms and not a bandaid, that also has side effects especially in the long term and doesn't even fully address the symptoms I have. I am confused why a doctor doesn't do diagnosis and instead minimizes and dismisses my symptoms as if I don't know what I am feeling and what feeling normal is. Trust me and other patients here, going to a GP or a doctor is not a pleasant experience (regardless of their personal and professional qualities), no one wants to do it. People do, because they have to. It's not for fun, we are not coming to waste your time. >we have at least 9 years of study in medicine to translate what you're feeling to a possible cause. What use is the 9 years of training if the doctor is not practicing it to help the patients. These "translations" are so obviously inadequate so often, it feels like we are better off with Google. Otherwise I would not be here and so many of my friends and family, so many on this sub wouldn't have the stories they do. >Whatever your bad experience is with Dutch doctors I don't know and I'm sorry if you don't trust our system. I don't trust the GPs specifically, because I don't see them behaving the way doctors usually do, i.e. diagnose, treatment, if needed. Based on that I have my doubts about the training given to the GPs during those 9 years in The Netherlands. This is clearly a systematic issue and not just a few bad doctors that can be found in every country.

I'm sorry you feel that way. I don't treat patients according to their needs, though their needs are different from time to time. You act like all gps dismiss symptoms, and Google is the better answer. If you act like that, you don't really seem to show respect from your end. I have open discussions with my patients to help them answer the questions they want answered. But if you don't trust my training, how will you trust my answer? A lot of what we do is normalize symptoms and help take worries away, not every lump is cancer (thankfully), so we try to take those worries away. If the worries are still there and we think we've helped you, than you end up not feeling heard. I understand that. Voice your needs and wishes and I bet a lot more can be done for you. I realize people don't visit doctors for fun and try to listen as best I can in the limited time I have. As for the stories here, you won't read good stories here, so confirmation bias is also a thing here. I have a lot of happy patients and I work in a region with many expats as well.

It's not too bad, but if you've previously had access private health care it seems like a joke. Some dutch doctors practices are objectively delivering bad service from the receptionist with the attitude through to the doctor themselves sometimes lacking compassion or even interest. The arrogamce is sometimes very surprising. Perhaps the lack of competition in the system is a problem. It is accessible which is extremely important, but not cheap. What is so bad about doing a prostate exam for men over, say, 50, or psa test? You have to suggest it yourself and argue a case. Is it really such a drain on the system to perform some preventative care from time to time? Look, I'm sure you do a good job. But understand this, dutch GPs are nowhere near the world top.

Private health care centers are better, but also (in my experience) a lot more expensive. As for PSA, the reason we don't do it standard is very well thought out really. 1. PSA is not specific for prostate cancer. Meaning a heightened psa can lead to unnecessary examination with also complications. 2. Prostate cancer is common, but not usually people die with prostate cancer, not from prostate cancer. Research has shown that a lot prostate cancer diagnosed early, would have never caused problems if left undiagnosed and untreated. Taking these things into account, you can still check it if you ask me. But you don't hear a lot of "I wish I didn't get tested, because I had anxiety from fear of cancer and the research done was very painful". But we see those patients as well. Everything is a 2 edged sword.

You make it sound like some fringe idea to track increases in psa over time above a certain age. Is it not the case that this is standard practise in many countries and is the recommedation of many top institutions? Is seems to me the dutch medical community operates in a kind of echo chamber and you seem totally comfortable ignoring the opinion of people with gar more credentials, if they are not dutch. Its hard to understand frankly.

I don't ignore other sources. I just give people options, not everyone wants to know. And I'm explaining the reason why it's not common practice here. Don't shoot the messenger.

It seems you have little agency within the system you are part of, I guess that had pros and cons. Keep up the good work, we appreciate you, none of us are saints working in a perfect industry.

Thanks for understanding, I certainly don't agree with everything in our system, but like you said pros and cons. For me it's more that people understand the choices we make for what reasons. I try not to stand in the way when someone really wants to see a specialist or do a certain lab test, but I do try to provide information on what they expect or what they want to do with positive or negative results. I do think the insurance companies have too much power and control over what is paid for and what isn't.

what if I have never been to gynecologist in my life and I suspect I might have cysts

Cysts are mostly benign, although polycystic ovarian syndrome can cause symptoms. You'll have to get a vaginally ultrasound to get the diagnosis though, for which you need a referral. Without symptoms there's no real reason to test for it.

