Is there an AMA American thread?

[upskilledotter]

I have so many (probably really boring) questions to ask of Americans (USA) but don’t know if a suitable thread exists.

Yep, spiders they were. We used to have them at the local small town milk bar. Happy days.

No NFL preferences to speak of, but for college football, GoDawgs! (University of Georgia)

We have midwives.

https://www.ohsu.edu/womens-health/brief-history-midwifery-america

As childbirth became more medicalized in the 20th century, OB/GYNs and nurse midwives started handling more of the deliveries, especially the high-risk and geriatric cases.

For me, it's Go Black Knights! (West Point). I live near there and have family members who attended.

Now my experience of Brits abroad is that not only do they constantly shout but they swear so much in completely inappropriate places, like family restaurants and hotel lobbies and water parks.

Sorrry if that sounds rude, but as a Brit myself it’s incredibly embarrassing.

Americans are incredibly polite by comparison.

A little more about primary care providers and insurance. In general, if you're employed by a business or organization, your employer will offer an insurance policy, which you opt into, and you can then choose any primary care provider who accepts that insurance. Like many people, I see a physician's associate or nurse practitioner for my primary care. I go in once a year for a check-up, which focuses on blood tests and preventative care, and I can make appointments as needed for specific illnesses and injuries. When I had shingles and needed to see someone the same day, I saw a different PCP in the same practice. Either my PCP or another doctor or nurse practitioner in the practice can prescribe for me. I see specialists much less often, usually on referral by my PCP.

I'm very happy with the quality of my medical care, but some vulnerability is introduced by the employer-provided medical insurance. My employer just changed my insurance on July 1. This happens about once every 8-10 years, and because not all health care providers accept all insurance policies, it sometimes forces patients to change doctors. Fortunately, I didn't have to change my PCP this time. I did have to change pharmacies, because the one I had been using does not accept my new insurance.

The multitude of insurance policies, all with slightly different rules, often creates confusion. For example, my PCP referred me to a dermatologist that she thought accepted my insurance. In fact, she made a mistake--he was affiliated with a hospital that accepted my insurance, but he didn't accept the same insurance in his private practice. My care ended up being more expensive than it otherwise would have been. Unfortunately, I found this out only after the first appointment (a biopsy), and I liked the dermatologist enough that I decided to stick with him for the treatment. I was very conscious of the expense, though.

I'm just offering these as two examples of why even financially secure, well-insured Americans sometimes seem stressed out about paying for health care!

Ok if you had a typical pregnancy who would you see for most of your check ups?
Would it be a midwife or an obsteatrician ?
Who would be most likely to deliver the baby in hospital ?

Sorry assuming it was a straight forward birth .

I just moved into an HOA and there are no rules controlling any of that stuff. We pay about $150 a month and in return for that they maintain and plough the roads, built and maintain the tennis court, and provide boat moorings, a beach on the lake, chairs and umbrellas etc.

They also are very social if you want to join in - they’ve arranged a party to welcome us, and there’s loads of other social events.

About 20 houses in our HOA which I think is pretty small as they go?

Also correct me if im wrong
Were most baby boys circumsised?
Was this a thing
Is it still a thing ?

It would be largely up to you. Most women opt for an OB, but some give birth with a midwife.

Yes, most are circumcised. There is some controversy about it, but there are some medical benefits.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3684945/

And for some, it’s a religious or cultural practice. And is a fairly small number of cases, it’s medically necessary.

Perhaps they differ depending on who is on the board. People that I know have had their holiday decorations policed, their outside paint coloures prohibited, their bushes and trees somehow declared in violation of HOA guidelines. For those HOAs, the benefits you describe are in place, but creating a homogeneous presentation is also a high priority.

Thanks its so interesting ro see the differences between the UK and US from personal experiance

One thing that no one has brought up is waiting lists. They’re rare here. Medical imaging, including MRIs and CT scans can typically be done in 48 hours.

Last year I was diagnosed as needing coronary bypass surgery on a Thursday and had the surgery the following Monday. Most specialists can be booked in a week or two, and if I’m sick someone in my medical practice will see me that day. It might not be my regular PCP, but someone will fit me in.

