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.

Riven, funnily enough, I had the same impression in the uk. I couldn't believe that my colleagues at work would sneeze and then run off to the gp (because it was free). In the us, you don't go to the doctor unless there is something really wrong, because it costs so much! I do agree, that people here (in los angeles) seem to get overly agitated about their kids' health for the silliest things). I had the school nurse in a tizzy last year when I mentioned that ds had a fever of 104 and I hadn't called the pediatrician. I told her that ds gets high fevers regularly and it probably wasn't a sign of anything serious and pediatrician probably wouldn't call me back because he knows that ds gets high fevers. In the end she insisted I call, which I did, but as predicted pediatrician didn't call me back. Next morning, I took ds in (as fever hadn't gone) and it turned out to be appendicitis, which ironically is not usually characterized by a high fever.

Revolting, yes, on approximately the same income (I was a poorly paid architect) in each country, I was paying significantly more in income taxes in the UK than in the USA. That of course, doesn't even begin to take into account the higher sales tax in the uk and higher cost of living. I lead a much more comfortable life here than I did in the UK on the same income. (It helps that I am in Los Angeles and it's sunny every day).

I apologise, I guess I'm just not sure why it's necessary. However, I can understand that the Uk system would be strange if you've grown up with being checked by a paediatric doctor over everything.

But I still think YABU, mainly due to calling this system negligent. I'll be nice though and say firstly, check if the type of cancer was a genetic one and mention that to any future MW. Secondly, there are some very good private medical insurance companies in the Uk, check those out and see if they will fund any private consultations with paediatric doctors for you. And good luck for you and your future little ones. I hope they are ok, honestly, childhood illnesses are very scary and I do understand your concerns after the history.

sofia my son has an annual review too - I call it his private MOT!

Riven - sorry I wasn't clear, that's kind of what I meant. Having learnt everything I can about general childhood illnesses I am quite confident in my abilities, but also very certain that I wouldn't subject my children to any unnecessary tests. DS had/has extreme needle phobia and this has made me very wary about any tests, even ones that he does need. Hence my stance on this subject - and why I just don't get it, I suppose. I am sorry to hear about your DD - I knew she had medical needs but I didn't know much else.

To answer someone's comment/question...Unfortunately not everyone is perceptive or smart or educated enough to notice if their child needs medical attention. The point of an annual checkup is for a doctor to pick up on these things when the parent doesn't. The "luxury" of having this extra check is not available on the NHS because there simply aren't the resources to do so. The english (and many other europeans) have chosen this type of system and choose to pay extra for it. The Americans, for the most part, have chosen a different type of system. Both systems have their failings. In the uk you have to be competent enough to recognize your own illnesses, while in the usa you have to be competent enough to maintain your health insurance. There are people in both places who are simply not able to do this and neither country does a particularly good job of helping those people. Not sure how you do help those people without forcing them to do things and neither the english or the americans are into forcing citizens to do things in their personal lives.

Not read all the thread, but I do agree, to some extent, that there are gaps in the care of children.

I had to take DD to A&E when she developed an all over pinprick rash (a reaction to her HibMenC jab). Unfortunately the nearest A&E didn't have specialist paediatric cover and the consultant who saw her had never even heard of the HibMenC jab - rather worrying. He also advised me to give her (at 8 months old) an antihistimine only suitable for people over 12 years old. So my experience of non-paediatric care within the NHS was pretty abysmal. Now if there's a problem we always go to the Children's Hospital where very doctor has paediatric training. I guess we're lucky to live within a short drive of such good care.

There are things you can do - either go private, or hopefully have a good enough GP (never guaranteed) who will be able to refer any children to the right specialist.

My child's cancer was identified by her GP.

I was a member of a forum for parents of children with cancer throughout her illness.

I thanked God for the NHS when I read the posts from my friends in the US.

They had set up fundraising events to pay for their childrens treatment.
They posted questions about which drugs they should choose, which were more affective but also which were cheaper, what should they do next?

I took my child to the hospital and she was given tens of thousands of pounds worth of treatment without question. One of her drugs cost 1k per vial. No-one told us to keep it in the fridge and it had to be destroyed - she got another one.

