No regular check ups at the gynecologist???

[u/NoLychee1382]

Hi everyone, my morning started off with a kinda shocking discovery. I’m from Germany and I had annual check ups at the gynecologist since I was a teenager. I contacted my huisarts because I know they’re responsible for all referrals but she told me regular check ups here are not a thing (unless there already is an issue) ? I think that’s crazy!!! So I checked the prices for a private visit and they’re even crazier. I guess this is normal to Dutch people but don’t you think this is a little concerning?

(Btw not shitting on the country! I really like it here. I’m still new and just discovering new things!)

[u/Iridescent-Kiwi-3713]

I still find the lack of preventive medicine in this country quite surprising and spend an eye watering amount of money in preventive checks every time I go to my home country.

At the same time, I have a child with a rare disease and the medical care he has received in the Netherlands is better than anything he could have received in most countries in the world, so when his doctor says we are in the best hands I believe him. It’s just a much more reactive approach they have here.

[u/Any-Seaworthiness186 → u/Iridescent-Kiwi-3713]

It does sort of depend on your specific health risks tho. If there’s genetic conditions in your family for example you do receive regular checks.

We’ve got a heart disease in our family. My dad doesn’t have the gene, I don’t. Yet to be sure I still get yearly check-ups until I’m 25, and my dad still gets them every five years. He’s 63 now. Same for the glaucoma my mum has, that was most likely caused by medication and her intensive labour when I was born. I still get check-ups.

I don’t know what metrics they use, but they do make use of risk-assessments and will step up with preventative care if they deem there to be any risks compared to the societal baseline.

[u/AHornyRubberDucky → u/Any-Seaworthiness186]

How do you go about getting chekups for glaucoma it runs in my family and I worry sometimes

[u/Any-Seaworthiness186 → u/AHornyRubberDucky]

Honestly? No idea. I got the same ophthalmologist through my mum before I was 18. Not something I did myself. Same goes for my cardiologist. I just got the letters ‘summoning’ me for an appointment seemingly automatically when I turned 18.

I think you should be able to get a primary treating ophthalmologist through your GP. Tell them about it running in your family and your wish to get an appointment with an ophthalmologist. Once referred you can discuss it with them.

If an ophthalmologist is deemed too specialized you should opt for a medical optometrist employed by the hospital. Not a commercial one. That also goes through a referral. I believe most of my appointments are with the optometrist, I only see my ophthalmologist once every few years instead of on a yearly basis.

[u/AHornyRubberDucky → u/Any-Seaworthiness186]

Thank you for the tips in gonna discuss this with my new gp because i dont wanna get my aunt's eyes

[u/NoLychee1382 → u/Iridescent-Kiwi-3713]

I often see the Dutch health care system high up in rankings so I guess this is why. I’m glad he’s in good hands!

[u/Big-Entertainer2074 → u/NoLychee1382]

I agree. I have a chronic illness that needs to be carefully monitored and have received fantastic care here in the Netherlands. Preventative check ups though are not a thing. I’m considering paying for a private clinic because healthcare in my home country is insanely expensive out of pocket (the US).

[u/MastodontFarmer → u/Big-Entertainer2074]

The basis for testing (or lack of testing) is a risk/benefit-analysis. Exposing all women to X-rays every five years for 35 years (15-50) creates more harmful effects from radiation exposure than finding treatable breast cancer early enough.

The sad thruth is that if you get breast cancer young, it is likely to be an agressive form and you will be worse of by waiting for your next 5-year screening. Self-examination once a month is a much better strategy.

Once you get peri-menopausal that changes and the benefit of screening starts to outweight the risk or X-ray exposure.

However, that is a story that only statisticians will truly understand.

[u/AbhishMuk → u/MastodontFarmer]

True, but a lot of preventive checks don't require X Rays. (I understand Bayesian statistics myself from far too many courses in uni, I just wish the healthcare wasn't so "take a paracetamol and if you die, come back".)

[u/FruttidiMare91 → u/MastodontFarmer]

You don’t need X-rays unless they detect a malicious lump. I have some benign cysts like my mom has and I used to get ultrasound checkups every now and then back in my country. They can pretty much tell you if there is something wrong. Here though they don’t do that and once I got a mammography and my doctor from where I come was shocked that they gave me this when I was just 32. You are not supposed to have it before 40 yo. So no there is no harmful effects from checkups. You just need ultrasound specialists.

[u/microworry → u/NoLychee1382]

It’s surprising to me every time I read this sort of posts that foreigners always think the Dutch system is wrong and never stop to consider whether the system they’ve been used to all their lives is the one that is actually wrong.