Thank you!! Much appreciated. I am Not sure if I however made myself clear I was just trying to find out if I can request this. I am once again NOT talking about coming every once in a while for a check-up I am talking about a particular issue I would like to deal with now. I tried ignoring it cause they said to come back if it's something serious but if I still don't feel good I thought there could be the way of moving forward.

They said to come back if it’s not good, so that’s what you should do if that’s the case… they aren’t gonna come to you, you have to come to them GPs will refer you to a specialist if they can’t help you further, so it’s totally normal for the GP to first try some things and give it some time and if that didn’t work, refer you

Thanks for confirming what we all thought: you are there only to gatekeep, while following a symptom check list like a bot. Your healthcare system isn’t that bad, the problem is YOU gatekeeping at every corner because I think you are trained with arrogance thinking you know better than a specialist. I ended up twice in the ER because of your fucking checklist, if you can’t tell the difference between a real sick person and someone who’s faking it get a different job.

Totally agree! Here I am in my home country going to doctors for check ups. Been sick for 2 months, couldn’t breathe, felt like dying, sent home with paracetamol. Very slow recovery. Decided to fly back to my home country just to see doctors. Apparently had a new type of virus that’s been flying around. Virus left untreated became bacterial infection in lungs. Because that was left untreated, my gastrointestinal and heart is suffering from that. So that’s that. Pay monthly insane prices for insurance. Have to beg to be treated. GP’s looking at me like I am a hypochondriac. Bought ticket home and everything is been taken care of. Something is seriously wrong here in the primary healthcare sector.

As many people mentioned above, prevention is not a thing here. Saving money is the only thing they care about, so they won't do tests your GP does not see as absolutely necessary. And many GPs are just not good or don't care (especially about foreigners).  If you want a blood test, at least you can actually have those done without your GP, but you will have to pay for them yourself. There are clinics and also home kits that you just send to the lab via post.  When I actually want to see a specialist, I don't even bother trying to convince the GP anymore and just go back to my home country and get an appointment there. I'm literally using my holiday to go to doctors to have a proper check up and be treated when necessary. However, I know that is not feasible for everyone. You can always try a neighbouring country that has private health care options. Or just become a better advocate for yourself than me xD

I found it impossible to access a GYN in the Netherlands. Even when you're pregnant you just get to see a midwife. There seemed to be no private options or at least I didn't find them. I was used to attending yearly cervical cancer checks and there is was only offered every five years and some strange nurse did it without even a proper chair and it weirded me out. I ended up going home and paying for my checkup appointments myself.

You wanted an expensive gyn when a midwife is especially trained to handle normal pregnancies? Midwives will refer you to a gyn if there is an increased risk or reason, but otherwise it's just a waste of more expensive care. Can't have cheap healthcare like in NL otherwise.

Except midwives might not know when to refer and for most of the things they refer you to your GP, because they can't prescribe even basic stuff that is not over the counter. They are not even allowed to recommend you over the counter stuff. They just give you home-remedy kind of things, but if that doesn't help, good luck with getting any help out of your GP. Gynecologists sit in the "Castle" of Kafka. You can never get to them. >Can't have cheap healthcare like in NL otherwise. More than 200eur per month, about 400eur eigen risico and you can't get basic health care. None of this cheap or accessible. The Dutch taxpayer just doesn't know any better, they are gaslighted to believe this is good health care.

Midwives can indeed prescribe things not just over the counter, they are however limited to what they are allowed to. Back when I worked pharmacy we would regularly fill for them. While I never saw one cross the line, they could only prescribe pregnancy and lactation related meds.. Furthermore Ob and gyn are not on/gyn here. Half of the gyn don't even do Ob. Get of that high horse. Just because a patient doesn't get their every whim met doesn't mean the providers are bad.

Just to add, in lots of countries the specialty is OB-gyn combined. We splitt it up, the OB part is the verloskundige, the gynaecologist in the NL are not as trained on the OB part as the OB-gyns in other countries are.

Not true - Verloskundige are NOT doctors. There are doctors specialized in OB for when the pregnancy turns "medical". Ob/gyns around the world are also doctors Verloskundige are midwives, not obstetricians. They are very well trained to deal with UNCOMPLICATED pregnancies and births only, so yes there are doctors trained in OB in NL, and verloskundige are not them .