1k was more than we earned in a month. What would we have done if we didnt have the negligent NHS?

She stayed in hospital for the majority of 2 years. How much of that would have been covered by private insurance? Insurance that we wouldnt be able to afford anyway.

There are problems all over the world identifying Childhood Cancer because it is so rare (although it doesnt seem that way). You could see a paed who has never seen a case of certain cancers in their entire 40 year career.

I think you are being unreasonable.

You DO have the option of private care and you could see a paed anytime you wanted. Why dont you do that?

American "healthcare"

my sister got her kidney transplant paid for by Medicaid
but they will not fund her anti rejection drugs (to the tune of $26,000 per year)
see if you can work out what is happening to her?

I a a bit confused about the annual check thing too.

If your child is checked in April and everything is fine. How does that help if they develop neuroblastoma in July?

As the OP said, her sister's cancer was detected though luck. If the appointment had been 3 months later the outcome may have been very different.

Hey Reindeer, it's okay :) I did ask to have some sense talked into me!!

Yes, I think the cancer is genetic because my DSis is not the only child in our extended family to have had that particular form of cancer, and also because she herself has to go back to be reviewed by her old oncology unit when she wants to have DCs of her own - they have told her this.

I will go through it with MWs etc when/ if I get pg.

I suppose my wider anxiety is simply about access to specialists. See, people keep saying that if you are ill, you go to the GP, get referred to a consultant, and then it's all fantastic. Obviously this is just my experience, but I have really not found that. I went to the GP 4 times before they took me seriously that I had a kidney problem, it took over a year and a half to get on a waiting list for surgery even when the consultant said that waiting might be dangerous, and when the operation went wrong and I was in too much pain even to lie down, I couldn't just be readmitted to hospital - I had to see a GP who referred me to a surgical assessment unit in the hosp who THEN referred me back to the consultant who did the surgery. But that took 24 hours. Given that I had a post-surgical complication, I genuinely worry about what could've happened there. I am supposed to have had another operation to fix the pain I am still in - last month - might be some time in November now but they don't know :(

Sorry to whinge - !!! - but I just worry about having a sick child in a system like this, seeing what my parents went through with my DSis.

But I fully appreciate I am paranoid have an idiosyncratic experience!!

You can have regular checks and tests, whatever you want really if you're prepared to pay for it so I don't see your problem.

OP, I think YANBU TBH.

I agree with whiteoleander who said "I think YANBU entirely and have often found this very odd as well (without your cultural background).
But as you will see from the responses you will get, people in this country are totally brainwashed into thinking our system - where there is no routine oversight of children's health by a qualified expert - is not just adequate but excellent. People get very emotive about this. Similar to maternity care. It's all about resources and in a state funded system of healthcare, they are not sufficient for this kind of gold-standard monitoring.
You can see a private paediatrician which I have done on occasion. If just for your peace of mind, I would recommend it."

It seems the system may vary as to where you are, ive never had a problem getting access to specialists.

We have loads of hospitals. The RVI, Freeman, QE, Sunderland Infirmary and Dryburn hospital. Depending what you have you are refered to one of the hospitals. I had a lump in my neck removed for a biopsy at the daysurgery unit at the QE. When dd had a earring stuck after a fall she was sent to ENT at Sunderland. When i had to see a specialist for a weird mole i was sent to Dryburn.

I dont know if this is how the rest of the country works.

I've skimmed the thread.

Some of the original posters concerns: regarding no regular paediatric follow ups probably arise from a lack of understanding about the difference in medical training / structure between the two countries.

Office Paediatricians in the US don't actually have that much training (3 years post internship). They are not 'paediatricians in the UK sense of the word whereby people will do 8 post registration years of training. This is true of lots of the medical subspecialties (my own anaesthetics - 4 yrs US, 7 years UK). This means that if we can get licensed to work there (even for short periods of time) we are sought after because as a 'generalist' we work at a higher initial level. Most of their specialist Paediatricians will go on to do further work/ study ++ but many of the office ones don't. They essentially perform the role for children in the community that a UK GP does.