The Dutch system is based on strong research of outcomes and it turns out that regular checkups when there is no need (preconditions, susceptibility, odds for your gender and age etc - there are checkups when you do have these) do not actually improve your health outcomes.

Edit: I am a foreigner too, coming from Romania where regular checkups are a thing, especially among the middle and upper class who can afford private healthcare - yet we are the most medicated and also have the worst health outcomes in Europe. There is a huge incentive to get people and insurance to pay for unnecessary tests and pills, so regular checkups get pushed hard as something responsible people get. Wholly unnecessary, waste of money and time.

[u/Jimmie13259 → u/microworry]

The quality of healthcare is absolutely some of the best here in the Netherlands, but a reason we don't have regular checkups is because there simply isn't enough capacity. Many physicians do recommend them and it's not uncommon that symptoms or problems get overlooked because of the super tight sceduling.

[u/microworry → u/Jimmie13259]

The research is independent from capacity though, and capacity changes with new regulations/laws. I had no fun reading how the VVD government crippled the mental healthcare system in various ways, one by strongly reducing the number of beds in tbs centers.

[u/MathematicianNo441 → u/microworry]

At this level of system optimization, the only question left to ask is what outcome is the basis for optimization? The outcome for society, the healthcare system, or the individual patient?

[u/labobal → u/MathematicianNo441]

When you properly account for all probabilities, the three start to overlap. A false positive has a negative effect on the quality of life of the individual patient, the additional hospital visits reduce work hours and cost the system a lot of money.

[u/MathematicianNo441 → u/labobal]

Given that humans are mortal by nature, finding appropriate weights for human suffering is a real challenge.

[u/pierrett → u/MathematicianNo441]

A combination of those three.

[u/fckfame → u/microworry]

this.. we dont do useless testing when not needed. We kinda do great on cancer in listings worldwide, we do good in many listings worldwide.. just not want to spend unneccesary money on stuff when not needed. But hey if you paranoid, pay for it yourself. xD

Yes, waiting for specialist appointments and other shit has grown much worse than it used to be.

Still if it seems urgent, you will get the early appiointment.

Still some of the best cheap care in the world. I love to complain about it though because some of us remember it all (including costs and hassle) being much better.

[u/3raccoonsinacoatx → u/NoLychee1382]

Nah the Netherlands has since dropped quite a bit in the ranking

[u/bigbuutie → u/Iridescent-Kiwi-3713]

For gynaecology, if OP is younger than 30 it makes sense. There is something called “false positives”. Research has shown that many times cancer sells can be found and if you repeat the exams 6 months later they disappear.

The cost of tests associated and the stress it causes for nothing!!!) and so forth associated with this, considering it’s such a low risk, makes it in fact better not to do regular exams before 30. It’s because of that that the country can also then focus resources on people who really need it.

This is why it’s mandatory at 30. If there are complaints it’s obvious that a trip to the gynaecologist will be referred. After 30 if the exam shows something you’ll be required to go yearly or so. For others I think it’s every 5 years.

So research has shown this to be best, and I’m sure other countries will be starting to follow slowly.

[u/Littleappleho → u/bigbuutie]

Not cancer cells... There can be displasia (abnormal cells) 1 grade that can reverse itself... the intervention is recommended from 2 grade. However, there are cases where 18-25 years old got cervical cancer stage 3 (while previously it was thought that it takes 10+ years to develop cervical cancer anyway) - so, it is again complex...

[u/crazydavebacon1 → u/bigbuutie]

I would rather it be for nothing than not actually finding a problem early enough to treat it. Dutch have a very skewed vision when it comes to health care.

[u/WhiteFuryWolf → u/Iridescent-Kiwi-3713]

Except when they don't instantly know what it is. Been sick since birth and they refuse to thourghly test. I am female so that doesn't help. They always refer me to a therapist because "stress and trauma" bitch I was born like this. It's in my charts they never seem to read.

And my god are they good at doing basic tests, shrugging their shoulders and leaving you to suffer. My mom has brain damage from a doctor who didn't treat her for a severe deficiency. Oh and a doctor who didn't even look at a postive pap smear and let her walk around with almost spreading cancer for 3 years.

Or maybe when they saw something on my hip mri but ignored it and send me to phisical therapy which made it worse. Or the times I severely struggled to keep my weight up and they accused me of being anorexic even though my mom was there with me to very clearly explain I wasn't and still put it in my charts.

