The quirks of Dutch healthcare
An international walks into a doctor’s office…
It was late 2019 and international business student Carlo Vincenzini from Bahrain had a terrible case of the flu. He had high fever that didn’t go down for days. Completely exhausted, he decided to go see a doctor, who gave him some paracetamol and Strepsils for his throat.
‘I was shocked’, says Carlo. ‘I wanted something stronger. In cases like these you’d get antibiotics straight away in Bahrain. I even asked for some, but the doctor replied that the situation was not that severe.’
Carlo encountered one of the aspects of the Dutch healthcare system that often puzzles internationals: they go to the doctor with a fever, sore throat or cough and expect to be given antibiotics, but instead they are sent home with a pat on the back.
Chemical engineering student Francesco Filippi from Italy had a similar experience. ‘I went to the dentist to have a wisdom tooth taken out. All went well, but when I was about to leave I asked what kind of antibiotic I should take. The dentist told me none.’ In Italy, it’s almost standard practice to take antibiotics, he says. ‘But it seems they’re not even considered in the Netherlands.’
I wanted something stronger than paracetamol
It’s true the Dutch policy around antibiotics is different than in many other countries. According to the 2017 OECD report Antimicrobial Resistance – Tackling the Burden in the European Union, the Netherlands prescribes the least amount of antibiotics outside of hospitals: 8.9 daily doses per 1,000 people, whereas Greece, on the other end of the spectrum, prescribes 32.1 doses.
There’s a good reason why Dutch doctors work this way. Not only are there side effects to antibiotics, like nausea and diarrhea and dermatological problems, they also affect the good bacteria, like the ones in our intestines which help us digest food. And worst of all: these preventive antibiotics cause bacteria to become resistant, which means medication won’t work when we most need it.
In 2016, in fact, an independent review team commissioned by the UK government determined that by 2050, antimicrobial resistance could cause 10 million casualties per year.
Maarten Postma, professor of global health economics at the UG, explains that ‘the Dutch healthcare system is evidence-based.’ General practitioners (GPs) are not allowed to prescribe medication if there is no clear evidence that it’s necessary, he says. ‘Moreover, when prescribing a cure or a treatment, GPs follow nationwide guidelines.’
In Francesco’s case – the removal of molars and teeth – antibiotics wouldn’t have changed much. ‘Complications hardly ever occur without antibiotics’, says Maarten Goedhart, who’s a GP at Studentarts, a medical practice for students in Groningen. The same goes for a high fever, like Carlo had. ‘Antibiotics help with inflammation caused by bacteria. What’s important is the cause of the problem. Viruses like the cold and the flu don’t respond to antibiotics.’
Neuroscience student Imke Hrycyk from Germany had a different problem with the Dutch healthcare system. Following a pap smear, she had surgery last summer in her home country to remove some potentially cancerous cells in her cervix. Afterwards, she was told to get regular checkups and tests and so she called her Dutch GP for a referral. ‘She was surprised and reluctant to comply. She asked me why I did a pap smear test this young in the first place.’
The doctor asked me why I did a pap smear test this young
In Germany, pap smears are a standard procedure for young women over twenty. ‘It’s part of the German cancer prevention programme; they encourage women to start early and get tested yearly’, Imke says.
But population screening for cervical cancer in the Netherlands starts later. ‘In the Netherlands every year eight hundred women develop cervical cancer and two hundred die of it. Cases occur mainly in women between thirty and sixty years of age’, says GP Goedhart. Consequently, the focus is on them.
‘All those questions were a bit frustrating’, Imke says. ‘I was like, does she not believe this is necessary?’ Only after she explained the situation to her GP did she get her referral, although, due to coronavirus delays, she had to wait a month for her pap smear.
Straight to hospital
The existence of the GP is in itself a mystery to some internationals. ‘There are no GPs in Bahrain’, Carlo says. ‘You go to the hospital and there you are eventually directed to specialists.’ Germany does have GPs, ‘but you don’t need to go through one to visit a gynecologist. You just go’, according to Imke.
But in the Netherlands, you don’t get anywhere in the healthcare system without your GP. ‘GPs are well-educated and trained in recognising and dealing with all kinds of health problems’, explains Goedhart. ‘A Dutch GP deals with about 80 percent of the consultation contacts. The 20 percent of more serious complaints have to be treated by a clinical specialist.’
Patients are often unable to determine by themselves if they need a specialist, says Goedhart. ‘So if they were to be sent to specific specialists straight away, that would be very ineffective. The specialists would end up doing the job of the GPs.’
When Carlo moved to Groningen, he had heard of the support provided by Studentarts, but he wasn’t aware he should register there or with another GP. And even after he did, the Dutch way of doing things wasn’t clear to him. So when he felt a pain above his groin, he went straight to the UMCG hospital.
Trainees are always supervised by specialists
‘The first thing they told me was that I should have gone to the GP’, he says with a smile. Despite that, he was seen by two student doctors who suspected a possible appendicitis but weren’t sure. ‘That made me feel a bit uneasy’, he adds. It didn’t help that they were trainees, who would never be allowed to diagnose a patient in Bahrain.
In the end, Carlo was referred to the Martini Hospital, more suited for routine surgery like this, where he was checked by a specialist, got a final diagnosis – he did have appendicitis – and had a successful surgery.
The UMCG is a training hospital for medical students, which is why Carlo was first seen by student doctors. But he needn’t have worried, Goedhart says: ‘Medical students are always supervised by trainee specialists, who in turn are supervised by a graduated medical specialist. As a patient, you’ll encounter all of them.’