To worry about not being able to see a paediatrician on the NHS?

[RevoltingPeasant]

Okay, so talk some sense into me, please.

I grew up in the US with private health insurance (obv). My sisters and I saw a paediatrician until we were in our late teens - in fact our 'family doctor' (GP) would not take patients under 16. I think this is normal in other countries as well - my German friend says the same.

We also got check ups really regularly, at least once a year but often more, and especially when we were babies. In fact, my younger sister's extremely aggressive abdominal cancer was first spotted when she was still pre-verbal, just during a routine check up. A few more weeks and it probably would have been untreatable - we are super lucky she lived.

DP and I are planning a family now, so I'm looking into these things, and have been told by friends that it's not normal to take DCs to a paed in this country (except in serious cases in hospital) and that check ups aren't regular if there aren't obvious symptoms. I find this worrying in a general sense, and also because with my family history, there is an increased chance that any baby of mine will develop that form of cancer.

Am I just being extremely precious?? Suffering from culture shock? Or this is genuinely a real gap in the NHS? It just seems.... negligent to me, not to give children routine preventative medicine, especially when they are too young to verbalise properly.

I think the medical care in some other European countries is better - and that shows in the stats. But in the UK people don't want to pay the high tax costs some European countries have e.g. Germany and they want a much wider range of services than countries with lower taxes e.g. Switzerland.

I actually think for the amount of tax spent, the NHS is generally good value for money.

But I totally agree that in the UK it is very much up to you to be pro-active about using services. Although there is some chasing of people in preventative medicine e.g. cervical smears, mammograms, many people in the UK are hugely resentful of this minimal chasing up. National institutions reflect National culture and there is a huge antipathy here to anything that smacks of a nanny state.

But if you are pro active and if you have it use money for private care inthe few aresa where the NHS is much weaker, then I think generally you should have a good experience.

I do think in the NHS having a great GP makes a massive difference. My OH had to see a consultant and wanited 3 weeks. When we saw him he made a remark that our GP had been on the phone to him every few days demanding when my OP was going to get seen. The Consultant our GP had referred to ended up being amazing and easily the best I have ever seen. He spent 3.5 hours that first appointment doing a thorough assessment and making it clear he was using WHO best practice protocols.

So spend time getting a good GP. Ask friends and neighbours. This will help you get the best of the NHS.

But you didn't read what I wrote correctly you chose to accuse me of 'xenophobia' aka racism because I pointed out that the US is hardly known or for that matter successful at preventing it's own obesity crisis a cheap shot and actually pretty offensive.

Incidentally I never said you were American or indeed assumed you were just used the phrase 'come from' you are the one who took it to mean genetic origin or passport holder or whatever

very convenient to leave the thread after you've been so offensive

Thanks lesley - yes in my own case, my kidney issues weren't helped by my GP saying she 'wasn't bothered about' the dull, persistent pain in my side!!! I have a better GP now, although even now, it takes about 3 weeks to see him for something non-urgent (fertility issues, referral back to work after surgery, etc). I am sure you are right about the individual GP being key.

"I feel that because we have a health service which is free at point of use GP's are mainly there to shield specialists from the general public."

GPs are there to diagnose and treat more manageable illnesses and refer on for serious illnesses. Given the amount of people who demand anti-biotics unnecessarily for colds, if there wasn't a screening system, patients would be going to see specialists all the time for very minor medical matters. For example, a dermatologist for ordinary skin tags or minor dermatitis.

I'm not prepared to pay tax for this. If you want access to any specialist on demand then pay for it privately. But private insurance will still not give you access to a specialist when you want - they will screen as well to see if you need it.

"I feel that because we have a health service which is free at point of use GP's are mainly there to shield specialists from the general public."

It means that specialists precious time isn't taken up with trivial complaints, meaning they can focus on cases which actually need their expertise.

TBH, I'd be concerned that a paediatrician whose working time was mostly taken up doing routine checks on healthy children wouldn't develop the expertise needed to diagnose and treat more serious and rarer illnesses, as they'd be seeing so much less of them than paediatricians in the UK.

