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 have nothing but praise for the NHS - I grew up in a country where private health care was the norm.

My GPs surgery is lovely, always manage to get an appointment if I need one. My DSs are very active and also accident prone, so we have had a fair number of trips to A&E over the years. DS1 is also an asthmatic - so we have seen many a paed.

We have excellent preventative medicine for severe conditions - my son has regular asthma clinics, his meds are reviewed every 6 months, he gets flu jabs and recently, a priority appointment (even though I called at 11am, he was seen 45mins later).

Seeing a paediatrician on a bi-annual basis is a ridiculous waste of manpower and I cannot think that those paediatricians are any more competent than our GPs that have more things to look out for than ear infections and tonsilitis - which seem to me to be the things our kids have had over the years (asthma excluded).

Because there is no cost, I think parents are more likley to develop mummy "spider senses", and know when a child needs to be seen, rather than taking them down to a paediatrician for every sniffle and being run through a battery of tests every time - thereby justifying huge mark up costs and not providing parent with reassurance at all, but justifying them coming back in 3 weeks with the next cold/sniffle for more tests.

CHildren are robust, and most mums know the difference between a serious incident and a minor illness.

RP said: I suppose my wider anxiety is simply about access to specialists

You can leapfrog into the system and people do it all the time (against socialist principles but leave that aside).

You have a worry, you go to GP, GP says they'll refer you & the wait to see specialist is probably 6 weeks; you ask for specialist's contact details; same day you phone consultant's secretary directly & they book you a private appointment within 7 days. You pay for the private appointment (80-200 quid), but it leapfrogs you in. If there's signs of a real problem you go straight back onto NHS treatment (free at point of use). Else you have paid to get peace of mind quickly.

So the system has some flexibility (or is prone to abuse, depending on your POV).

May assuage some of OP's concerns, anyway. Where children are concerned I find that GPs are pretty cautious, anyway.

I happen to know a 5yo who died of complications of an undetected cancer, btw. :( But (from what I know) nothing short of X-Rays to explain his irregular but chronic shortness of breath would have detected it. And nobody sensible would suggest that for a 5yo, methinks.

How weird that our teeth erode yet they're the things that are left in tact once we die. They use teeth to identify decomposed bodies!

shaz the NHS is free at the point of use which is what people mean by free. And we don't pay for it with our NI contributions - it's through taxes. NI is related to state benefits not healthcare.

One of the things i here most from people here is that doctors in the US are too quick to carry out tests.

Last week i took my DD to our GP here. She has had a cough that appeared when she had a cold, and hasn't gone away. He listened to her chest, and said it was clear. So then he decided she probably has asthma and gave us an inhaler mask. In the US, in my experience, yes, they'd have done more examinations, asked more questions, and seen her again before they made a diagnosis like that and started an infant on medication. i was seriously pissed off. She does not even have the outward symptoms associated with infant asthma.

I also had my life and fertility saved through cancer screening and treatment that would not have been available to me here. I was fortunate that I had a great doctor and that I had insurance - but also fortunate that I was there and not here.

Whereas my DH's first wife died after a gross misdiagnosis/dismissal by an NHS doctor.

I'm not trying to make sweeping generalisations about either system based on personal anectdote (although perhaps am trying to offer a counterpoint to some of the personal anectdotes posted above). There are great things about the NHS, no doubt, and the principle of free, universal healthcare is paramount. But there are great things about the US system as well. The tragedy is that we've all been convinced that we have to settle.

"hear", not "here".

"i watched my great aunt die from dehydration after a stroke because no one could be bothered to give her fluids and no one took responsibility"

I think what the NHS does very badly is basic nursing care, particularly for elderly people. I would rather money is spent on improving this than giving regular checks to healthy people which have no proven medical benefit.

I and my partner both have genetic illnesses which would have made private health insurance very very expensive or very difficult to get. The NHS does cover you no matter how chronic or serious your illness is.

I think the NHS is good at preventative health care for those with diagnosed medical conditions or risk factors.

I do think healthcare is better in some European countries - maybe others as well - but they pay higher taxes e.g. Germany, or get much less services than us e.g. Switzerland. If people here would agree to pay more tax, we could have better health care.

And with insurance and co pays people in America pay much more than we pay per person for quality health care than we pay for NHS care. Medical bills is the top reason for bankruptcy in America.

Pay privately for what the NHS doesn't do well/you want.

brdgl - The key point of access to good healthcare in the UK is your GP. If you take time to find a good one you can get very high quality care. If you don't have a good one, you can have major problems. I have experienced both.

