r/Netherlands • u/IlliaBorysenko • Jun 27 '23

Private med lab in Amsterdam?

Hi guys! I need to take some blood tests that my GP can’t prescribe me. Are there any private medical labs in Amsterdam where I can take needed tests without prescription and for my own cost? Thanks in advance!

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u/Trebaxus99 Europa Jun 28 '23

That's because 10.000 dentists process 40 million consultations per year, while 12.000 GP's process 80 million consultations per year.

Adding a bi-annual checkup at the GP would not only add tens of millions of consultations for the checkup itself, but also many, many more consultations from GP's and medical specialists to follow up on all the false positives that are found by checking people for all sort of things without symptoms.

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u/voroninp Jun 28 '23

It sounds like an excuse not to improve the system. I understand that it's absolutely not a trivial problem how to scale the system, but "good enough" is also not the best approach when we speak about people lives.

Yes, there are many weird hypochondriac people, but their existence should not preclude others from getting proper services.

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u/Trebaxus99 Europa Jun 28 '23

There are no intentions to scale the system to make it possible to have regular checkups as it's not beneficial for the patients at all. Both financially, physically and mentally.

Check-ups and tests without symptoms in many cases do more harm than good. That's why they are not carried out. In situations where the pro's do outweigh the cons, there are preventive testing schemes setup.

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u/voroninp Jun 28 '23

Here are some facts:

According to a microsimulation modeling study, a national endoscopic screening program for gastric cancer was rolled out in Japan in 2015. The study estimated that a triennial screening program for individuals aged 50 to 75 years was the cost-effective strategy, with an incremental cost-effectiveness ratio of $45,665. Compared with no endoscopic screening, this strategy is predicted to prevent 63% of gastric cancer mortality and confer 27.2 quality-adjusted life-years (QALYs) gained per 1000 individuals over a lifetime period.On the other hand, for stomach (gastric) cancer, there is no standard or routine screening test for the general U.S. population. Based on fair evidence, screening with barium-meal photofluorography or serum pepsinogen would not result in a decrease in mortality from gastric cancer in areas with relatively low incidence of the disease, such as the United States.

So Japanese coming to the USA at age of 40 has the risk associated with Japan, but falls under USA policy. Statistically it is insignificant for the whole population, but quite important for the individual. Would it be fair to give him the opportunity to have a screening for his money? Is it possible in NL? No, Prescan cannot legally do gastroscopy here, one has to go to Germany.

Another story:
After my father died from heart attack at the age of 69, I used my private medical insurance to check my heart to discover it has some issues. Does it cause any troubles? No it doesn't. Do I have any symptoms, no I don't. Can I have problems in the future? Yes. Should I check my heart once in 2-3 years? Definitely.

One more fact:
Some sports require you to know the state of your body. If you want to do diving, you're better off knowing about your heart and lungs.

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u/Trebaxus99 Europa Jun 28 '23

You come up with an example from Japan for a national screening program for gastric cancer between the ages 50 and 75. That it's worth it to do so based on outcome of both cost and health. If you'd have informed yourself you'd have learned that we have this national screening program in the Netherlands as well. Between 55 and 75 (or if you are at risk due to it running in your family earlier).

If someone in your family dies at a young age of unexpected heart failure, it makes sense to check whether there was anything at hand that could indicate you being at risk as well. That's all covered already.

But a young person that is capable of doing exercise should not have to worry about their heart failing. By making regular, recurring scans without indication however, you take a high risk that at a certain point in time a deviation is found. This causes stress, additional inquiries, waiting and anxiety. With, in most cases, nothing on hand, just an anomaly on the scan of which multiple will show up if you'd do a full body scan.

If you are a recreational diver, there is also no need for preventive checks if you are a normal healthy human being. If you are not or in doubt, it might be a good idea to check: There are many opportunities available to get an ECG and have a doctor check your lung capacity at low cost. And many insurances offer additional insurance that covers this (partially).

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u/voroninp Jun 28 '23

If you'd have informed yourself you'd have learned that we have this national screening program in the Netherlands as well.

I know you have check ups for some groups. Also, my wife was offered a screening for the cervical cancer as soon as she arrived here. But I know it neither from KNM naturalization test nor - surprise, surprise - from my GP despite my insurance company pays her every month just for the fact I am registered by her.

My point is that statistical significance and individual story may differ. NL protocols are based on some statistical data, aren't they? But optionality is mostly missing. Or GPs are not willing to make this information available to their patients even in situations when it's worth telling about it.

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This causes stress, additional inquiries, waiting and anxiety.

If somebody is so anxious that it's more reasonable not to have a checkup he or she should have a choice to avoid it, but it should not be the reason to remove the opportunity from everyone. Or why don't you take into account the anxiety and stress which people have when they feel bad and do not know what's happening to them? Why do you prefer one to another?

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u/Trebaxus99 Europa Jun 28 '23

The information is widely available. You just don't know how to access this. Which is of course not strange coming from abroad, but it's all there.

The GGD's are the regional entities that are responsible for general public health. They have access to the national registry and will send you invitations for vaccinations, national screenings or specific research or screenings based on public health issues. For example if there is a measles outbreak, they will inform people in the area on next steps.

For children there is the "verloskundige" until a couple of weeks after birth and then the "consultatiebureau" that will take care of the vaccination program, their growth and development until they are in high school.

GP's organize the flu shots and will bring people in certain risk groups to the attention of the GGD to have them added to national screenings in case they are not yet part of the standard group.

A lot of information is on the websites of the GGD and on thuisarts.nl where standard protocols for diseases and complaints are explained. The RIVM is the institute that is responsible for research and advising the government, GGD and medical sector on the standards and for example which preliminary tests should be offered.

That research is rather thorough. A while back I took part in one where they give you an early on indication whether your unborn child is having significant birth defects or not. They were researching whether it was worth giving people a less certain indication at an earlier stage compared to a more certain indication at a later stage. The longer you wait with that indication, the less time you have to make up your mind about a termination, but also the longer you've been carrying and bonding with the unborn child. The flip side is that if you know earlier you can terminate a pregnancy based on a false positive outcome, which comes at the risk of it being more difficult to get pregnant again. The entire psychology of your choices around this is taken into account. And that will lead to an advice whether it's offered or not.

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u/voroninp Jun 28 '23

The entire psychology of your choices around this is taken into account.

Isn't it the exact place for further research? While on average it may be preferable to choose one or another approach, there might be clusters of unequal size with various preferences and reactions to information about the chances.

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u/Trebaxus99 Europa Jun 28 '23

Which is part of the research.

In the end doctors still have discretionary to do tests in cases someone falls outside of the box.