FWIW GalloweesG GP's used to describe themselves as gatekeepers (although I wonder whether they were referring to keeping patients away from the hospitals or the specialists )

shagmund that is an interesting point. iirc, the paediatrician we used to see worked half time in his surgery and half time at a local hospital, so I think he did have exposure to both.

But I see what you mean, such doctors could easily dwindle into being glorified HVs, I guess. Food for thought. This thread has definitely made me feel better about GPs and children.

I think shagmundfreud not all community type paeds have attending rights at the hospital so basically some have specialist training but work in the community some work in both settings and some only in the hospital

RevoltingPeasant, my chldren were born in London and we then moved back to the usa when they were 3 and 5. While living in the UK, I flew back to visit family twice a year with the kids. Having experienced both systems, I completely understand your questioning and current experience. I personally prefer the American system (with all its problems and warts), but don't want to get into a slinging match with anyone about it, just wanted to offer advice. I lived in a poor minority-heavy area of London where there was a severe shortage of GP's, so I had a period where I did not even have a GP (one was supposed to be assigned, but it is a lengthy process). Ds was quite ill and I was pregnant during this period. Luckily, I discovered a hospital that had a pediatric emergency where nurses and doctors (pediatricians and specialists) specifically trained in pediatrics were on staff during working hours. My ds was very sickly as a baby (still is) and I ended up bringing him to this hospital whenever he had a problem. The care was much better than my local hospital (and obviously couldn't bring him to my non-existent gp). I also, eventually moved to a neighborhood that did not have a shortage of gp's. In addition, I took my children for annual checkup's to a pediatrician in the us. I knew I would be eventually moving back, so made a point of following the American vaccination schedule as well. I received no preventative care in the UK at any time in the 7 years I lived there. However, as an aware mother, I was able to get the specialist care my children needed, by asking for it in the UK. (this of course, would not have helped your sister).

In summary, you need to understand the limitations of the system and work around it to get what you need. I currently have an HMO here in the USA and it is much the same as the NHS system. The GP (ours happens to be a pediatrician) is the gateway to any specialists. In addition you have to use doctors within the particular group. Currently my ds has developed a severe speech impediment (probably due to his migraines and other personal events last year). GP/pediatrician did not notice it and it took me demanding a referral to get one (he was eventually assessed as being in 1st percentile, it was so bad). It then took the HMO 4 months to come up with a speech therapist in my area (still have to drive an hour each way twice a week for speech therapy). However when ds got appendicitis last year, he was immediately diagnosed by gp and in the hospital having it operated on within hours and I didn't have to pay a penny (other than the cost of ordering in a decent meal...hospital food is horrible in both countries....ds tried one sip of the hospital broth they brought him and asked for a LifeStraw to finish it as he was sure it was in fact dirty river water).
My advice is to be vigilant, use the internet (wisely, not obsessively) and remember that the NHS has very limited resources (even more so in the big cities) and has to make choices about allocating them. This means that generally urgent, life threatening things will be taken care of, but non-urgent issues could be ignored or greatly delayed. The problem arises in what is considered urgent or non-urgent. It is your job to bug your gp if your child has something that you consider urgent, he/she doesn't.

Good luck.

'Tis not just for paeds and works the same way in parts of Europe too

I do wonder if all those health checks you get with private medical insurance in the US are so that the patients feel that they are getting their money's worth. If you were paying for it but were healthy and not needing to use it, would you feel that you were getting value for money?

Sorry i have dodgy computer and kids arguing over laptop (so much for preventing obesity in this household) my latest post was about specialists GPs community docs and hospitals

sorry my kids are arguing over crisps [shame]

RevoltingPeasant, I grew up with similar health provisions as you (not in the US) and I feel the same as you about the NHS. I do the same as your German friend does, go back home for treatment and regular check ups by a paediatrician. There is a lot that is good about the NHS, certainly the fact that it's free and available to all, but IMO preventative medicine isn't its strongest point.

SofiaAmes - I understand your real concern with GPs in some areas and the inpact this has on your health care. I lived in London in a very poor area and all the GPs that would accept me as in their catchment area - 3 practices - were ime absolutely terrible. The NHS and access to good care rests on your GP, so the quality and commitment of your GP is hugely important.

