AIBU to think I don’t need to go to the gynaecologist every year?!

[Watchagotcha]

I live in France but am from the UK. I was out with some friends last night - some French, mostly Brits who’ve been here a lot longer than me. We got talking about various medical issues, and it transpires that pretty much all my friends go to see their gynaecologist every year! I’m not sure what for: smear tests, when they are due; breast exams; and just “making sure everything is okay”.

Is this really necessary? What kinds of conditions might they be picking up on that I wouldn’t notice and go to the dr with myself?

Do I need to see a gynaecologist yearly?
YABU = yes you do, the gynaecologist might find something that needs treated
YANBU = no, don’t be daft, go to the dr if you need to and get regular smears when they are due

These threads enrage me. The NHS is a disaster and is killing women left right and centre by refusing to allow people referrals. I am so sick of all the 'and thanks to the amazing NHS and hospice staff who cared for XXX' when XXX could have not died aged 44 if the idiot nurse-instead-of-doctor misdiagnosed, or the harassed and under qualified GP gets into a standoff. You HAVE to stop being defensive when anyone suggests anything other than NHS worship. It's crap, it's a failure and its killing people in corridors, laybys and slow painful goodbyes in hospices, many of which were basic diagnoses.

The NHS is in a mess at the moment but it’s not because we don’t allow the needless annual examination of well women.

It's also not because you don't. If a woman wants an examination, she should get one. As someone else said, third world health are is vastly superior.

There is actually a good number of the top GPs in this country who disagree with routine screening due to the number of false positives and overtreatment. Particularly with mammograms. I don't have to make many decisions about investigations for cervical cancer where a woman has an up to date smear test but has symptoms. I simply refer and she's seen within a fortnight and the specialists decide what they want to do.

One issue with referral guidelines is that they are often written by GPs where as specialists should have ultimate control over who they want to see. I also regularly dismiss guidelines if between myself and the patient, we are unsure what is going on. I document well so that the higher ups don't have a go at me because it would be incompetent to note what I've noted and do nothing.

My best friend went to her GP to ask for a mammogram because her mother had just been diagnosed with BRCA breast cancer (the hereditary type). The GP refused because she was only in her 40s. Two years later she was dead from breast cancer. There are also disadvantages to underdiagnosing, not seeing specialists and being part of a system that tries to cost cut everywhere

So sorry to hear this. I think the problem is GPs refusing to refer, not the fact that we don't do routine investigations every year. And there should be more nurse appointments available so that if you can't see a GP you can see a nurse and get a referral that way.

It shouldn't depend on how pushy you are. Not same area of medicine, but my mother was told she couldn't have an MRI several years ago because the GP didn't want the cost coming out of their budget. She pushed and pushed and eventually they sent her to see someone to decide if she needed the MRI, instead. They said she did. So in the end it cost two appointments, rather than one. But it was only because she was pushy.

Anecdata on over diagnosis.

They used to start going smears much younger here (UK).

At 16 I was told I had CIN2 and had to go and have a bit frozen off my cervix.

Later they realised that cell changes in teen girls are normal, and especially common if they smoke.

The overdisgnosis and treatment was deemed to be doing much more harm than good and the minimum age was increased.

The treatment has caused me some minor issues. The experience of being told I was precancerous at 16 and having to be legs akimbo while a chap did painful things up my vagina was obviously not pleasant.

I know there have been arguments for reducing it again though.

All of this is a balance. They find out new things all the time. Doctors are not infallible.

The people saying they thing over diagnosis is well worth it to catch a few real cases are taking a bit of a simplistic approach tbh.

Interesting thread though.

Should say the reason for smear was as sexually active and used to go to brook up in London to get contraception, they did smears as a matter on the girls and women they saw.

I'm not sure what the age was for general screening.

The referral was to NHS who just did the procedure no questions asked as there was not the knowledge about normal cervix cell behaviour in teen girls.

As I say, anecdata.

I wouldn't want eg every 16 to girl in UK to start having annual smears because 1 in the X million might have a problem. This is the population Vs personal thing.

Person who said all women should be given a full check whenever they want, not viable on NHS. Also I get about reassurance you're healthy but that is not what NHS is for.

NHS being underfunded and driven into ground is a separate issue to whether frequent screens are a good thing for all conditions etc.

Certainly the age for screening was increased due to over diagnosis though.

A GP who refused someone with a moderately increased risk of breast cancer should be referred to GMC.

Here in the US, my GP discussed with me whether I'd like to start mammograms at 40, 50, somewhere in between, or not at all. We talked about the evidence together - as we do with any health issue I take to him - then decided to go with every two years from 40-50.