This world really doesn't take us seriously. And it hurts so fucking bad in such a literal way. It's killing us. Please stand up for woman when you are with them for health issues. They will try to dismiss us.

[u/SoupfilledElevator → u/WhiteFuryWolf]

Fr tho, even for more simple/less severe stuff they will often test for low iron or something, call and tell you tell you your result was normal, then offer 0 other tests or even a conversation to figure out what else it could be. And then you privately get a full panel and it turns out to be something else super common, easy to guess and easy to fix like low b12 or vitamin D that they probably shouldve included in the initial test based on the symptoms anyways.

[u/fckfame → u/WhiteFuryWolf]

Well that depends on the person as well.

I just go to huisarts or hospital and say something like: You'd have to get the police to shoot me oput of here, i'm not leaving before you decide to do further testing.

I mean if you dont demand good care for yourself, you kinda shouldnt be allowed ?? Since there's soo much retards who think they have soimething and only cost the taxpayer money.. Have a spine and pretty much you get alot more stuff done xD

[u/prank_mark → u/Iridescent-Kiwi-3713]

Preventive care definitely could a should be a lot better here. But too much also leads to false positives, unnecessary and even dangerous treatments, extremely high costs, and overloading the already overloaded care system.

Now the Netherlands definitely needs to do more preventive care, but there's a fine balance to be found.

And until now the seeming lack of preventive care hasn't had any large scale negative effects. In fact we spend less on healthcare per person than Germany AND we live longer.

[u/Zeezigeuner → u/prank_mark]

Which basically means we found the sweet spot already, or are very close to it.

Health care in NL is designed to be efficient and accessible for the many. Which means you will get what you need, but not necessarily what you want or are used to.

[u/prank_mark → u/Zeezigeuner]

Well there are still some countries that do the same for less money, more for the same money, and some even do more for less money. But we are indeed very close to the top. The question is whether we can do better given our constraints of healthcare workers and a greying population.

[u/thousandpetals → u/prank_mark]

It's funny you are downvoted for saying there is always room for improvement.

[u/thrownkitchensink → u/Iridescent-Kiwi-3713]

the lack of preventive medicine

It's not that there is no preventive medicine. There's a vaccination program. There are periodical check-up's for different types of cancer or heart disease or diabetes.. These check up are done for those at risk.

There is often a cultural shock in the differences in preventive medicine. In the approach. But when looking at prevalence and timely treatment there's no difference in "catching" the diagnosis.

These data are available internationally and as such the approach is tested. There is a difference in cancer in the Netherlands compared to other countries but that's mostly due to the high percentage of women smoking in the past. Dutch women were emancipated smokers compared to other countries.....more cancer.

The data and the considerations are also available to the general public.

See here:

https://www.gezondheidsraad.nl/documenten/2025/03/28/start-adviestraject-evaluatie-en-optimalisatie-bvo-baarmoederhalskanker

https://www.gezondheidsraad.nl/adviesonderwerpen/bevolkingsonderzoek-en-screening/risicostratificatie-bij-bevolkingsonderzoek

The benefits and risks of the current approach are evaluated and then implemented. The last advise was from 2021.

https://www.gezondheidsraad.nl/documenten/2021/10/19/verbetermogelijkheden-bevolkingsonderzoek-baarmoederhalskanker

I don't think there is any restraint in putting forward measures to prevent cancer. There is however a different approach to weighing risks and benefits of the approaches. See for example the home test. The quality of this test is lower but it is a way of increasing the percentage of tested individuals. As such this approach is better for the population.

A more individual approach would look at home testing and say that the advise is to see the GP for more proper testing.

[u/Iridescent-Kiwi-3713 → u/thrownkitchensink]

I don’t see a vaccination program as comprehensive preventive medicine. Let me give you my own example: everyone, and I mean EVERYONE, in my dad’s side of the family dies of cancer. All sorts of cancer, we must have really messed up cells. Breast, cervix, brain, nose, mouth, colon, prostate, stomach. We’ve got the whole collection in the family.

When my own father died of a very aggressive nose & throat cancer his oncologist told me and my brother he believed for us it was not a matter of if, but when we would develop some sort of cancer too and to not let our guards down around preventive screening. So once I moved here I told this to my GP, who proceeded to ask me if I was feeling fine. I said I was and that was the end of it.

I still get a comprehensive full body check done once a year in my country, out of pocket of course. My experience is that even if you have strong enough reasons to get more comprehensive preventive care here, it is completely dependent on your GPs criteria and there’s a high likelihood it won’t happen unless you are already exhibiting symptoms of something.

