Managing Expectations: The Dutch Health Service

Before we start I’d like to make it absolutely clear that on arrival in any foreign country, whether to live, work or take a vacation my expectation of the local health care systems is always neutral. This avoids confusion should the service not live up to expectations based on previous experiences elsewhere.

Having lived in the Netherlands for a while we are in tune with the philosophy of medical practices here and understand how things work. It took a period of adjustment when we first moved, from the American way of doing things to the continental european one; not better or worse merely different. And understanding that while private funds drives the medical industry of one, social medicine, and therefore the taxpayer, funds the other.

Over the years we have dealt with a wonderful GP who’s attitudes are open, helpful and understanding, and who is happy to discuss options and choices. We understand this is not always the case. Our rare forays into medical care outside the local surgery have always been positive, staff and doctors at the local hospitals kind, polite and caring.

The past few months have seen me spend a little more time observing the Dutch health service at close quarters than I’m used to. The reasons are immaterial; I am not yet at that stage in life where I’m happy to discuss the state of my health with anyone in earshot.

A few weeks back I was dispatched with requisite paperwork for a scopie, the cute sounding proceedure known elsewhere as an endoscopy. Making the appointment I enquired, quite reasonably I thought, what type of sedation was offered for the procedure. Like any normal hypochondriac I had read everything there was to read about an endoscopy on google. Silence crackled down the phone line,

Mevrouw, you will not need sedation for this procedure. Our nurses are very skilful. We do not give sedation, it is not necessary.” Not according to the information I have.

“If you already have prescribed drugs, like valium, you may take one before you come but it is not necessary.” She sniffed in derision as if such an option was for the pathetic and feeble. I assumed from her attitude I was being overly cautious and perhaps the scopie would be a new fangled piece of apparatus rather like the tiny fibre-optic strands you see on lights.

The scopie was not a fine strand of fibre optic elegance, it was a hosepipe with the camera attached heading to explore the far reaches of my stomach. Fortunately I was allowed a small amout of oral anaethetic for my throat.

The nurse was encouraging with her quiet words and gentle stroking of my arm, but the patient response was an overwhelming urge to lash out and hit her, reminiscent of the delivery suite in the presence of midwife telling you to breathe normally.

It was decided to take a couple of biopsies, and was soothingly told with a smile normally bestowed on a child under the age of three, “Mevrouw, you shouldn’t feel anything at all, but if you do it will be nothing more than a slight tugging sensation.” She lied. That or the  Dutch have infinitely thicker stomach linings than me.

In the aftermath, while tubes were pulled out and the doctor was finishing his report, I asked the nurses why it was that patients weren’t sedated, as was the normal practise in the US and the UK – I’d done the research. I wondered if it was a cultural thing and was asking for the sake of interest you understand. The nurse was happy to explain,

“We used to allow patients a small sedative, mevrouw, but patients would not do as they were told during the procedure, so it had to be stopped.”

A slight disconnect there between what is best care for the patient and most convenient for the medical staff.

Hot on the heels of that experience I was sent to another facility for a CT scan. A different experience for different reasons.

I was escorted into the scan room  by a 12 year-old male nurse.  He indicated a small changing room,

“If you could please remove all your top clothing, mevrouw and come through to the table when you are ready. ” Excuse me? Where was the hospital gown, the swathe of green fabric to hide my modesty and save the young innocent in front of me from lasting psychological damage?

I’m sorry, I do not wander around half naked in public like my continental cousins. Back in the day Cosmopolitan magazine advised any woman over the age of 30 not to expose certain body parts and I’m fine with that.

Seeing my hesitant look the young man advised me I could, perhaps, leave an item of clothing on but would have to remove ‘the undergarment’  because of the metal fastening. I was for keeping my large, woolly and warm sweater on, but we compromised with my camisole top.

Fortunately I was wearing my best knickers as, once on the table, was requested, “Please remove your jeans to below your buttocks mevrouw.” Not easy on a hospital table.

Before I’d recovered from that manoeuvre the consumption of a gallon or so of water was required, quite challenging when laying on your back propped up on one elbow. The nurse was most helpful, holding the white plastic cup and bendy straw, while another colleague struggled to insert an intravenous needle into the other arm bent behind me over the far side of the table.

Thanking the nurse for his skill in straw management I rolled back and found myself looking into the eyes of Dr Dreamy (Grey’s Anatomy fans will know who I mean) who’d appeared from nowhere next to the intravenous drip and looked to be 25 at the most. He peered down on me with a twinkling smile, tousled hair and a faint tan,

” Good afternoon Mrs Dean, I will be conducting the scan today, there is nothing to worry about.” He was Dutch but his English was flawless, I struggled to pick up any nuance of an accent, and decided he must have lived or studied in the UK. Before I had the chance to ask him he waved a small phial of liquid in front of me and said, “Now I’m just going to put this in the drip, it’s just a little something to relax the bowels.” There’s not a lot you can say after that.

For both these appointments I did have expectations whether I realised it or not. The first being the scopie procedure would be pain free, and the second that the CT scan would not involve wandering around half naked in front of young men. I should have been better prepared with the knowledge and experience I already had of the Dutch health service, and wouldn’t have been left feeling as rattled and unsettled as I was.