A good GP should always do simple tests such as blood tests even if they think the parent/patient is being over anxious - should be happy to refer you on quickly to a specialist - and should help advocate for you to access specialist help you need. My DP and I now have an excellent GP and do get access to top quality care. But like any system,it helps to understand the weaknesses and what you need to do to egt the best possible care - and imo your GP is absolutely key.

Thanks, lesley33. I think I need to find a new one. He took over when our first GP left the practice, and he has a nice 'bedside manner' but this is actually the second time he's done something I wasn't happy about. (The other time, he wrote the wrong dosage down on a scrip for DD's paracetamol; the pharmacist caught it though.)
During my pregnancy, I was pretty insistent when I wanted something checked out; I felt like I had to be. I also recently made my DH ask his own GP for a few tests - prostate, cholesterol, etc. DH is in his fifties, and in the States, would have had those as a matter of routine now. His GP did the tests (and found the cholesterol was pretty high!), but told DH 'we usually don't test for these automatically'; DH said 'my wife lived in the States' and GP laughed. :)

I agree, lesley33 ! We have a fabulous GP who has been more than willing to make referrals when he suspects something is going on, and he doesn't take a 'wait and see' approach. Because we are sensible, and don't bring our kids in for every single sniffle, he trusts that when we bring them in, it is for something worthy of concern. When my son was suffering with frequent tonsil issues, GP referred us to an ENT and we were seen within a week of the referral. I haven't felt any need to see a paediatrician...my GP has been in business a long, long time, and it is clear that he cares about the children who come to him.

Of course there are issues and problems related to any health care system, but I have had no concerns about the level of care we're all receiving, and definitely haven't felt like I'm settling for substandard care.

I should add that we also have private insurance, but have never felt the need to use it here in the UK...we only keep it because we wouldn't be able to afford healthcare if we need it during our annual trip to America!

brdgl - Your DP GP doersn't sound great either. The recommendation in the UK is all people over 40 have cholestrol checked regularly - can't remember the interval recommended. You do have to ask for thoses tests though. If you have risk factors e.g. type 2 diabetes, GPs are supposed to try and persuade their patients to have regular tests. If not it is up to you to ask for them.

With prostrate you can ask for test at any time on NHS. There have been discussions about introducing a national prostrate screening service - where all men over a certain age would be chased to come for regular screening. But lots of the debate is whether this would improve health as screening leads to results that mean you get treatment you wouldn't have actually needed long term. And treatment often comes with side effects. Some argue it would improve health, some it wouldn't. But imo it will be introduced.

Try and find a good GP now when you are healthy. When you are really ill you won't ahve the energy necessarily to do this.

DD1 playing dizzy duckings eneded up with a greenstick fracture to her rist
DD2 dad fell asleep with her on the bed she fell of and had a greenstick fracture
DD2 wouldnt stop screaming and came out in what looked like a rash. I was admitted and the doctors due to the 2 previous incidents were concerned. DD2 was sent for a ct scarn and xrays. The doctors thought i had done something to her. After staying in hospital for 2 days she was diagnised with gastric reflux.
A year to the day that DD2 fell of the bed she stayed at grandparents. Their GD was in the bathroom having a shave and dd1 and 2 were bouncing on the bed. At her own admission dd1 pushed dd2 off the bed into draws. Que a&e and another greenstick fracture.

I was locked in the hospital, couldnt leave and ss called. I know the system works where i am. Although it was a horrible experience i completely understand why they done it.

DD2 had since fractured her elbow falling off a micro scooter. Luckily dd3 seems more hardy and has got to 3 without incident.

Just to say I know several people who had operations on the NHS where they had the same surgeon as they would have done if they went private - they had investigated having it done privately - and with the same waiting times. In one case the surgeon could see her more quickly on the NHS than through her work BUPA insurance. So private insurance isn't always best.

Also known one person have terrible neglectful nursing care in a private hospital.

What I have done is pay privately once to jump a queue i.e. for an MRI. Cost I think £400? Speeded up my treatment considerably. Not fair to people without money to do this, but imo you are much better using the NHS, finding a good GP and paying for extras where the NHS does fall short. For example, I know someone who paid for 2 weeks nursing care at a private home after an operation - had to stay in hospital for medical care after operation. Quality of nursing care he got was very high and cost I think about £1800.