I have found great GPs in poor areas. But I also find GPs in well off areas tend to be less over worked and it is much much easier to get appointments. If I want to see my brilliant GP I usually have to wait a week. If I want to see a perfectly fine GP in the same practice I can usually get seen that day or next day.

So with more serious or ongoing issues I wait for my brilliant GP, for every day stuff I see anyone.

So Sofia
despite what revolting says about me (honestly she is wrong and in fact I've been here for years and been on lots of threads with you under another name) do you feel that recently your ds has had a good experience from the US system? because the long wait and the long drive and the failure to recognise doesn't sound that fab for him TBH it does in fact sound exactly like the UK system

And I am honestly not being confrontational here (I am half expecting you to say there are other reasons why you like the current system) of course not having a GP is a total failure of the NHS.

(I think I know the hospital in the UK you are referring to very well BTW)

Regular check ups reassure patients. But where there isn't an evidence basis for them they do lead to over treatment and side effects including death. I can't remember what it is, but I have seen an estimate done by WHO which set out the proportion of deaths in the USA and other countries because of over treatment - it was much much higher in the US.

Over treatment is not just about resources, it does lead to side effects the patient wouldn't have had without it. And it is a result of the defensive medicine practicised in private practice in America.

My son was brushed off by our GP for weeks. Instead of ordering blood tests when I said he was pale (amongst other things) the Gp pulled down his eyelid and declared him to be "not anaemic" which was clearly guesswork as a week later he was in Addenbrookes with a diagnosis of Leukaemia. It was the practice nurse who eventually ordered blood tests to be done. By that time my little boy was bruising constantly.

I think that the hardest part of the NHS is getting into the system, once you're in the wheels start turning but getting "in" is a nightmare.

So do forgive me when I prefer a referral to a brush off.

Thanks Tinsey and Sofia :) Sofia, so sorry to hear about your DS's issues, that must be very scary and hard to deal with.

I think it's also often small cultural issues that create these feelings of unease, you know? I have spent a fair amount of time in hospital recently, obv feeling sick/ tired/ anxious, and although it sounds princessy, things like not being allowed to decide to walk to a scan (had to be in wheelchair, hospital policy) or being made to wear hosp gown rather than my own, or not being able to see a surgeon for 24 hours when an operation went wrong, all those things add to a general feeling of anxiety about being trapped in a system you don't understand.

I think those who say that you have to learn how to manage the system probably have it right..........

Gallowee- Some GPs are like this unfortunately. I know my GP would have ordered blood tests. The problem with the NHS is that your care is very dependent on the GP.

The only good point is that it is easy to change GPs - if you can find a good one near you though.

I do wish crap GPs is something the NHS would tackle. IME the terrible GPs are well known. Before I found a good GP I remember being in a GPs room getting poor medical treatment with a nurse present. When the GP left the room to get some equipment the nurse actually said to me - you know you can change GP?

Gallow how horrible :( I missed your earlier post but sorry to hear about your DS - having to fight to get a referral in those circs must just be teeth-clenchingly awful. Hope he is being looked after properly now.

Primary care is done by GPs in this country. You will also be under the care of a midwife team up intil just after birth and then of a health visitor for 5 years. If you have any concerns (or if they do) you can be referred onto someone with more specific knowledge who can investigate more thoroughly and, furthermore, you will not have to worry about whether they take your insurance or not.

My GP at the time was practice lead. He retired shortly afterwards and we have a better one now. I do wonder if we have better treatment because we "know" the system and have very close ties to the Hospital doctors.

My Mother has been fobbed off for months by the same practice, she has constant pain due to arthritis. I went with her to the GP and requested a referral to to the pain clinic. Funnily enough my mother didn't even realise there was one. She has been referred to the pain clinic and the arthritis specialist. The doctor gave me a face. She was getting away with fobbing my mum off and was most put out when she realised that shed been snookered.

In countries where you can see a paed for everyday care you also usually pay private health insurance premiums for the privilege. tbh have dealt with both systems and still really don't feel it is necessary to have a paed on call for minor or routines issues, comforting though it may be. The benefits were that he could do xrays and routine tests on site, which often UK gp surgeries aren't equipped for, and had more focussed experience of patients under 16 than a gp of same years' experience but no more so that a gp with more years of practice or who has specilaised in paediatrics.