So for all of the complexity and expense, there are some things that work well here.

Nooooo not the Giants!! They're terrible!

I'm a diehard Ravens fan but not going to recommend unless you're into absolute agony (amazing teams that fall apart at the very end)

I'm going to suggest one of the NFC North teams: Chicago, Detroit, Green Bay, Minneapolis. It's a very good division, they all play each other twice, so lots of good games. They're some of the most historic teams so Old School Football. The Packers are owned by the local townspeople and wear cheese blocks on their heads. Good fun.

I have recently had a similar experience (not nearly as serious as a coronary bypass), but very fast from initial visit to PCP, then tests, then referral to surgeon, and then to the hospital for the operation, all within a two-week period in a non-emergency situation.

Also as I am over 65 and have Medicare, I don't have to have a referral from my PCP to see a specialist. This is especially helpful for othopedic issues.

As for the practice of midwifery, the laws and rules governing it are up to the individual states, so it varies. I don't know anyone who has used a midwife; I think using an obstetrician is the norm.

I am in Northern California and there were midwives in the OB practice we went to when I had DS

My sons are not. I am Hispanic and at the time they were born, it wasn’t something routinely done in my culture. Add to the fact that my husband is English, it is also why they weren’t.

Yes, a lot of baby boys are circumcised. Yes, this was also a thing in the past. It might be regional.

I am a fair weather fan of the NFC north. In order of preference and as long as they still have some hope of the playoffs, I support the Bears, then the Packers, then the Vikings. I then switch allegiance to the Bills, Pats, Eagles/ Steelers. I only reluctantly support the Vikings as they have a covered stadium.

I'll also back the Lions if they're doing well.

Very fickle indeed. ..

You would see whoever you could find to get an initial visit - a midwife or an OB accepting new patients.

You would do all of your prenatal care with that practice, ideally seeing all the midwives and/or the OB/gyns in the practice as the months went by. When you went into labour, you would call the midwife/OB office to tell them you were heading to the hospital (very few home births), and hopefully one of the members of the practice would be there when you arrived. Someone who had seen you during the prenatal visits would assist with the delivery.

I had 'two and a half' OB deliveries and one midwife delivery, out of five total. One was done by an OB resident in the wee small hours as the member of my OB/ midwife practice who was on call that night was doing a CS. The 'half' OB delivery occurred when labout went very fast and the baby was born just about half an hour after I arrived at the hospital. The OB ran into the room when everyone was cooing over the baby. A resident did the honours that time too.

I had either a room to myself or a double after each delivery. The food was great. All the rooms had impeccably clean ensuite shower and loo. I had both private and medicaid insurance, three private and two medicaid. Availability of rooms was the deciding factor in whether I got a private or shared room, not insurance.

The vast majority of Americans live in large metropolitan areas. Many of them live in apartments where you can hear your neighbours' TVs, smell their cooking, hear them singing in the shower or fighting, etc. Even those living in detached homes in the burbs will more often than not have done their time in college dorms, sharing rooms and communal bathroom facilities and dining halls.

Americans don't have the horror of everyone knowing their business that Britons often have, and generally do not consciously listen in to the conversations of others. Likewise, they are mostly untroubled by the gap of up to an inch on either side of public loo cubicle doors or the big gap at the bottom of those doors, and many do not pull down blinds or draw curtains at night.

Just to clarify wrt the different primary care specialties -
what is known in the UK as a GP would be a Family Medicine doctor in the US. A pediatrician is a separate specialty, focusing on infant, child, and teen primary care. There are sub specialties like pediatric gastroenterology and cardiology. Internal medicine specialists can practice as GP equivalents (family medicine) or focus entirely on hospital medicine (hospitalists), or branch into cardiology or other areas of special focus, and there are also sub specialties like ICU medicine for hospitalists.

Family medicine, pediatrics, and internal medicine are all separate residencies. Each takes three years after the fpur year bachelors degree and the four years of med school. Fellowships after a residency can also be undertaken.

Obstetrics/ gynecology is also considered a primary care specialty.