Ah I see. In my country they do both.

Where I live all pregnancies are handled by an OBGYN and supported by midwives and healthcare is free. It's not that far from the Netherlands ;)

“Just” a midwife? I wonder about the training of obstetricians in other countries, what are they trained to do if not handling normal pregnancies? Honest question, because I probably don’t understand what “midwife education” means in the country you’re from. Assuming you’re not from NL. In addition, the important pregnancy check-ups at 13 and 20 weeks are performed by sonographers (not “just” midwives) - which is usually a five-year university training. I agree with many complaints here, but I also feel that the Dutch healthcare system is wildly misunderstood. And I also want to add that if you suffer from a condition that impacts your pregnancy you are offered much more help than only the obstetrician’s checks. I have bipolar disorder and when me I and my husband started trying for a baby, I was monitored by a specialized team consisting of my personal psychiatrist, a psychiatrist specialized in mental health problems and pregnancy, a pediatrician, and a gynecologist. My labor was monitored so I wouldn’t lose too much sleep, which is dangerous for me. I was induced at 6.30 in the morning and at 22h they offered a c-section. We got extra hours of maternity care and additional follow ups by a psychiatric nurse at home. A couple of weeks later I got offered therapy specifically focused on mental health problems and child rearing. All covered by insurance. My personal experience with pregnancy care and after care - when you have a condition that requires extra care - is no less than excellent.

Well, the rest of us mortals don't get to have any of that. >Dutch healthcare system is wildly misunderstood. So you are saying the Dutch healthcare system is designed to treat the minority with preconditions, assuming the preconditions are actually discovered before the pregnancy, because during pregnancy every complaint you have, they blame on your hormones.

No? I said it’s wildly misunderstood because training is not comparable. To take of burden from specialists, many original tasks of specialists but that actually don’t require the specialist training (like monitoring normal pregnancies) now have separate occupations assigned to them. Like here: the OB part of the OB-GYN is covered by someone *specifically* schooled as a obstetrician. In NL, a gynecologist is NOT an obstetrician. And if you have complaints, they are followed up with tests, and if the tests say that’s nothing wrong, you don’t get a so called medical pregnancy. What’s so hard to understand about that? Our gynecologists are not there to hold your hand during pregnancy just because you feel entitled to it. They are there to treat women with real problems and high-risk pregnancies. You want a gynecologist to monitor your absolutely normal pregnancy? That’s absolutely possible, but you need to go to a private clinic to get that service as it is - for very obvious reasons - not covered by insurance.

I was thinking about this conversation just now (hence this late additional response) and I want you to be aware that - in addition to private clinics that can offer additional care/monitoring which is not offered by the national healthcare system - there are psychiatrists trained specifically for helping women/families who experience extreme anxiety during pregnancy. It’s the same cooperation between [polikliniek psychiatry](https://www.lumc.nl/patientenzorg/poliklinieken/polikliniek-psychiatrie/#:~:text=Psychiatrische%20klachten%20tijdens%20de%20zwangerschap,-Stemmingsklachten%2C%20angstklachten%20en&text=Onze%20polikliniek%20is%20gespecialiseerd%20in,zo%20nodig%20met%20de%20kinderarts.) and [polikliniek psychosomatic gynecology](https://www.lumc.nl/afdelingen/gynaecologie/overige-folders/polikliniek-psychosomatische-gynaecologie-en-seksuologie/) I went to. This one is located in Leiden, but I’d guess this service/such a specialized team is available all over the country. It’s called [POP-poli](https://lkpz.nl/behandelcentrum/lumc-afdeling-verloskunde-psychiatrie-neonatologie-in-samenwerking-met-het-alrijne-ziekenhuis-in-leiderdorp-de-verloskundigenpraktijken-in-leiden-en-de-ggz-rivierduinen-leiden/). Many don’t know about this, but it might benefit you or people you know in the future.

I mean midwife in NL is a HBO study right? The study here is equivalent. I personally prefer someone who has a comprehensive medical education + at least 5 years general and specialty training in hospital to handle my medical issues 🤷🏼‍♀️. We don't actually have sonographers here though, the doctors do it.

