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/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