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In the Netherlands, if you need medical attention, your first port of call is not as in some countries the hospital, but your “huisarts” (general practitioner). This is for all non-emergencies.
[If you require an ambulance (heart attack, road traffic accident, etc.), please phone the emergency number 112 and ask for an ambulance clearly stating the address of your location, the nature of the emergency and the age and gender of the patient.]
But back to the “huisarts”. The literal translation is house physician and this is what he or she should be. Someone to whom you can entrust the medical well-being of your family throughout the years. So how does it work?
1. Find a huisarts
Ideally, you need to find a huisarts as close to you as possible. This is important as you may need them to make a home visit and you want to minimize your own travel time when you or your kids are sick. Look in the telephone book/on-line, ask your neighbours or ask the gemeente. Ring the practice (most huisartsen operate in a practice with 2-3 doctors sharing) and try to get accepted. Practices can refuse you if they are oversubscribed, if you are not in the right post code, if you are too far away etc., so you may need to ring more than one. If you prefer to be treated by a female doctor, please make sure to ask if the practice has one. Most doctors (especially the younger ones) will speak English to a good level, but check! Also note that many people (and especially women) work part-time in the Netherlands, so you will not always be able to see your preferred doctor. Which brings me neatly to the next segment.
2. Making an appointment
First you will be connected with the receptionist. This is often a woman and appears to be a fierce defender of the doctor whose mantra is: “you shall not bother the doctor/waste their time and I am not here to provide a service”. Be prepared to explain your medical symptoms to this non-doctor and plead for an appointment. Make sure you keep this person on your side as he/she will determine whether you get an appointment that day/week. Note that in true Dutch style these people will take coffee breaks and lunch breaks at times convenient to them. Note that at weekends/holidays/other times the practice is closed, you can ring your local “huisartsenpost” to see if they are willing to see you. Be prepared for them to ask you to wait to see your own huisarts when they reopen if they do not feel your situation is sufficiently urgent.
3. Turning up for the appointment
a. Turn up on time. You will invariably have to wait. However, do not keep the doctor waiting. It is the rule!
b. When entering the waiting room make sure to call out Goedemorgen/Goedemiddag and expect to have to return this greeting when new patients come into the waiting room.
c. Some doctors require you to register with the receptionist; some just to take a seat. You will figure it out soon enough.
4. The appointment
Do not be surprised if certain procedures (suture removal, PAP smear, blood pressure checks, for example) are carried out by the receptionist\nurse and not by the doctor. If you do see the doctor, don’t forget to shake their hand!
Note that you will only have 10 minutes for your entire appointment. It is therefore important to be prepared, concise and to the point. Do not be surprised if the doctor sends you away with the message: “this will solve itself, if you are in pain take some paracetemol”. Doctors in the Netherlands are wary of (over) prescribing antibiotics and believe in the body healing itself. If you have a condition that does need further treatment the huisarts can refer you to a specialist (usually located at a hospital) or for blood tests for example. These are usually taken at a different location with different opening times to your huisarts practice. You will not be able to get a blood test, or see a specialist without a referral from the huisarts. By the way, you do not need a referral to see a physiotherapist, but consider going to your huisarts first for them to determine whether physiotherapy is a safe option for you.
5. Screening
You may be used to having regular health checks and screenings in your own country. This is not the Dutch way. There are screenings for people who fall into risk categories due to age, genetic or medical history and you will automatically get called up for the age-related ones, but general health screenings are not considered necessary and even counter-productive.
All this may sound barbaric, basic or a great luxury to you depending on your personal or cultural experiences to date. But not to worry. Proper health care is there when you need it and the costs are generally taken care of by your insurance (which is mandatory, but financial assistance can be available to pay this insurance). Also, the matter of fact approach to colds and other viruses (which really cannot be cured by antibiotics you know) soon becomes a way of life and some even come to appreciate it.
If you cannot get used to the Dutch system, help may be at hand soon.
About 400,000 “internationals” live and work in the Netherlands, and 1/10 of them live and work in the northern three provinces of Groningen, Friesland and Drenthe. A health care survey of 500 of these internationals, representing all nationalities, age groups, and regions of the Netherlands was conducted by International Health Services.
The results of this survey indicate that 77% are dissatisfied with one or more aspects of the Dutch first-line health care experience and only 32% have confidence in their general practitioner. In addition, 37% feel that their experiences with health care are a reason to want to leave the country. However, 64% would stay longer if health care would align with their expectations. According to the Ministry of Economic Affairs, internationals are important for the economic development of the Netherlands, bringing special skills with them and filling in gaps left in the Dutch labor market. Therefore, keeping the Netherlands attractive so these internationals come to and stay in the country is important.
In the survey, internationals indicated that they would like to see the following:
• Investment in knowledge about other health care cultures;
• Development of multicultural communication skills in first-line health care;
• Interaction with and treatment of individual internationals taking into account health care backgrounds;
• eHealth applications in multiple languages and translations of health and illness information;
• Information in multiple languages about the health care system in general in the Netherlands, the important role of the general practitioner and the successful system of health education and the restrained interference policy of the Dutch;
• Development of care tailored to the specific problems of internationals;
• Increased duration of consultations, if necessary, to improve trust levels. Since internationals go to their general practitioner less often than Dutch people, longer consultations but less of them would equal out on average.
In response to this survey, an initiative is underway by the Ministry of Economic Affairs to address these sources of dissatisfaction by engaging health care insurance companies to work with them on the above solutions. In addition, one could imagine that insurance packages could be developed specifically suited to the needs of internationals, or that international health care centers could be set up keeping in mind the multicultural and multilingual backgrounds of the internationals.
So, for any international who has expressed reservations about the Dutch health care system, the Dutch government has heard you and is taking your experiences seriously. As with any change, it won’t happen overnight but at least the wheels of change have been set in motion.