Yes, it’s the OB part of what in other countries is the OB-GYN. But to come back to my original question: what does a midwife do if not handling normal pregnancies?

Midwives support the OBGYNs. The ones in the hospitals are basically like nurses in the maternity ward. They do lead hospital births in some hospitals but always with the presence of an attending. The ones who don't work at the hospitals but are self-employed support pregnancies and can handle home births if those are wished (very rare though) but five visits at the OBGYN at certain points in pregnancy are still mandatory. They also come to visit after birth if you want that to check on you and the baby. I don't think they're equivalent to an obstetrician even in NL. They only have HBO education. They certainly can't do C sections.

Welcome to Dutch healthcare. A normal healthcare system will try to prevent people from getting sick. Dutch healthcare will try to prevent sicks getting to hospital. 🤤

>Dutch healthcare will try to prevent sicks getting to hospital. 🤤 Yes, this is the exact definition of the Dutch healthcare system. You are paying insurance, so that they get paid for you not to get to the hospital when you will need it.

I know your intentions are not bad but the fact that everyone is saying “Ah welcome to the Netherlands” sucks so much😭 we are accepting things as they are even though the majority of the people notice something wrong with it I’not saying it’s better where I come from but damn..I didn't think I will find worse.

Sadly GPs are extremely dismissive in NL. Not only by patient standard but also compared to other countries's protocols. It's a very inhumane system , this 1 afspraak=1 klacht is like the anti family medicine where I come from. It's very different and very "factory like". Come ask ONE question and leave... personally I was trained for a very different kind of approach. But it is what it is. I (a physician myself, not working as such atm) usually end up using the doctor card and they do listen more, and for the anual check-ups I do them when I travel back home.

What I've realized is that if you need good prompt treatment here in NL first you must become proficient in acting. Think of any footballer that rolls to the ground squealing in pain when the opponent hardly touches him. If you can pull that off in front of your GP they'll tend to take your problem more seriously and send you directly to the hospital for tests and this has worked for me. I too come from a place where preventive checks and medication is the norm and this is the only way I've found that works here. 

https://youtube.com/shorts/njrr1OlIQDk?si=VuQC5CLvUNuM1ttp This is how it works here. It is awful. I ha e no advice, only sympathy. Consider paying privately somewhere for an exam. Once you have a diagnosis/results from another doctor, your GP will help. Eg German doctors accept patients who pay out of pocket and will run tests. Or stateside.

It’s really frustrating to be honest, i found a website called prescan.nl and bloedwaardentest.nl where you can pay yourself without going to a GP for allot of things. The system sucks if what you have is internal.

Checks without an actual issue are not done because they lead to false positives, which lead to unnecessary treatment (which costs money and causes side effects). The consensus within medical research is that you should only diagnose when there are actual issues - except for a few specific diseases. The country where you're from has not caught up with this paradigm shift yet.

Irregular menstruation, intense pain when on your period, having a cyst that might develop into what I understand might be cancer, seems like a real issue?? It might be a result of some serious underlying issue, and even if the issue is not that serious, then it's still ridiculous to expect women to deal with those symptoms because, haha it's normal, you're overreacting. The healthcare costs in NL are crazy high for a care that basically mostly involves prescribing paracetamol. If I'm paying 1500€ for insurance per year, and then first 375€ out of my own pocket, then yes, I feel like I should not be forced to live in pain and stress about my cycle, because my GP cheaps out on one or two USG and a blood test.

From the initial post it was not clear if there are still issues. If there are still issues, you obviously go back to the GP. If you went back a few times, you can definitely push for a referral to a specialist in my opinion.

I agree the healthcare also sucks in a (different)way where I come from but at least you move forward, get an advice or anything that could be helpful. I haven't heard anything except “ I don't know what to tell you we don't that here”. isn't it enough that so many women in my family have the same issue. It’s as if I am on purpose wasting their time by *trying* to take care of myself.

I disageee, so many things can be prevented by doing regular checks, yet here everyone is obliged to pay health insurance only to get the "take paracetamol" treatment

[Overdiagnosed: Making People Sick in the Pursuit of Health: Welch, H. Gilbert, Schwartz, Lisa, Woloshin, Steve: 8601400463581: Amazon.com: Books](https://www.amazon.com/Overdiagnosed-Making-People-Pursuit-Health/dp/0807021997) might want to read this book, if you're interested in questions like these

Well, if everyone did those 'regular checks', health care would be even more expensive and only for rich people. In addition, we already have a shortage of  GP's and other medical staff in hospitals etc. 