That takes time though. My appointments are all at least 20 minutes, and often much longer.

I had my first smear when I was about 23, before they changed the rules so that you had to be 25.

I had a panicked call from the doctor's surgery saying I had a cervical erosion (I think it's called something different now). I think at the time they thought it led to cervical cancer. Anyway, I ignored it. In fact I was really annoyed with them because they phoned my parents! (Oh we can't leave a message on your landline voicemail, but phoning your relatives is fine).

Anyway, years later I had polyps and the doctor I saw mentioned the cervical erosion, said they sorted that at the same time and did say it might have been the main reason for the bleeding, more than the polyps. But I was 40 by then, so it was hardly a reason to panic when I was 23.

It may be that 25 is too old, but now that women are vaccinated against HPV I guess protocols etc will change again.

The problem in the UK is that you deities doctors, they are above question. Especially is in the NHS. Whereas elsewhere a doctor is a failed engineer

Spot on and LOL, Aveline, therein my first cousin engineers, my own father and his brother would agree. 'Who couldn't go past diffy-q?' 'A doctor!' LOL. 'Who designs all they use?' 'Geordie to engineering, haha!' 'What do you call an undergrad who fails integral cal?' 'M.D.!'

Where I live, smears are recommended once a year and this is what I do (and I'm nowhere near 50). Better safe than sorry, in my opinion.

@Avelinebread I really don't think this is the case at all. I see far more scepticism around medical advice in the UK compared to other countries.

Oh far more here. When we have doctors from abroad they are often shocked that our patients come armed with their own research and opinions and will point blank refuse your advice. In some other countries, you'd be removed from that physician's books if you didn't comply.

I'm intrigued to know if theses countries where there are annual smear tests and gynae check ups have better rates of early cancer detection etc.

Like most people in the UK I have never had a routine check with a gynaecologist, and I have had three children, and a coil. The only time I saw one was when I had a burst ovarian cyst and had an operation (ie when there was actually something wrong)

The policy in the UK seems to be very much go and see a doctor if something is wrong, otherwise carry on. My 11 year old daughter said to me the other day that she was surprised we don't have annual check ups with the doctor or nurse. I told her you get one when you're born, at the age of about 2, and then not until you're about 45 (dh just had a letter through for a health check, though I think that was just a nurse). Lol.

'Who couldn't go past diffy-q?'

What's diffy-q?

bonbonours someone linked to the statistics above. The statistics relate to survival rates and France, for example, has better survival rates than the UK although not by much. It is a matter of interpretation to judge why that might be. Could be because of more frequent smears, or fewer errors in interpreting smears, or faster access to treatment, or different treatment protocols, etc.

diffy-q is a differential equation.

Diffentiation, then.

Diffy q wtf 😁

Many studies that focus on speed in diagnosis and treatment in other countries have a far bigger gap between how rapidly the lower social classes receive treatment and their wealthier counterparts. Whereas here we, have, for example, GP services like mine who only deal with homeless people to try and improve the inequality between the richest and poorest. I'm not sure about cervical cancer and France but how this might play out is that your average working or well supported woman might receive quicker treatment and diagnosis, but homeless women regularly die of advanced cervical cancer due to their lack of access to services.

Sorry that's bollocks. Lived in Bangladesh, Kenya, Colombo, Galle, Congo, Iraq after invasion and other places and if you have a kid, you go to the hospital, queue up and see a specialist paediatrician within a few hours. If you have a rash, you either pay a few quid to see a dermo or join the same queue and see one.

My Sri Lankan assistant asked for the day off because his arm ached from a cricket match. I suggested he saw our local general physiology doctor under occ health as live in a company facility and he said in Sri Lanka he would see an orthopaedic surgeon not a general doctor. There was literally nothing wrong with him that a brufen wouldn't help. And he comes from the poorest mc poorest area of the poorest region in the world, Tamil Nadu.

if you have a kid, you go to the hospital, queue up and see a specialist paediatrician within a few hours.

Not where I lived in Africa. There were about 4 doctors for the entire district (including one missionary doctor). I think one was the district surgeon and the others were generalists. In the capital you could take your child to the children's clinic at the national hospital but you would probably see a physician's assistant (Medical officer I think they were called?)

If you had a child where I lived, and they were sick, you went to hospital (which could be 3 hours travel, so you actually probably didn't, you either saw the nurse at the village clinic or you waited to see if they got better), and at the daily children's clinic you waited to be seen by a nurse or medical officer. If your child was really sick or had something unusual then you saw a doctor.

There may have been dermatologists in the capital but they never set foot in the district centre I lived in.