Although with hindsight the latter may have had far more to do with the youth and gorgeousness of the Dutch medical staff than the procedures themselves…




About wordgeyser

Our anglo/american family used to live in four countries (USA, Canada, UK and the Netherlands) on two continents, separated by distance, time zones, circumstance and cultures. It has been a scary, enriching, challenging place to be. The only things guaranteed to get us through were a sense of humour and the amazing people met along the way. . . This year everything changed with a move for us from the Netherlands, – and a move along with us for our son and his wife from the UK – to Houston, Texas, the same city as our daughter. With our youngest in Vancouver, Canada, we are now all living on the same continent. How this happened, and more importantly why, will be the subject of this ongoing blog...
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6 Responses to Managing Expectations: The Dutch Health Service

  1. Audra says:

    really appreciate you taking the time to write this. I just recently experienced something similar. I am an American, married to a Dutch man, living near Amersfoort. I had the need for a hysteroscopy. I, too, was told that I would not need any anesthesia and that it was not a big deal. I entered the room, not knowing what to expect. Bright, white, clean. There were two women standing by the bed/chair w/stirrups (kinda reminded me of a dentist chair modified with stirrups…LOL) Anyway, then there was the doctor, who greeted me kindly. They nicely showed me to the chair in the room with a curtain that goes around it for changing. Ironic, as after I took everything off from the waste down, I must exit that area in the room to come out in all my glory. No gown or anything else was given to give into my modesty. Alas, I braved forward and sat on the chair. Here I see modern flat screen TV and all these gadgets…hmm, sophisticated system I think to myself. Well, maybe this won’t be too bad, I think to myself. I get my legs up and do the typical position all us women need to do in these circumstances. I am told I don’t need any pain medicine and that I should only feel a little cramping as they pass through the cervix area, but after that…it should be fine. I brace myself for a ”little” discomfort. Hey, I can take this I think to myself…after all, I am not a woman who hasn’t experience bad cramping here or there. Well, I feel like I am a person with a higher than normal pain threshold and I can tell you it felt a lot more than cramping. I finally had to ask them to stop because I thought I was going to throw up from the pain. She was kindly saying, just breathe, oh and hey…look at the screen and see inside your uterus! I thought to myself, are you crazy woman!!! Like I need a reminder where that thing is at the moment. Finally, she pulls it out and says that because I am in too much pain they will do this another way. They scheduled me a procedure with, this time, anesthesia. It was even odd to my Dutch husband that they had me in pain. I also don’t understand why there is a need to make people be in such pain. I can see not giving pain medicine when it is minimal, but this was in no case minimal. Again, thanks for sharing. I also had a reality check with modesty and the lack of gowns provided. I am tempted to bring my own and tell them to just deal with it when I go in for my visits! LOL. Aside from that, I have experienced a rough edge when going to the dentist too. Very abrupt, rough, and to the point! Well, I think maybe we have been spoiled a little by the CUSTOMER SERVICE within the American healthcare system. Perhaps it is because of the private donations, the board to satisfy in most cases, etc. Well, maybe….

    • wordgeyser says:

      You have to wonder what the philosophy is with things like this. Surely it can’t all be down to money when we have to pay so much towards health insurance – it’s not as if it’s totally free here in the Netherlands. I do wonder how people from non-western countries are treated, one hopes with a little more personal respect than ‘westerners’.

  2. I feel guilty for laughing and am truly sorry to hear what you went through, but as an American having gone through similar experiences here in Norway, I feel your pain.
    I’ve learned how to take out my own stitches. Always wear a dress to the gynecologist. Don’t get sick in the summer while all the doctors are on holiday, and to check my pride and humiliation at the door.
    Now, whenever I find myself in an uncomfortable or demeaning medical situation, I simply remember the saying; What doesn’t kill us, only makes us stronger!

    • wordgeyser says:

      I find the process of wandering round half naked in a room full of people mortifying. It’s one thing when you’re young and gorgeous (as every young person is) but not over 30!

  3. sarah koblow says:

    Thanks for making me laugh just when I needed it, and sorry you are having to go through this but humour is definitely the best armour during medical checks whatever the culture or country. Just for the record, if you ever have to have a fine needle biopsy, they lie too, think knitting needle. And if you ever have to have an MRI mammogram, and knowing your curves are generous as my own, don’t let a young male assistant try to cram your abundant fruits into a cup size fit for Kate Moss. That was in an arabic hospital and then I was told to lie face forward completely still for 30 mins while whole body rests on said insufficiently sized breast cups with spilling over parts of boob. The other assistant was no help in full black veil and tutting throughout. Ah memories which reminds me I need my annual MRI and it will be back in the same place ah!!! bring back Bronovo and buxom dutch MRI breast cup sizes.

    • wordgeyser says:

      Thank you for this Sarah – I’m going for a mammogram tomorrow so at least I have a heads up! Although when you last saw me I must have been wearing something well-cut and flattering as generous curves aren’t an issue. Will let you know how it goes!

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