Medical Misadventures

After one year, maybe you thought there would no longer be misadventures.  But, I am here to prove that, as an expat, there can always be misadventures!  We were very lucky in the past year and didn’t have to make any doctor or vet visits, but recently we had to jump headfirst into medical care abroad!

First off, we needed to get a longterm pain in our daughter’s elbow evaluated.  The first step in using medical care in The Netherlands begins when you first arrive.  You must pick a doctor as a primary doctor.  You can not just pick anyone though.  The doctor you choose must live near your home.  We were informed that the reason for this is that some doctors will still make housecalls if necessary, so their office needs to be near your home.  Also, for those used to things in the US, you do not pick a pediatrician for your children.  They too use the primary doctor and may be referred to a pediatrician if necessary.  And there is no need to check if a doctor is on your insurance.  While there are variations in what is covered/amounts based on the plan, insurance covers the medical expenses regardless of where they are received.

Once we knew we needed to see the doctor, we called and were able to get an appointment very quickly, even though it was holiday time here, and we were not sick or with an emergency.  The doctor listened to the symptoms and made some preliminary predictions, but suggested we go get an Xray to verify that there was nothing fractured.  We immediately went to the hospital where the radiologist is located.  Upon arriving, you have to first register at a desk in the main lobby area (you only have to do this once; if you have registered before and are in the system, you can skip this step).  After registering, we had to then find radiology and take a number.  As a side note, when we were called in, the person receiving an Xray before us was leaving, and it was quite exciting to find it was a man being escorted by four police officers!  Receiving your Xray is just like receiving one in the US except that they do not use any kind of protective vest on the patient as they would in many situations in the US (this held true for dental Xrays as well).

As soon as the Xray results were sent to the primary doctor, they decided to refer us to a pediatrician as there was nothing on the Xray that would indicate the reason for the pain.  They do work on a referral basis here in The Netherlands, so you do need to receive a referral to see most specialist doctors.  As soon as we received the referral, we called the pediatrician, whose office is located in the hospital, to make an appointment.  Again, they were able to schedule an appointment for a date within a week of the date we called.

Here is where things began to get a little different.  When we arrived for our appointment at the pediatrician, we signed in and were sent down the hall and around the corner to an office where a woman looked us up in the computer and then took height and weight measurements.  She imputed the information and then sent us back to the waiting room for the pediatrician (which was also the waiting room for a gynecologist and perhaps some other specialists as well).  When they called us, we went into a room that looked like your average room at a pediatrician’s office, but, in addition to the exam table and sink, it also had a desk with a computer and chairs as you would find in an office.  This is where we sat while the “doctor” informed us that she is actually a doctor in training and will consult with her supervisor who was not present at this time.  She asked a lot of questions and then finally asked my daughter to sit on the exam table while she did some manipulation of her arm and hands to test some things.  After this, she exited a rear door in the room to retell everything to the actual doctor and consult with her.  About 10 minutes later, she returned with the supervising doctor and they told us what they thought might be going on.  They also said, that since they are not certain, they would be consulting the next day with some rheumatologists and Xray technicians that they meet with monthly for further review of our case.  We left with a referral to a physiotherapist and a promise that they would call the next day with the results of their conversation.  The next day, they called several times, but we missed the calls and they left no information (though they did make an attempt to call after hours which was nice).  On the second day, we finally managed to speak to them in person, and they told us that they wanted us to do some bloodwork just to rule out arthritis.

The bloodwork was made very convenient.  We were able to go in the next day, they explained.  As the doctor informed us, we should just go in and tell them that we had a blood draw order, and, before leaving, we should make an appointment for one week later to receive a phone call from the doctor to receive the results.  It all seemed so simple, but as an expat, simple things are not always simple.  The lab was, of course, also located in the hospital, so we ventured back, and, since we did not know where the lab was located, we headed to the front desk to ask.  Here we had a slight language difficulty, but they sent us to the lab.  Hurdle one was out of the way.

Upon arriving at the lab, there were two people at a counter receiving patients.  We walked up and were promptly informed we needed to get a number.  We found a digital machine issuing numbers, but, of course, all options were in Dutch.  Using our very limited language skills and the power of deductive reasoning, we were able to obtain a number which was immediately (I mean within 1 second of spitting out of the machine) called to the counter.  I told the clerk that we were sent by the pediatrician to receive a blood draw.  He asked for my paper.  I did not have one.  In a rather curt manner, he informed me that we needed to go to the pediatrician’s office to obtain it.  Then he told me to get a “B” number and leave it with him so he could help us when we returned and pointed to the number machine.  Now, I had barely figured out how to get a number at all, let alone a special “B” number, and he certainly was not going to assist me as he just kept saying B number and pointing to the machine.  So, after staring at the machine for several seconds, an older Dutch woman walked up to get her own number.  I asked her how to get a B number, and she showed me what to press.  B number in hand, I returned to the counter to leave it with the clerk, and then headed up to the pediatrician’s office.  Hurdle two-done!