UK GPs usually do 6 months of paediatric training and it is focussed on development, treating minor illness, spotting other abnormalities and flagging those up to their tertiary care (hospital or community paediatric) colleagues who have undergone more extensive training. GPs retain children as core to their practice unlike family physicians in the US. There has been some discussion here about introducing specialist paediatric GPs but so far it is felt to not be a positive step forward especially as it would cause problems with implementing OOH care effecively. GPs in this country, although much denigrated are actually a highly skilled and respected bunch.

In addition in a system whereby as an office paediatrician you get income from seeing kids regularily the system of routine examinations makes most sense. However the evidence to support that such routine examinations are useful is actually limited. That wonderful maxim anecdote x 1 does not equal data holds true here regarding your sister.

In general the role of 'routine' checks is much questioned in the country as many screening tests also have negative and expensive consequences and in order for a test to be as it is implemented it has to be shown to be useful in that it detects a treatable condition, for which an effective treatment exists and doesn't cause harm to others or cause many to have needless investigations. This is not my area of expertise and I can't find a good summary of the points I'm trying to raise elsewhere.

I appreciate that some people will criticise me for defending the NHS but I genuinely believe that as a low cost system it delivers good quality care, mostly, to the whole population. The US system in my opinion delivers excellent care to those who can afford it and substandard care to those who can't which an old socialist like me finds very distasteful.

fedup yeah I probably will take out private health ins, not for me but for any DC I have. I guess I was just mulling over the wider system and whether others feel there are gaps - that's why I posted ITFP.

gasman that is very interesting about the different levels of qualification, thank you :) Yes I know one child's illness maketh not a general rule..... Although obviously if you are the parent of that one child, it comes to seem disproportionately important!

GPs have been a paediatrician for 4-6 months as part of their GP traning so should have some skills.

I do think the person best able to look out for the health of a non verbal child is their parents. A friend of mine her child had a very rare form of cancer when he was 4 months old. She couldn't put her finhger on it but knew he wasn't right, took him to t GP the next morning, he was admitted to hospital by lunchtime and was then transferred to a specialist hospital that evening. So when a child is very ill they move very quickly.

Haven't read everything so sorry if this has already been mentioned, but health visitors are another tier of the checking system here-fir the first five years you can see them whenever you want to for weighing measuring and healthcare advice. At certain key times they'll invite you in for check ups, eg six months and two years but if you felt inclined you could attend clinic weekly.

I'd be surprised if any UK insurer will take the children without the parents

the US system is fine for the able bodied and the working - my sister never had insurance as she could not hold down a job while on dialysis and hence is at its mercy now on what they choose to provide for her, or not.

Just to say that I'm leaving the thread now but thanks to everyone for posting; this has given me a lot to think about and made me feel rather better about entrusting my still hypothetical DCs to the NHS.

yabu, because both systems have their pluses and drawbacks.

It's funny because I grew up in the USA (American by birth) and I never saw a ped from age 5 to 15; my mother did get told off for it, mind. though she protested that I was "never sick".

The idea that the US approach somehow leads to better medical outcomes is fairly debatable. It certainly leads to lots of scares, interventions and extra diagnoses and tests, but the USA doesn't actually do that well on the league tables for disease prevention. This is especially depressing reading, and specifically address the question of "over use of health services".

MrsDV we have annual reviews to see if DS has developed a certain type of diabetes, liver/kidney checks to see if there are enlargements/tumours, x rays, blood tests and height/ weight checks to see all of the different aspects of DS's condition and the overall affect on his health. He has a higher risk of cancers which may or may not be picked up on during his annual review, but then again his annual review is so much more than that, and we see our consultant a lot so if anything did occur it would be picked up on.

Revolting please don't leave the thread, I think it's an interesting debate, yes people get emotive but I find I always learn something from threads like these, even if it doesn't change my opinion.

I have a (very lovely) friends fro the US. She too was uncomfortable with the UK system with its lack of annual check ups. o she has a private GP and pays a lot for her annual MOTs.

She was however very grateful for the NHS care at A&E after falling over whilst drunk, bruising her spleen and cracking a few ribs.

So, like her, you can chose to pay for private GPs / paediatricians with all the check ups you like - but the NHS will be there if you need it in emergencies.

If you want them to see a paed you can take them to the childrens hospital a&e.