differences in doctoring

I really should write this entry, about the differences in visiting the doctor here vs. in the US, over at the travel blog site. However, it was a gynacological check-up type visit, and I don’t really care to parade details in front of assorted grandparents, coworkers and so on. I may post a redacted version there later. I do think some readers here will be interested, but probably not all, so I’ll put some of the details behind a cut.

The first difference in a visit is that though there are several several doctors sharing an office suite, each one (or two) has their own assistant. Instead of going to a general reception desk, you go to the assistant for your specific doctor. Actually, that’s the second difference; the first was that wen I called a month in advance for an appointment, I was told I only had to call a week before I wanted to come in. I only had to wait maybe ten minutes after my appointment was scheduled to see the doctor. He was a somewhat scruffy young guy, compared to most US doctors I’ve seen – I think doctoring tends to have less status in countries with socialized medicine, because there’s less money involved.

He had an even younger and scruffier student on hand to observe. Also male, sigh. (They did ask if I minded the student observing.) I don’t normally care about a doctor’s gender, but when they’re sticking thems into me I like to have one who’s equipped to know how it can pinch. There was a far extending halfway across the office to divide the examining room from the desk area. They sent me behind it to take off my pants (in both American and British sense of the word), telling me I could keep my shirt on. There was a wall cabinet to hang my pants in – a nice touch – but no paper sheet to cover up with, as American doctors generally have. Fortunately I’m not terribly body-shy, and even more fortunately the office wasn’t cold (not that the paper sheets help much but they’re better than nothing).

I’d told them I needed a Pap smear – actually, that could have waited until June or so, but I was out of birth control and needed a new prescription – back in the US, I could only get a 6 month supply before we moved here. I suppose I can say they were responsive to what I wanted – I’d asked for a Pap smear and a BCP prescription, and that’s what I got. You know how in the States they usually take a patient history, do a breast exam, ask a few questions, and so on? None of that. Off with the trou, on the table, out with the speculum.

He did warm the speculum first under warm water, always a nice touch. They set up the patient bench so that I was sitting up, not laying down as in the US, though I still had my feet in stirrups. No paper sheet meant I could watch everything, not always a plus when discomfort is involved. He tried first with a speculum that was too big. Maybe because of my age? I don’t know. I told him it wasn’t working, that I’d had no babies, and that it hurt a bit, and after a few more attempts he tried a smaller one, mentioning to the assistant that if this didn’t work he’d need to use the virga speculum. (He also said something about wanting to use as big a one as possible for the best view, so he wasn’t just being insensitive.) Anyway, that one worked, though it wasn’t what I’d call comfortable. They never are.

In my time getting Paps, I’ve been through the cotton swab, the wire brush (owie OW!) and more recently the plastic brush, less owie than the metal one, more pinchy than the cotton swab. That’s what he used too, so that was the same. At least it wasn’t the metal brush. I was bleeding more than usual afterward; he said it looked like I was jut due for my period, and I agreed, until I remembered later I’d another whole week and a half to go, not hal a week. It wasn’t all that much blood.

Unfortunately I’d forgotten to bring my current BCP (which I HATE) and all of the brand names are different here, so he just prescribed a common one, telling me to take it for three months and see how it went. Then he had me pay him directly, not at the reception desk, which seemed really odd. I think it was odd for him too – I’m not sure he’d ever been paid in cash before. He handed me the sample to take to the assistant, and she had me take t down the block to the lab, which I’d never done in the US either. Then again, a Pap smear isn’t something you’d want to tamper with, not like a drug test.

The apothecary (apotheek) seemed quite cavalier about the prescription. As far as I can tell, I could request any amount up to 12 months at a time, and can come back for more without getting a new prescription. Handy, if I can take a 12-month supply to Taiwan.

All in all, I wouldn’t call it a pleasant experience, but not any worse than back home.

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4 Responses to differences in doctoring

  1. Melissa says:

    Thank you for sharing all of this. I find the little daily life detail differences like this very interesting.

  2. Melissa says:

    Oh, and I had a question. Did they give you the option, when you made the appointment, of requesting a female doctor? Or did that not come up?

  3. LA says:

    Interesting about the sitting up part. And the no history or breast exam. Are the Dutch more educated consumers/have more patient self-knowledge, do you think or just that here the ever-present threat of the lawsuit makes docs over-cautious and most ‘standard’ procedures are just CYA? ~LA

  4. Suzanne says:

    Thanks for sharing – since I did paps in Israel and the U.S and had ample training in both countries regarding each – I can honestly say – that your description is far from how I conduct exams in the US, nor was it the method we used in Israel. If a woman wants a view, I give them a hand-held mirror and let them position themselves. I have had to do paps with patients lying on their side when it was for comfort, lack of stirrups (army), or disability. I always keep a pediatric speculum on hand – in fact the one I have in the office, I bought at an Israeli flea market, it is probably originally from Europe or the former USSR – works great, but requires being sterilized and autoclaved. Not as easy to use as the lighted plastic disposable ones I use that come in small, medium and large.
    Unlike the US, in Israel patients have more responsibility and autonomy – such as receiving their results personally and bringing them to the doctor for discussion.
    Payment in Israel was also a copay directly to the physician prior to the exam, as medical care there is usually the socialized type paid via a health tax to the population. It was a meager 10 shekel piece ($2 US)when I was there, but if the Dr. didn’t collect it, it came straight out of there salary. Dress is more casual in Israel in general, not just for doctors. Unlike the U.S. it is accepted to wear jeans or sandals, but regardless, we adorned white coats – just thinner than in the U.S. as the climate is warmer, often downright hot without AC. In both places the order of the visit begins with history and training in both countries agrees with the belief that history is 99% of diagnosis. Thus, the art of medicine, not simply the science for both treatment of the patient and decision making. Modesty is upheld in Israel as much, if not more, than in the U.S., especially when the patients is religious – Jewish/Muslim. Glad to hear that you are keeping up with your preventive measures. Keep in mind, OCP’s still carry a risk of blood clots, and that increases with our age (my twin) – so get up and walk about on those planes trips and I look forward to seeing you when you get home. Hugs,

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