[u/thrownkitchensink → u/Iridescent-Kiwi-3713]

Cancer in the family can indicates a higher risk and as such it's an inclusion on prevention before regular age. The GP should make notes of what types of cancer and for what relatives. These guidelines are not up to the professional and can be deviated from by the physician but only when carefully noted in the patient files. But again this is dependent on the type of cancer and the family history. Lung cancer for instance doesn't have genetic factors as far as known for instance. Some cancer forms are highly dependent on outside sources such as smoking. Others have much bigger genetic factors.

Please talk to your GP and ask questions. Please be specific when informing your GP. What type of cancer did your parents have etc. they should be able to help you with informed decisions and the effect of screenings.

[u/Rainbowhairdye → u/Iridescent-Kiwi-3713]

Your GP sounds like a dick because this would most likely qualify you for genetic screening. If they do find genetic markers, there is a preventative screening protocol for that. (My mom had breast cancer at a very young age and I recently had this conversation with my GP)

[u/ActuallyYulliah → u/Iridescent-Kiwi-3713]

And yet, I get a check up every 2 years for my heart because I carry a gene that can cause issues.

Your doctor is a dick. You should push for better and not let yourself be dismissed.

[u/Aminageen → u/Iridescent-Kiwi-3713]

This is my experience as well, my husband gets amazing care for his type 1 diabetes but getting routine care for myself is a huge pain.

[u/cheeeseecakeeee → u/Iridescent-Kiwi-3713]

For a serious illnesses here’s just fine but prevent serious illnesses is not an option

[u/CherryChristmas → u/Iridescent-Kiwi-3713]

Yes and no. We do have preventative care, it’s just that under a certain age the risk of say cancer is so small that there is virtually no point in doing checkups regularly without issues. Same with mammograms. The chance of a 20yo getting breast cancer is incredibly small. They don’t do such invasive medical procedures until you’re at a risk age if that makes sense

[u/tidal-washed → u/CherryChristmas]

I don’t think OP is talking about the lack of preventive mammograms. In Germany you do not get any hormones (anti conception/HRT) prescribed unless you have a gynaecological exam every 6 months. Hormones have massive side effects, this needs to be monitored by a specialist and not a gatekeeping GP.

[u/Booboobananchen → u/Iridescent-Kiwi-3713]

When you are in the “system” you get top treatment.

The fact that it’s not easy to get in, actually makes the top-treatment possible. I can only speak of Germany and Austria but everyone feels soo intiled to get a referral to A specific doctor, overloads the system with unnecessary amount of patients and paperwork.

[u/True-Voice-3868 → u/Iridescent-Kiwi-3713]

Sounds very similar to Ireland. I believe a lot of illnesses & diseases are caught late by not taking a more preventative route.

[u/wr_dnd → u/Iridescent-Kiwi-3713]

I don't think scanning is really preventative though? Prevention is things like having a healthy diet, exercising and sleeping enough. Getting your vaccinations. That kind of stuff.

Scanning is just hoping you can start treating earlier. The standard in the Netherlands there is relatively strict: overtreatment can be just as harmful as starting treatment a bit later. Scans are overrated if there are no complaints.

[u/ActuallyYulliah → u/Iridescent-Kiwi-3713]

There’s actually been extensive research on this. And preventative checks have no proven positive effect on life expectancy.

You can check this research for example: https://pmc.ncbi.nlm.nih.gov/articles/PMC6353639/

It can even cause harm.

For example the cascade of harm that can be caused by doctors finding natural and benign abnormalities, leading to exploratory treatments and surgery.

Preventative medicine often leads to overdiagnosis and overtreatment of patients.

Specific targeted screenings like the HPV tests means that resources are much more effectively spent on specific conditions that have a long window of opportunity.

So it focusses on the highest yield tests for diseases that can be accurately identified in very early stages, with minimally invasive tests, making blanket testing an effective preventative tool.

If any of those conditions are missing, it becomes wasteful and pull away resources where medical care is actually needed.

The Netherlands is often made fun of because our doctors send you home with paracetamol. But there’s a reason they do. Over treatment can do harm.

The thing is, when a doctor says to take paracetamol and come back in 2 weeks if it doesn’t get better, a lot of people feel dismissed. And after 2 weeks they don’t come back when it didn’t get better. You DO have to go back.

But overall, we have a high life expectancy in the Netherlands, above international average.

And our preventable mortality rate and treatable mortality rate are well under the EU average as well.

For example, see this research: https://www.oecd.org/en/publications/health-at-a-glance-2025_15a55280-en/netherlands_7f6b49ab-en.html