HEALTHCARE INFORMATION

Transcription

1 HEALTHCARE INFORMATION DIFFERENCES IN HEALTHCARE SYSTEMS The differences between the American and Dutch medical care are more a matter of philosophy than of science. The Dutch take a more holistic approach to health care than is common in the US. The philosophy is to let the body heal itself whenever possible. Medications such as antibiotics and pain relievers are prescribed less often than in the US; when they are prescribed it is usually in a lower dosage and for a shorter duration. Routine tests such as throat cultures and x rays are done frequently. Well child checks are not typical either, especially after the age of 6. Alternative and complementary healthcare homeopathic practice and remedies, acupuncture, physiotherapy etc. are more widely used in the Netherlands than in the US. Most doctors here speak English very well; however there can still be a communication problem. A Dutch doctor may not give as much specific information as Americans expect; physicians are not accustomed to having their directions questioned. Also, some nuances of a language can be lost in translation and lead to misunderstandings. Requesting a second opinion is not customary here. Referrals to specialist are usually made through your huisart. While you can make an appointment directly with a specialist, it is not the norm. A report from the specialist will be sent to your huisart. EMERGENCIES DIAL for an ambulance, fire, or police emergency, for life threatening and other serious emergencies. Stay on the line, they will respond to all languages. If you have an after hours (evenings and weekends) medical case that requires immediate attention, first call your GP's answering service for the local on call physician. If you call an ambulance when it is not a true emergency, you will have to pay for the service, or they may not help you when they arrive. Only a doctor can call an ambulance for you in such cases, if they feel it is required. Emergency medial care that does not require an ambulance (for Wassenaar and Den Haag) is done through a service called S.M.A.S.H (Mobile Doctors Service Foundation) for after hours care on Leiden has their own after hours care called DOKTERSPOST and they can be reached by calling Medical care will only be provided if one has contacted and received the go ahead from the on call physician. One should have all medical insurance information on hand ready to be provided to the physician.

2 You CAN take serious cases directly to the emergency room/casualty department of the nearest hospital in the case of a dangerous injury, poisoning or allergic reaction. You must bring your insurance and local doctor's information. If they feel it is not serious enough they may refuse to see you or have you wait for a long time. For a less serious emergency, for instance, a cut that might need stitches or a sprain that might need an x ray, call your huisart. During nights and weekends, if your huisart is not on call, there will be a recorded message telling you which huisart you can contact. Local hospitals (know where your nearest ones are!) Leiden University Medical Centre (LUMC) Albunusdreef 2, 2333 ZA Leiden Bronovo Ziekenhuis Bronovolaan 5, 2597 AX The Hague Juliana Kinderziekenhuis (Specialist Children's Hospital) Sportlaan 600, 2506 LP The Hague (includes the Red Cross and Leyenburg hospitals in Den Haag) Medisch Centrum Haaglanden (MCH, formerly Sint Antoniuhove Hospital) Burgermeester Banninglaan 1, 2262 BA Leidschendam (includes the Westeinde hospital in central Den Haag) International Health Centre, The Hague (IHCH) Prins Willemstraat HT Den Haag FAMILY DOCTOR: THE "HUISARTS" Your initial contact for a family doctor is the Huisart. They are similar to a general practitioner in the U.S. To see the Huisart, you must be registered. It is important to register with a family doctor as soon as you can. Do not wait until you need a doctor to register. The Huisart is your first point of contact for any problems except serious emergencies. Although you can approach a specialist independently (check your insurance coverage first), you usually need to be referred for anything by your huisart. Check their hours and location before signing up, and perhaps go for an introductory talk before registering, or ask for recommendations from other expats.

3 You can also find huisarts in your area using the website or call ACCESS for a list of english speaking doctors at There are many Huisart located through Wassenaar. The Huisart office is located in their home. Once you register with a Huisart, you will be in the general healthcare system in the Netherlands. Changing Huisart is frowned upon. It is acceptable to make an appointment to interview a huisart before registering, to discuss office procedures and hours, and specific health concerns in your family, and generally to assure that you are comfortable with your choice of huisart. You will be charged for this consultation. To change a huisart, you must notify them in writing that you are discontinuing their service. All Huisart are considered equal in the Netherlands, and local doctors cover for each other during holiday/after hours. Fees are the same across the board. Most huisarts have drop in hours, usually at the start or end of each day, and then appointment only hours in between. Some reserve parts of the day for doing rounds, or answering phone calls. Note that huisarts will charge for a short phone consultation. Doctors have varied billing practices, sometimes billing for each visit at a time, sometimes saving up a months or several months visits for a single bill. They may insist that you pay by automatic bank transfer, due to their in house accounting system. Normally you will be billed first and then must claim the money back from your insurance. The Huisarts take care of routine illnesses and makes referrals to specialists (including pediatricians, obstetricians, surgeons, etc), and for hospital care and health care services such as physical therapy, midwifery, etc. Huisarts in Wassenaar Dr. P Yff (Praktijk ZON) Landgoed de Wittenburg B.R. Dinger van Kruiningen Hofcampweg M.F. van der Feen Hofcampweg J. Huls en M. Smit van Duivenvoordelaan > R.JjP. van Niekerk Hofcampweg E.J.J. Op 't Land Middelweg G.Th.J.M. Schaepman van Z. van Nijeveltstraat I.C. Spelt Hofcampweg J.W. Stuijfzand Kerkstraat M.H. van Tolingen Jr Hofcampweg J.N. Vonk Wittenburgerweg