At the pediatrician’s office, I was met by a receptionist who first began asking for my daughter’s date of birth in Dutch, even though I had explained what we needed in English-hence she probably knew that I didn’t speak Dutch.  This is fine because maybe English is not strong for her and she prefers Dutch, so I made an attempt to understand what she was saying but wasn’t quite getting it, at which point she said it in English.  I answered, and she promptly went back to Dutch to ask for our last name.  That time I did get it, but asked, in English, to verify that I had the correct meaning.  She found us in the system, printed our lab order and said something else to me in Dutch before sending us on our way.  Now, I have no problem with people not speaking English or even expecting that I speak Dutch, but when she knew I couldn’t and she clearly could speak English, I’m not sure why she was making me struggle (especially in a medical setting where you might be having some anxieties anyway).

But, hurdle three out of the way, we headed back to the lab where we approached the clerk who had taken our B number.  He told us that his colleague would instead help us, so we moved to her counter.  She took our paperwork, said one thing, and then told us we needed to step aside.  She helped someone else and then called us back.  The chaos of what was happening was beginning to make my head spin and my daughter was also having some anxiety about having her blood drawn, so I was starting to feel the pressure.  After verifying our information, the clerk told us to watch for our number.  After a few seconds, our number came up on the screen, but I realized I didn’t really know what to do when the number appeared.  She had told us to go to an automatic door in the room when we were called, so we did.  The door admitted us into a room with several lab tech stations set up, but I didn’t know which one to go to.  Finally, the tech called us over and then began to speak in Dutch.  When my daughter said she didn’t speak Dutch, we got a very strange look and then, I believe seeing my daughter’s anxiety, she became a little friendlier and proceeded to do the draw.  As soon as it was done, we followed the exit signs.  All hurdles were complete!

It was only after we were almost back to the parking garage and my shoulders were starting to relax that I realized I had forgotten to make the appointment for our results call.  I had no idea if I was supposed to make this at the lab or with the Dutch-only receptionist in the pediatrician’s office, but I was not about to go back in to find out.  Later we had to call to schedule it, and they told us that it was no longer possible to schedule an exact time, but they would just call us some time on the following Friday.  Luckily, we were able to answer the phone when they called.  They informed us that the results were fine and that they would call back in 5 months to see how the elbow is doing.  Quite an ordeal!  I’m not sure if I breathed a bigger sigh of relief over the fact that the results were favorable or that I was done with that process.  You see, you can often fit in within the confines of your daily life as an expat, but something that is outside the norms of what you “know” in another country can be overwhelming and make you really feel how much you don’t really belong.

But, for those of you who have stuck with me through this long post and are still curious about other forms of medical interventions, we can also report on the dentist and orthodontist.  The dentist is much the same as in the US, however, when you schedule, you choose whether you would like a 15 minute, 30 minute or 45 minute cleaning session and whether or not you would like to see the dentist for an exam with your cleaning or just have the hygienist clean.  Also, you can determine how often you want to go in for a cleaning, although the insurance (at least the plan that we have) only covers one cleaning a year.  We have been informed, though, that the costs of dental care (routine items anyway) is so low, that the insurance really only saves you a few dollars and thus many Dutch people do not carry dental insurance.  The orthodontist is also similar to the US, although, one thing that I have found different, is that you don’t actually see the orthodontist each time you go in.  In fact, the assistant put the braces on and the orthodontist didn’t even check them.  Also, the time between appointments seems to be more like 6-8 weeks instead of 5-6 weeks.  The cost for orthodontics is also very inexpensive compared to the US.  We will pay about half of what we paid with insurance and a prepay discount in the US.  But, children’s orthodontics here are covered through the parent’s health insurance plan rather than a dental plan.

Finally, we can also speak to the medical care of pets here in The Netherlands as our dogs recently decided to injure one another necessitating a visit outside of the annual exam they had received a month prior.  The annual exam was similar to the one in the US in which the vet examined the animals and administered vaccinations, the difference being that some of the required/suggested vaccinations are different than US requirements/suggestions.  Also, they administered the vaccinations in a nasal spray format rather than by injection (not sure my dogs were big fans of this).  The procedure in an emergency was very similar to the US.  The most seriously injured dog received antibiotics and pain medications while the less serious received a natural cream to rub on the swollen/bitten leg as well as a pain medication.  The main difference, again, was that the costs for these treatments were a fraction of what we would have paid in the US.

Fingers crossed that this is all that I will be able to report from the medical front in The Netherlands.  In the meantime, you can rest easy knowing that we have survived a few more misadventures!


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