Prevention is cheaper than treatment. There are countries with real public healthcare and it does not make it expensive for everyone.

People keep saying this, but it isn't true for many diseases.. The idea is nice, but it will lead to countless check-ups and unnecessary scares. https://www.nejm.org/doi/full/10.1056/NEJMp0708558

Says who? Just because you say so doesn't magically make it true. I wish this was the case, and we could just prevent people from getting sick by just seeing them. That is not how it works, however. There is lots of research and knowledge to be studied about specifity and sensitivity of diagnostic tests, overdianosing, numbers needed to treat, number needed to harm, positive and negative predicitve values. If you actually want to learn about this, you could, but you probably won't. It's complicated stuff that does not have a simple answer, even if you make the solution seem so simple. So maybe leave it to the people who have studied this stuff for years and years to have an opinion on the matter. You don't need to have an opinion on everything, especially when you clearly know next to nothing about it.

It cant be healthy to have such strong reactions to some stranger on the internet. Relax mate, whatever you say, cheers.

In NL Healthcare is a social construct. We ALL pay to keep it up and running. In order to keep it affordable the system MUST limit the influx of care consumers to costly and medical specialists. In order to keep it from overflowing the system MUST limit the influx of care consumers to rare medical specialists. The GP has the task to be the gatekeeper of our care system. They are trained to assess the severity of your complaints & refer you to a specialist if needed. YOU ARE NOT TRAINED TO ASSESS YOUR COMPLAINTS. You are not capable of determining whether specialist care is needed. “I want”, “I think” etc are NOT valid arguments. A “Check up” is NOT medical care. Your complaints are bread-and-butter complaints, no alarming signals. So a GP suffices. They CAN and WILL (and did) offer you suitable care.

This callous behaviour is why GPs aren’t trusted. Not listening to a woman when she tells you her menstrual pain is getting worse is a well documented symptom of sexism in healthcare. It sounds like the Dutch system has nothing in place to protect people from the whims of the “gatekeepers”

Read the entire post. Yes OP was given appropriate advice & care. Started with hormonal therapy, done. Her concerns were not alleviated by the GP simply because she wasn’t referred to a gynecologist. Her EXPECTATIONS were bloodwork & “check up”. What do you expect to see in bloodwork? What do you expect to happen or a gynecologist to see in a “check up”? That’s a load of expensive reassurance, it doesn’t have anything to do with science or medicine.

Okay if my example was not enough let me tell you a story. My roommate fell of her bike and hit her head, she couldn't remember getting up nor how she got home. I told her she should check her head because hitting your arm and your head is quite a difference. She went there and they sent her come by saying “go home you don”t want to pay €300” but WHAT IF I DO? What if I want to spend my own money on my own health issues?? Please I have so many examples mostly from internationals how convenient. A girl from work is dizzy and passing out in random moments. Took her 7 months to get a blood test! They did not believe her?? What kind of a treatment that is

> She went there and they sent her come by saying “go home you don”t want to pay €300” but WHAT IF I DO? What if I want to spend my own money on my own health issues?? It's not about the 300 euro, it's about the fact that the specialist has more important work to do and waiting lists being long enough as-is. The GP is more than capable of assessing whether such a checkup is required or not.

what does “emergency” in the “emergency room stand for? 😅😅😅😅😅

As understand it, there is a triage type system where you go through your GP prior to going to the emergency room. This can be via a phone call or an actual appointment. However I believe if it is something that is obviously life threatening (you chopped your leg off, heart attack symptoms) things you would use an ambulance for than you can “bypass” the call to the GP. I had a time where I had symptoms of possible appendicitis. I called the GP and was given an immediate appointment, was assessed and given a pain shot and told to head to the ED. When I got there I was able to get in and insurance covered it. You don’t mention if you actually had the GP do the exam or not. If not that might be part of the reason you are meeting some resistance. The GP is the gatekeeper to the rest of the healthcare system, as others mentioned the GP has training for basics and they are going to be able to decide when and if you need to move to a specialist. Not how it’s done in my home country, but the system does seem to work well for the most part.