4 DENTISTS: THE "TANDARTS" You must also sign up for a dentist in advance, and many have waiting lists in our region. The tandarts may not do a routine check up for you unless you ask for one (or for a reminder), and even then the office may have a separate, resident dental hygienist for this job. Some dentists are able to perform surgery some may need to refer you to another professional. Contrary to rumor, Dutch dentists DO use local anesthetic during their work if you are unsure what they will use, just ask. Some dentists may be reticent to offer, perform, or refer cosmetic forms of dentistry such as whitening or orthodontic work that they feel it unnecessary, but you can always approach an orthodontist independently. Just check first with your insurance. Note: The water supply in the Netherlands is not fluoridated. Tandarts in Wassenaar W.A.J. van den Bergh Westerhoflaan R.M. Crul Rozenveldlaan J. Klaver Hofcampweg W.E.L. Mangelaar Meertens Stoeplaan A.G.J. Okhuizen Schouweg G. Bisschop Zijjlaan 30A P.J.N.M. Pluijmaekers van Z.van Nijeveltstraat Cross Dental Kliniek Tarwekamp 77 (Den Haag) R. da Silva van Duivenvoordelaan You can also search for tandarts in your area at: Tandarts offices are located in their home or residential areas. PHARMACIES: "APOTHEEK" AND "DROGISTERIJ" At the Apotheek you will receive prescription medicines, as well as some over the counter drugs, and there is always a pharmacist present to give professional advice. At the Drogisterij, you will purchase over the counter branded drugs, as well as basic drugstore/chemist consumer items. The drogist will also give advice about, and sometimes recommend, herbal and homeopathic treatments, which are very popular in the Netherlands. Make sure you tell the drogist if you do not want an alternative medicine. Many prescriptions from the US can be refilled without seeing the huisart. Simply present your prescription bottle or package to the apotheek. They can typically find a suitable match. Prescriptions are often faxed or ed by your huisarts through to your local apotheek, and they can prepare the prescription for you to pick up later that day. You can often order a repeat prescription from the huisarts' assistant on the phone, and then go later to the apotheek for it. It is common to pay up front for a prescription and then claim back from your insurance. Opening hours are usually 8.30am to 6pm during weekdays, shorter on Saturdays, and apotheeks are usually closed on Sundays. There is always an apotheek open in your area for after hours service on a rotating basis. You can call the answering service of your local apotheek or check their doors for the schedule and contact details. For emergencies, you can also use the Bronovo Hospital night pharmacy (see below) from Mon Fri from 5.30pm through the night until 8am, and on weekends from 10am untilmidnight.

5 Pharmacies in Wassenaar Kring Apotheek Langenhoff, Septer & Exler Stadhoudersplein Apotheek Langstraat E Claushuis, A van Rhijn Langstraat Apotheek Wassenaar Zuid MS Stutterheim Mesker Rijksstraatweg Bronovo Hospital Duty Pharmacy (all night emergency pharmacy) Bronovolaan 1C Den Haag (on Bronovo premises, park your car and walk) Dutch drug prescribing philosophy Most Dutch huisarts may be less inclined to prescribe medications than the doctors in your home country. Their philosophy is that the body can heal itself in many cases of common ailments such as colds or bacterial infections, and they will often choose to wait for several days to see if a common disease runs its course before prescribing drugs such as antibiotics. They believe that overuse of antibiotics will rapidly make them ineffective against bacteria and weaken our immune response. You cannot order a physician to give you prescription drugs, and you cannot get a second opinion unless you have a chronic problem. However, many huisarts will be understanding of your "unusual" desires as a foreigner, and if you politely explain your concerns, and are open to the doctor's opinion, they may well prescribe the drugs you want (or their equivalent). Sometimes a huisart will suggest a "home (traditional) remedy" rather than a modern drug, which may appear unprofessional to some expatriates. However, if you ask clearly for information on the effectiveness of any advice they give you, they will always take time to explain their diagnoses and prescriptions. Drug availability Sudafed is not available. Alternative is nasal spray/drops Xylomethazoline (not for under 2 years). Tylenol (acetaminophen) is not available. Alternative is paracetamol. Combination drugs, like the Tylenol range of products are not common, instead separate cough syrups and pain relief is used. Ibuprofen comes in 200 mg doses only, for ages 8 and over. For young children, use paracetamol. Hydrocortisone creams are only available by prescription