HAving a great GP isn't always the be all and end all of great medical care though. Mil had a stroke a few years ago, ended up in the local General hospital, which had no neurologist! What good is that? We ended up forcing her to the private neurologist who used to be at the NhS General hospital who left because he couldn't give the patients the level of care he wanted, nor did they receive the specialist nursing care he wanted his patients to have.

It's an unsustainable system that does some things very well and others very badly.

Ah yes, the NHS and thyroid problems. Tick the boxes rather than treat the patient.

There are serious gaps in the NHS. There are pockets of substandard care and pockets of cutting-edge care. It is difficult as a patient to know what you're getting without really researching and understanding what you are getting..

I am grateful that the NHS is free etc as I grew up in a country where I would have to pay for healthcare, but as a pregnant women, when I read about the shortfall e.g. in midwives and obstetric consultants, the extremely high stillbirth rate etc I would prefer to have the option to pay for private services or at least have some contribution (e.g. a semi-private option). In my area, this option doesn't exist which makes the whole experience sometimes quite out of my control. And pregnancy, as we all know, is NOT an illness. I can't imagine what it must be like to face the post-code lottery when it comes to cancer care!

Some interesting posts on here especially the ones about jumping the queue/abusing the system.

I am also frankly gobsmacked at the care some of you are receiving no wonder the care in London is so frequently crappity crap you lot 'up North' are getting it all!!! (only joking)

Please tell me the bit about paying for a cab is not true? clearly they never saw 'sicko' no wonder we have no money for so many things
(our drop in wont see children under 2 they do at least tell you that when you arrive not after you've waited a few hours)

ironically we do hawever have better access to out of hours GP than we do to our own normal GP (although no public transport and I'm sure they'd laugh if I asked them to call me a cab) although when we took dd there and said we think it's measles GP said it wasn't (of course it was)

so you see it's good as in we can actually get seen at the OOH but bad since it's really inaccessible (for late night London) and bad since the GP got it wrong so on balance I think that experience was poor but had i gone with a correctly diagnosed ear infection/cold/whatever i would think it OK I guess

Galowee - Some hospitals are great, some aren't. Some are good in certain specialities and not others. The NHS is far from perfect and having a good GP won't take away all the failings. But it is one of the things you can do that will make a big difference to diagnosis, access to tests and referrals to consultants/operations.

When you have an emergency and are admitted to hospital a good GP doesn't have any input into this.

Leonie - I am treated for an underactive thyroid. My tests are just in the normal range. But my GP follows the protocol of treating symptoms which is recommended. I didn't push for this at all, he told me that although my test results were just normal, recommendation is to treat symptoms.

Not all GPs follow the protocols. It also makes a big difference how old your GP is and if he is older whether he keeps himself up to date with current protocols.

I too am treated for an underactive thyroid, I have had TSH, T4, T3 and thyroid antibody tests done at various times depending on need. I've had my dose increased when my TSH was within normal range based on symptoms alone. When my TSH came back as 0.02 my doctor said he was happy to keep me on that dose as long as I felt better. So in my experience I've been treated as a patient not a number. I don't doubt that other people's experiences are different, I'm just not sure it's an NHS v. other systems thing.

On top of it all free prescriptions for life

No its true, i know 2 single parents who were on their own with sick DC's. They rang the emergency doc who told them to get to the out of hours centre. There was no way they could get there so instead of them ringing 999 for an ambulance to casualty they sent a taxi on hospital account. I was also transfered from Gateshead to Sunderland casualty via taxi as 3 RTAS came in within 4 hours. There were no ambulances or staff available so they sent me to a different hospital

holidaysoon - When I lived in London in a poor area the medical care was crap. I now live up north. I can see a GP usually same day, but always next day. GP will phone me back at work if I have a query/question - usually after surgery. GP has pushed for and got quick referrals to consultants.

Even when I could tell GP thought I was being over anxious over the phone about something - turned out I was - saw me within 24 hours.

Always get any blood tests I ask for e.g. cholesterol/iron. I have had anaemia a lot in the past and sometimes when I think I have symptoms I just phone up and book in a blood test - just say GP suggested this - no-one ever queries it.

Had counselling at surgery, but told by GP if counsellor doesn't suit me I can come back and talk to him regularly.

GP often prints of lots of medical info for me. And will often do things to save me another journey e.g. offers to do flu jab rather than waiting for flu jab day.

Can you tell I love my GP!

Of course this still means someone can have crap care in hospitals. But with chronic conditions which I have, good GPs are essential.