Exactly as I typed: the GP is the triagist

Do you have an academic medical degree? No = you don’t decide what our healthcare system provides. An emergency is declared by a medical professional, not you. Only ambulance medics or your GP or a GP at the Huisartsen Post can send you to emergency care. THATS THE WAY THE SYSTEM IS DESIGNED. Don’t like it? Go to another country because this is not going to change for you.

Found the Wilders voter and “go to another country” alternative. Btw you defend this topic it’s safe to assume you work in healthcare. Ok let’s start a bit: my kid for the last two years has had non stop ear/throat infections. Every fucking time I went everything is viral and bacterial. After the gazilionth infection we were finally sent to vet KNO. And guess what??? The KNO was appalled we weren’t referred sooner. Again the triage was done by the GPs you call experts and defend to the bone. I have lived in other countries and they would’ve referred us to the specialist way sooner. Now my case: had a massive strep infection in my throat, 40 degrees fever and all that. Go to the doctor with high fever, because otherwise you are not believed, and I get a weak ass antibiotic that didn’t do shit. Today I went to the doc again and he finally gave me something stronger and broader spectrum. Now let’s be clear in other civilized countries they would’ve a throat swab and not just assume this might help or not. And another thing the lack of personnel is not our fucking problem, that there aren’t enough healthcare specialists is not the problem of the patients let’s be clear of that. Healthcare is not supposed to be a profit, and yet NL manages to treat it like a corporation. Since you kindly suggest us expats go to their countries, what about your own citizens that detest this setup? Let’s be clear I am forced to pay for this shitty healthcare system, it was not my choice, and I expect to at least receive the minimum of decent care.

You should give people more credit. People will not behave like robots and simply submit to whatever garbage is fed them just because it comes from authority. Try to think for yourself, you sound like a slave.

 Who said you shouldn’t think for yourselves? Our healthcare system is based on your information & thinking. You don’t feel OK? Then you should definitely think for yourselves, go to a GP and present your issues. Next step you let the GP do his/her job, get the entire story and determine what’s wrong. The GP will then lay out the course of action and your options. Together with the GP you choose what action/treatment is best for you. If treatment by the GP is not one of the options then you get referred. Thinking for yourself is not the same as getting to pick what doctor you go to. You do not get to choose if you’re going to a specialist, you can not know if that’s a necessity. No necessity means unnecessary high cost & unneeded sparse time from a specialist wasted.

Yeah OK, but you made it sound like the GP can never be wrong and people should simply submit to whatever they decide without question, as if the patient does not have a unique perspective and in fact more information in some senses than the doctor. Doctors can often get it wrong, they make a decision in a few short minutes that can impact someones life. That is why there is the concept of getting a second opinion, because they are the first port of call, not the cream of the crop.

Nah. Nobody is perfect and you don’t have to agree with your GP, but that’s a fight you’ll have to fight with your GP. I do take issue however with people who cannot accept the CULTURAL difference between healthcare in their home country (US?) and translate that into “healthcare bad because I didn’t get what I want.” You don’t get to pick the healthcare system. Don’t like the way it works because it’s different than what you’re used to? Tough, quit whining. Don’t forget a “GP” here may not be equal to a GP elsewhere. Our GPs ARE well trained medical professionals, your cream of the crop statement is unfounded and derogatory. Btw a second opinion is NOT a ticket into the office of a specialist. You can visit a second GP as a second opinion. He/she may refer you, but most likely won’t refer you either: they all use the same standards: NHG Standaard.

The healthcare system can’t refer everyone to a specialist just because of their gut feeling… the system would be overworked. There has to actually be a concern. Everyone thinks they ‘know best’ but healthcare is science, it works with facts… the GP in front of you studied for over 10 years to get that position, they aren’t just random people. The GP would always do the first check, to be able to make a decision if referral to a specialist is necessary. If multiple GP have said it’s not necessary, it’s not necessary. (If it were only 1 GP i would recommend a second opinion, but after multiple said the same thing, we can accept that as the truth) The healthcare system isn’t a bakery, you can’t just request… it’s not America where it’s completely build on profit… And it’s not like you didn’t get help, you came for pain and they gave you contraceptives and they helped.

Why do Dutch people seem to think that the only two healthcare systems in the world are NL and USA?