6 Benadryl (Diphenhydramine) and Claritin (loratidine) are not available over the counter. Many antihistamines are prescription only. Alternative for seasonal allergies is Zyrtec. Antibiotic ointments are only available by prescription. Yeast infection creams are available without prescription. Use Miconazol, Zovirax, and Denavir. CENTIGRADE FAHRENHEIT CONVERSION : All physicians in the Netherlands use centigrade thermometers. Use the centigrade scale when speaking with them. CENTIGRADE FAHRENHEIT DUTCH MEDICAL VOCABULARY Doctor Family doctor Dentist Veterinarian Consultation hours Appointment Weekend service Pharmacy Prescription Drugstore Eye doctor Eyeclasses Hospital Emergency room Municipal health Immunization Insurance Medical insurance Early childhood care Health Care Center After hour emergency Medical care arts huisarts tandarts dierenarts spreekuur afspraak weekend dienst apotheek recept drogist (for over the counter drugs) oogarts bril ziekenhuis EHBO or eerst hulp G GD inenting verzekering ziektekosten verzekering or Zorgverzekeraar baby consultatie buro gezondheidscentrum husartsen post

7 NOTE: ICE In Case of Emergency We all carry our mobile phones with names and numbers stored in its memory, but nobody, other than ourselves, knows which of these numbers belong to our closest family or friends. If we were to be involved in an accident or were take ill, the people attending us would have our mobile phone, but wouldn t know who to call. Yes, there are hundreds of numbers stored, but which on is the contact person in case of emergency? Hence this ICE (In Case of Emergency) campaign. The concept of ICE is catching on quickly. It is a method of contact during emergency situations. As cell (mobile) phones are carried by the majority of the population, all you need to do is sore the number of a contact person or persons who should be contacted during emergency under the name ICE (In Case of Emergency). The idea was thought up by a paramedic who found that when he went to the sense of accidents, there were always mobile phones with patients, but they didn t know which number to call. He therefore thought that it would be a good idea if there was a nationally (US) recognized name for this purpose. In an emergency situation, Emergency Service personnel and hospital staff would be able to quickly contact the right person by simply dialing the number you have stored as ICE. For more than one contact name, simply enter ICE1, ICE2, ICE3, etc. Below are answers to many common questions posed to the Pharmacist. If anything is not clear from these answers, please feel free to ask for more information. Q. Is there an equivalent to Sudafed available? A. We do not have a systemic drum to treat a nose cold. Xylomethazoline nose drops or nose spray in different strengths is the alternative. Children under 2 years of age should only use salt solution, which is available in drops and spray. Q. Are there any combination cold remedies available to treat sinus congestion and a cough? A. We advise the use of separate medicine, a cough syrup, nose drops, or spray and paracetamol (=acetaminophen, Tylenol) to treat the various symptoms. Some preparations combine painkillers with vitamin C, like Citrosan. Q. Can the pharmacist compound natural hormone replacement therapy creams? A. For hormone replacement therapy transdermal pads and tablets are prescribed. Creams made by the industry are available on prescription for local treatment of postmenopausal discomfort. These creams are compound in the pharmacy since the health risk of this preparation is high and the use is not validated. Q. In what instances will an antibiotic be prescribed by a huisart? A. An antibiotic is used to treat bacterial infections. The huisarts will decide when and what kind of antibiotic is needed. Most colds and the flu are caused by viral infections. These can not be treated with antibiotics. The huisarts will most likely not prescribe an antibiotic in these cases.

8 Q. Is there a first aid cream available without prescription? A. To disinfect a wound we have betadine ointment. For minor injuries you may also use homeopathic creams and ointments of which we sell several (e.g. EHBO gel by Traumed). Q. Are antibiotic ointments available without prescription? Are creams to treat yeast infections available without prescription? A. No, any preparation containing an antibiotic is only available on prescription. An exception is miconazol cream and application liquid (=Monistat), which is used to treat yeast infections. Creams to treat viral infections containing acyclovir or vectavir (=zovirax or denavir) are available without prescription. Q. Is paediatric ibuprofen available/? If not, what is a substitute? A. Ibuprofen is available in 200 mg coated tablets; these can be given to children over the age of 8 years. For pain relief for younger children, paracetamol is available in suppositories, tablets, and syrup. Q. Can I have a prescription from my physician in the US filled here? A. A prescription can be filled here, when the medicine prescribed is registered as a medicine in Holland. Q. Is drug information available in English? A. The information leaflets from our computer system and the drug information provided by the industry is all in Dutch. Drug information in English can be best found on the internet, either at the site of the drug manufacturer or on independent sites like: and In the pharmacy we can always print out a specific page for you. Q. Is hydrocortisone cream available without prescription? A. No. Q. How long does it typically take to get a prescription filled? A. A doctor can send the prescription by computer or fax to the pharmacy. When this is done in the morning, the medicine will be ready to be picked up in the afternoon. This also allows us to order drugs we have not on stock. When you take a prescription with you to the pharmacy, it depends on how many medicines are prescribed and whether we have those medicines on stock.