On Nov. 23, 2005 I moved to The Hague from Washington, DC. This is my new Dutch life.


I'm Dumbfounded

A root canal treatment involves the removal of the nerves and "stuff" that have been contaminated by bacteria in the roots of the tooth. From my vantage point in the chair, it looked like the dentist was cleaning the canal out with little, metal pipe cleaners. Since the nerves are removed, the post-procedure pain should be minimal. My pain seems to be getting worse and over-the-counter pain killers aren't helping.

About 4:30am this morning, I woke to excruciating pain shooting up into my cheek and spreading around the side of my face. It actually feels much, much worse than the original tooth pain. So, we decided to call the dentist office in the hopes of getting some kind of on-call number for a dentist who might prescribe me some pain meds. It's doubtful that there's even such a thing as a 24-hour pharmacy in this country, but I felt like I needed to try.

The emergency dentist apparently quits taking calls after 11pm. After begging the answering service woman for some kind of help, she gave me the number of the only doctor available in The Hague at night (her description). I'm not sure if I talked to an assistant or an actual doctor, but we were completely appalled by his (her? I honestly couldn't tell) "medical" advice.

At first, s/he tried to refer me back to the emergency dentist, apparently not believing my story that they were the ones who gave me the doctor's number in the first place. Then s/he tried to shirk any responsibility for my pain by claiming over and over that it wasn't their field. Duh, I knew that, but I called a doctor who should be able to treat pain at the very least.

S/he just kept saying over and over that there was nothing that they could do (would do?). At this point I'm crying from frustration and helplessness and B- is getting mad at this cold-hearted, completely unsympathetic voice on the other end of the phone. After begging this second person for any advice on what I could do, s/he suggested I drink "a lot of strong alcohol." Liquor. WTF? What medical professional in his/her right mind tells a patient that she should drink?

My heart sunk, and I started to bawl. Drink alcohol. That's medieval. In one instant, I lost all confidence in the medical profession in this country.

B- started protesting, "I can't believe you're telling her to drink!"

To which s/he said, "I'm not joking. You're laughing and you think I'm joking, but I'm not."

B-: "We're not laughing. She's crying. We can't believe that you just suggested that."

I just told him to hang up.

At this point, we start contemplating just going to the ER to beg for pain killers. I feel like a junky, but it really hurts. So, I call my (US) insurance company to see if they'll cover the charge. This lovely woman, bless her heart, was my life line. Say what you will about American insurance companies not wanting to cover anything, this woman was more supportive than the supposed medical professional I spoke to here in The Hague. Her response to this predicament was to wholeheartedly agree that I should go to the ER. Then she wished me good luck and said that she hoped I feel better soon. People here didn't even want to talk to me. That's just wrong. I guess they don't take the Hippocratic Oath*.

Let's see, I speak to two Dutch operators/medical professionals whose first reaction is to try to pawn me off on someone else and then offer completely unsympathetic and harmful advice. On the other hand, I speak to an insurance claims agent in America who has every interest in me not seeking medical attention, and she's the most supportive of the lot. What the hell?

Since it was almost 5:30 by time we spoke to all these people and I'd be able to call my dentist at 8am, we decided that it probably wasn't worth our while to go to the hospital after all. We could imagine waiting ages and ages only to have to wait even longer for a pharmacy to open. I go back to my dentist in a few hours.

Expat resources are rife with cautionary advice to people seeking medical attention in The Netherlands. The prevailing sentiment is that the Dutch approach is to 'wait and see,' and they are especially proud of not prescribing pain relievers. Message boards are brimming with barbaric tales of Dutch doctors refusing to even run tests, sending patients home with extreme symptoms sometimes resulting in permanent damage that could have been prevented by a quick, initial response.

Contrary to what everyone thinks, healthcare is NOT free to everyone here. I'm not even sure if it's free to anyone here. B- pays the equivalent of a US monthly rate for his coverage. After our experience last night, it's doubtful that we'll receive remotely equivalent care.

The word on the street is that Belgian doctors are a million times more modern in their approach, so what's up with doctors here?

* I did a cursory search online for "Hippocratic Oath, Netherlands," and up came hundreds of references to a Dutch euthanasia report in which nearly half of all Dutch doctors admitted to giving lethal injections to patients who hadn't asked to die. Medieval. Shocking figures are revealed in a Daily Princetonian article from 2002. I won't get into my personal views on physician-assisted suicide, but the slippery slope that people fear in the US definitely seems to have emerged here. This combined with an already apparent tendency of Dutch doctors not to bother treating their patients, one can't help but worry that they might not bother to save your life at all.



Blogger soo doh nim said...

How is your pain now? Do you know why it hurt more later than before? I've had two root canals, and both did the trick.

One possibility might be that you have developed an abcess that was not resolved by the root canal. I once had one, and honestly, I ended up taking Valium to relieve the pain and the fever.

On the immediate question, I think that the best thing to do is to tell the dentist what happened, have him/her deal with it some more. But... before leaving, it's worth asking them what to do should a similar circumstance befall you once again.

What did the dentist say?

On the Dutch medical system, I don't know how quick I'd be to judge the merits of the U.S. healthcare system based on the callous treatment you received vs. the kind treatment you got from the U.S. counterpart.

I only say that because the horror stories about dealing with HMOs and other U.S.-based insurance companies are similar to the Dutch story you told.

I once dated a woman who was concerned about a recurrent, aah, woman's problem. It ended up requiring a biopsy as she had pre-cancerous cells multiplying among her cervical tissue. We knew full well something was up, but the idiot HMO phone nurse repeatedly advised her to smear yogurt on her genitals because that was a low-cost way to deal with what she thought was a yeast infection and thus save the HMO (Blue Cross/Blue Shield) some money.

Some treatment.

More important than any of that is how you are feeling now. Hoe gaat 't?

3:45 AM GMT+2

Blogger Doc Paradox said...

Jeez, how are you feeling now? I can't even stand getting Novocaine shots, especially with the electric shots of pain when the dentist wiggles the needle searching for the nerve. But you raise a curious point about physician-assisted suicide, because after all, if you're a bean counter at an HMO, euthanasia is by far cheaper than treatment where a terminal disease is concerned. From a completely bloodless perspective, I wonder how many euros those "nearly half of all Dutch doctors" are saving the national healthcare system? Hope you're feeling better.

7:56 PM GMT+2

Blogger akaijen said...

My thoughts exactly, Doc! If you didn't read the link, you really should. The 'talking people into dying' is the part that really freaked me.

Soo, I think you related that story to me before and I'm full aware of the pain of an American HMO. However, at least most doctors still try to help you, and a lot will even try to help you navigate your HMO. Even the moron pharmacists at CVS will help you on that front. There's a big difference between insurance companies not wanting to pay up and doctors being inclined to do nothing.

Perhaps not as alarming as the euthanasia stats, but prenatal care in this country sounds ass backwards as well. The gist of it is that they claim they don't treat pregnancy like an illness and instead want to help you enjoy the pregnancy. This translates to home births with midwives, and you have to fight your way into a hospital birth. For all this nonsense about it not being an illness, they also seem to treat you like a child who can't make decisions that affect your own body. Ef that! Should that time come while I'm living over here, we're going to commute to Belgium. No joke people do that.

FWIW, yogurt could help the right problem.

10:18 PM GMT+2


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