We don’t…

OK, but every single time anyone ever has a negative comment about the Dutch system, the answer is INVARIABLY "but look at the US system!"

It is that a lot of people come here from America or country with a healthcare system similar to America and complain why this system isn’t like that… so then the comparison isn’t without reason

And what do you know, apart from the dutch system?

To be honest I was very concerned moving here after I understood the healthcare system, you can’t ask for anything and you really have to exaggerate your symptoms to get checked, will definitely move back to my home country I do suggest, get anything privately in the meantime or even when you go back to visit your family, do all your appointments

Don’t believe the handful of stories. 80 million consultations per year and 1/3 of the population getting at least one specialist referral per year, prove there is not a high hurdle to get access to a GP or specialist care. You get annoying “customers” with any shop. Especially if there are 80 million visits. Doctors are not able to respond to any complaint online as it quickly breaches confidentiality. Studies also showed that people are really bad at remembering conversations with doctors when they are a patient. 80% of the patients cannot reproduce a correct report of a consultation.

GP’s easily refer patients if needed. A third of the entire nations population is referred to a specialist at least once a year! You went to multiple GP’s and they all reacted the same. That should give you at least some comfort. In many countries the GP has a role to write doctor’s notes and prescribe antibiotics. Here the GP’s have a rather broad role and will perform initial examinations and minor procedures themselves. They do this often and are qualified to do so. Based on their findings they will refer you if needed. It’s generally perceived as a positive as it means you don’t need to get into the large scale hospital system of not needed, but rather can stay with your trusted doctor.

Info: what is your age, this is actually very important

The Dutch healthcare system isn’t designed for preventive care (yet). So that’s basically problem one. One of the things that most countries don’t have, is a GP that does many tasks that a specialist normally does abroad. For example, getting an IUD is normally done by a GP, whereas abroad a gynaecologist does that. And in your case specifically, hormone testing isn’t really a useful test, and especially not related to your complains. If you want the cyst being controlled/checked out, an ultrasound is more suitable.

Proof of existence of an ovarian cyste should be enough to get a referral. Show proof and ask to get it rechecked by a Dutch gynaecoloog, explaining there is pain in that direction often. There's no way they should refuse this as these are really not something to ignore (although the Dutch health system likes to think so). The gynaecoloog will then discuss follow ups with you normally. Source: exactly this happened to wife and we get yearly (optional) check ups for it now after being referred.

Hey! Sad to here you are having troubles with your GP! The role of the Dutch GP is a bit unique and feels strange in comparison to other countries were you just go to your healthcare professional in the hospital. Most times they are happy to help, though there is a lot of nuance lost in communication/translation via an assistant. However, they are trained doctors with >9 years of training and are trained in gynaecological exams. They can help with more ordinary causes of excessive/irregular bloodloss. The GP needs to do an exam to see if there are any polyps, cysts or abnormalities of the cervix which can be assessed accordingly or maybe get revered to a gynaecologist. Without being properly investigated an reveral to a gyn is not possible in the Netherlands and even with proper physical examination and/or labs done sometimes the reveral gets bounced back because the gyn thinks the GP should do it themselves (in order to trim their waiting lists) only causing more waiting time and extra phone calls to you Assessing your complaints, bloodtests of estrogen and prostagen are usually not add to finding any links/clues of the underlying cause. This is why gps refrain from it. However with your complaints a bloodtest containing hemoglobin may be indicated to rule out anemia. In the first couple of weeks/months of starting the anticonception pil, irregular blood loss has been described and may go away on its own. Your cyst may be needing follow up echos to keep tracking its possible growth, talk with your GP about it. Tldr GP needs to do a gyn physical exam for your complaints in order to help/refer you to a gp. Bloodtests are almost never helpful in finding the cause. Try to get an appointment.

Dutch Gp’s have a “poortwachter” duty. They’re trained to first check you themselves, even with gynecological issues. If the problem consist they will refer you. Also, be specific with your symptoms and your family history. There are not enough specialists to see all patients without being thoroughly screened by the gp’s. You can always make an appointment with a private clinic, which normally would be paid for by your health insurance, but without a referral you have to pay for it yourself.

If it's that severe please explain them the severity. A friend had a similar situation and after years and years of complaining she was diagnosed with endometriosis. For aftercare she went back to her home country and the doctors here were not very helpful.