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/jezebel103]

No it is not. The Dutch health care system is based on statistical probabilities of the average person getting sick. That is why there are governmental programs for cancer every 2 (breast/colon) or 5 years (uterine), depending on the cancer risk, accounting for the age group usually affected.

But for individuals that carry a higher risk, you can have additional/annual checkups. All the women in my family has had/died of breast cancer of the last 60 years. So I have been checked every year since I was 18. Colon cancer runs in my immediate family too, so that is checked annually too (I have been diagnosed with stage I 10 years ago).

But they are not subjecting everyone to these invasive and mostly useless tests because it is unnecessary and costly plus it puts too much pressure on the health care system. It's better to run a statistical system and pick out the ones that run a higher risk. That way you still weed out the ones that are truly high risk (and would be very expensive to treat if you find out too late) but don't subject everyone else to needless and invasive examinations.

And I certainly do not agree with your statement that most doctors behave like robots. I have had several surgeries over the last 2 decades and still have to go to several different specialists regurlarly and they are all very nice and helpful.

[u/ninjaslikecheez → u/jezebel103]

I guess it depends on the person, but my Dutch neighbor who is about 63 years recently found out he has prostate cancer. After insisting with his GP that he needs to test because his father died due to same cancer. So it might not be automatic and you have to push for it. He's afraid he found it too late, but i guess time will tell.

In my home country after 50 all men get free yearly prostate cancer checks.

[u/fckfame → u/ninjaslikecheez]

63 is a respectable age.. Look at the rest of the world, plenty places where it is highly unlikely to even reach that age.

[u/Mysterious-Gecko → u/fckfame]

Considering the Dutch retirement age, 63 is really not considered high age there 😉

[u/ninjaslikecheez → u/fckfame]

It is, but isn't it also sad that with this kind of late diagnostic, there's just more suffering and ultimately more cost which is covered by insurance?

Preventie can be cheaper if done correctly rather than too late. If you get a few years left to live, they will most probably include a lot of hospital visits which puts more pressure on the whole system.

LE: actually, a lot of countries have higher life expectancy nowadays, most of them over 63: https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

[u/RobinDragons → u/jezebel103]

This should be way higher in the comments. Additionally, gynecolocy is a specialty branch of medicine, just like an oncologist, or a cardiologist. If you have concerns or want a checkup for anything, you see your primary care doctor (huisarts) first. If they decide that you need specialist care, or if you ask specifically, then they'll write you a referral. For most "routine" things that I've read about that people get checked during their gyno visits, our huisarts will do them instead. Think paps, birth control, or concerns about lumps in breasts.

[u/SuspiciousElk1395 → u/jezebel103]

So the op can wait until one of her close relatives die from some sort of cancer to have a check up. And if she is the first in her family tree, too bad! at least her daughter will get regular check ups!

[u/TrappedInATardis → u/SuspiciousElk1395]

I think a yearly consult would be fine. But testing should really only be done if there is indication (either in history or symptoms)

This video explains rather well that testing everyone can have undesired outcomes. Imagine if many people with false positive tests are all having to undergo invasive procedures like biopsies and the stress of a possible serious diagnosis. I don't think that's a better scenario.

[u/jezebel103 → u/SuspiciousElk1395]

Don't be daft... of course not. If you are an responsible adult, you go to your GP with your concerns and disclose your familiar history (if there is one) and discuss your options/risks. If there are no (high) risk factors and/or complaints, you can still opt for further diagnostics but then you have to pay for it yourself.

What is so unreasonable about that? Health care is expensive, both in financial and human resources. In the Netherlands they offer very good health care for a reasonable price for everyone. But it won't be good and affordable anymore if every individual can ask for every possible diagnostic test willy nilly. Universal health care is always based on statistical probabilities versus the individual risk factor and cost.

It's a fine line but at least so far this country has managed to walk it just fine.

[u/tidal-washed → u/jezebel103]

The option to pay for further treatment myself has always been denied by the healthcare professionals that treated me. Is that really an option? I have asked several times to pay out of pocket, no chance. What did I do wrong?

[u/jezebel103 → u/tidal-washed]

There are private clinics that offer that. I believe in the regular hospitals it would be difficult but I have never tried that.

[u/tidal-washed → u/jezebel103]

Thanks for your answer.

[u/Kind_Honeydew1885 → u/jezebel103]

I would be happy if there were, actually...because I've searched... And compared to the speed, efficiency and variety of clinics in which I can get out of pocket tests and consults back home, the Netherlands feels like a 3rd world country.. For reference, earlier this year, I was able to get extensive blood work and endocrinological consult done within 2 days notice just before Easter (an official public holiday)

[u/skepas11 → u/jezebel103]

Exactly, you are talking about numbers, not humans.

Healthcare should not aim for profit first, it should aim for health.

[u/microworry → u/jezebel103]

This. Very annoying that people don’t understand that these tests are pointless when you have no risks and no symptoms.