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

Women’s reproductive health isn’t taken seriously in the UK. I would have welcomed such a service. It’s also relevant in later life. As someone with unusual and debilitating menopause related issues, I had to really press to be referred to a specialist clinic. GP was clueless (practice nurse less so).

You can't just "go to a gynaecologist " here in the UK. Surely you need a referral here. From a GP. Which means they have to think there is a reason.

I am also in France. Firstly yearly gynecologist visits are covered by social security and are the national recommendation, so nothing to do with a money making scam.

Secondly, the U.K. has a GP gatekeeper system. In theory patients see GPS very regularly, the GP recognizes their medical needs early on and refers appropriately as well as having a holistic picture of a patient’s health needs. In the reality of an underfunded NHS almost none of this works, bit in theory it’s a good system. However, it is not the only system. Other systems, like the French one, allow patients direct access to specialists. I see a gynecologist and my DCs see a pediatrician, etc. I only go to my GP for routine issues or when I don’t know what is happening or why. There is no evidence that patients are particularly wasteful about using expert doctors in such systems.

As for your question OP, I go every two years just because it is a hassle to get an appointment and because I don’t have any gynecological issues or use contraceptive treatment (for contraceptive treatment on prescription one would need yearly appointments anyway to renew the prescription).

I'm in CH. the insurance covers every two years but we go annually. Why wouldn't we? I don't understand your post OP

Why do people do it? As a form of prevention

What can be prevented by an annual check up?

Earlier detection maybe I could understand but preventing? Obviously I'm not a doctor, what am I missing that I might be able to prevent?

I think it's fantastic, if I could afford it I'd definitely pay to do this annually.

Why wouldn't we? I don't understand your post OP

I think there is a balance to be had. It is not good for mental health to assume our health is liable to catastrophically implode if we don't keep checking them. Equally we shouldn't be totally avoidant of taking a closer look at out bodies.

As someone who had had breast cancer, it is a fine line and one I sometimes battle with. Not to obsessively keep checking myself for instance or become totally avoidant of even looking in the mirror. So I make make myself check, once, every time I have a bath and I don't let myself keep checking if I think it all seems ok,

What can be prevented by an annual checkup? Errh early detection leads to prevention. A doctor may notice a symptom a patient has missed, a patient may be more likely to mention an issue if they see their doctor regularly, screening is offered, information is provided, etc. the whole point of public health policies is prevention of ill health through education, screening, early detection, etc.

Errh early detection leads to prevention.

Strictly speaking you can never really know. Some things may spontaneously heal without treatment.

It all seems very paternalistic to me. However, some people love going to the doctors and all the attention it affords.

I'm not sure who else you would consult if you had a suspicion about a lump in your breast. GPs don't regularly do breast examinations so presumably are less used to how they feel.

In the UK you go to your GP. It’s happened twice to me and I have had a fairly speedy referral to hospital. Women over 50 are called for a routine mammogram at hospital every 3 years, so you’d already be in the hospital system if anything wa wrong. Presumably, if an independent gynaecologist find a breast lump, they then have to refer you to a separate hospital in much the same way as would a GP.

Errh early detection leads to prevention

Maybe prevention has a specific medical meaning, if something can be detected I would take that to mean that it hasn't been prevented as it's already there. But as I said I'm not a doctor.

The time between checks is all pretty arbitrary too. I've been checked and been apparently fine and then had a cancer detected 3 weeks later. Does that mean I think checks should happen more often? Not particularly. I tend to take a more philosophical view. If there is something I'm worrying about I take the appropriate action. Otherwise I aim not to worry. If something gets missed well everyone has done what they reasonably could. Being scanned and biopsied everyday would do more harm than good.

"I thought in England we are struggling to train enough doctors, how are all these other countries training so many, are they all fully qualified doctors?"

The UK has fewer doctors per 10,000 population than almost every other EU country
This obviously affects the type of service we can get
Yes, they invest money in training them, free grants etc
it's a choice - the UK is richer than some of those countries

https://www.telegraph.co.uk/news/politics/11271216/UK-has-fewer-doctors-than-almost-every-EU-country.html

I am used to having internal pelvic exams annually from the age of puberty (being delivered as a part of school health programme

Say what now? No way wou l d I have consented to that at that age, I would have run and hid. I'm so glad that not the norm here. Traumatic isn't strong enough to cover how I would have seen the situation at puberty age.

Were they done AT school?

Never seen a gynecologist. But I shy away from a lot of medical stuff due to fears and full blown phobias.

I used to go every year for preventive exam and get smear every year, so i was shocked about 3 years for smear.
However, even with that UK still had lesser % of deaths from cervical cancer than where I am from. It looks like UK is better in treatment.

I haven't been to Obgyn for half a decade My GP did some blood tests which included ovarian cancer screen afaik and I have no issues so yeah...

The question to ask is are people in countries with regular health checks for otherwise healthy people any healthier? The way the NHS is funded means there's a high bar for screening. It's expensive so must be shown to be cost effective. A healthcare model funded privately or through insurance will have a different bar and might well choose lots of screening because it generates income.

The trade off is 'incidentaloma', ie. finding conditions that are benign and subjecting people to unnecessary and stressful treatment. Screening programmes are also a very real problem for people with health anxiety so the pros, ie. actually saving a life, must outweigh the cons. It's a fact that most diseases will ultimately present with symptoms. It's rare that things are discovered by accident and lives saved as a result, despite anecdotes.

I think the NHS has it about right. Although I think I'd add chicken pox vaccine to our schedule.

I'm curious about treatment if things are detected. I've had an ovarian cyst, I was only aware of it when it burst, treatment was painkillers and time. If it had been detected earlier, what would have happened?

I go every 2-3 years ( in the U.K., to the GUM clinic or similar) but if I have any concerns etc I just nip up to the local NHS Sexual health clinic, or the GP or nurse practitioner at my docs office.i get a smear every 3 years usually too.
I do think UK women need to take a bit more charge of their health in general, but my US friends who go to the Gynae every year are only doing it because they have health insurance and can - I don’t see the pout myself if all is okay, it’s deffo a money making exercise from their doctors... the same reason they get prescribed a ton of pills for no reason ( Valium for flying, with no actual anxiety, Oxy for a sprained knee instead of recommended an over the counter milder pain killer) it’s all about the $$$$

yearly gynecologist visits are covered by social security and are the national recommendation, so nothing to do with a money making scam.

Who made that recommendation? The French College of Gynaecologists?

In the UK recommendations for smear tests and mammograms are made by NICE, based on epidemiological data.
If more lives are saved with annual smears, they'd change to those.
That's why we don't have annual physicals either - they pay the physician's salary but they don't save lives.

And over diagnosis IS a thing. It’s about finding the correct balance between good preventative medicine and not over diagnosis and interference

I'm also in France and had the same shocked reaction from friends and colleagues when they discovered I had never been to a gyno. Now I go and like a PP he also followed my pregnancy instead of midwife. Depending on where you live you might have to wait a few months for an appointment and not all Drs accept new patients. Where I am there is a shortage of Drs. Also different from UK... Dr gives you privacy to get naked but theres no sheet to cover yourself with. Found it odd first time but got used to it. Also had the situation where Dr just about to start smear test and his mobile phone rang so I had to lie naked with legs up until he finished his call (it was another patient, not all Drs have secretaries).

Surely the scraping done during a smear cannot be overly good for the cervix if it were done too often. It might lead to scarring which could cause problems.

No way wou l d I have consented to that at that age, I would have run and hid. I'm so glad that not the norm here. Traumatic isn't strong enough to cover how I would have seen the situation at puberty age.
Were they done AT school?

Schools in certain countries were very included in the healthcare prevention system. Mine had a dentist office when I was really young. Like an actual fully equipped dentist surgery. They used to take us to gp surgeries or obgyn etc. I got vaccined in a classroom. It was good if school given up couple of days a year to do this because it meant working parents (or the parents who didn't give a fuck) didn't have to make appointments and drag the children there. We were in a group so we were less scared😁 It was the only time anyone could come near to me with a needle without me bursting into full on hysteria.

I don't think they do it anymore tbh.

Dr gives you privacy to get naked but theres no sheet to cover yourself with.
I think I'd be wearing a long flared skirt then!