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

Are there stats to show going for a yearly smear means fewer women die of cervical cancer (or that its picked up earlier)? Having an annual breast exam seems pointless as you are far more familiar with how they normally feel and should be able to feel anything different (I'm not talking about a mammogram).
Here it's obviously money spent vs effecacy. I assume there'd have to be a significant increase in diagnosis for the expense to be warranted.

@waterbottle12 you’re right, it is reassurance , but it also saved my mother’s life so that’s all the evidence I need. I’m a banker I know more about cost/benefit analysis than most, but as I said we’re individuals NOT stats

How does your average patient (let alone one who has some kind of learning disability, mental health problem or confusion) know where to refer themselves?

I wonder about this. I know someone from Germany who spent months visiting orthopaedic surgeons, neurologists, and physiotherapists trying to get help for a back problem he had. After various treatments which didn’t help it turned out he actually had a kidney problem and that was what was causing the pain, but it’s wasn’t picked up on because each specialist was looking it it through their own lens. To me that’s the benefit of being able to visit a GP with an issue first, they can look at a person more holistically.

I am bit baffled by people having issues with regular gynae check ups while half a uk moans that women's health isn't taken seriously enough

It's not really the same. What you want is access to a GP (or nurse) when you actually want to see one, not in six week's time, and then a referral without being fobbed off because referrals come out of their budget. I see no reason to have stuff stuck up my wotsit every year when I am otherwise perfectly fine.

It may well be that women in the UK put up with things women overseas wouldn't, such as problems after childbirth or heavy periods. But I think if it is affecting your life unduly you go to the doctor. If it isn't, you don't and you don't necessarily want to be messed around with.

I had polyps removed about 8 years ago, they were affecting my life because I was more or less bleeding all the time. But other than heavy and painful periods and thrush, which I did see the doctor about when I was a teen, and didn't have invasive investigations, the only time I've been since is for smear tests.

Also we don't need to go to the dentist every year but if you don't, they take you off their lists both NHS and private. My private dentist recalls me every 6 months, I usually eventually go after about 9.

but it also saved my mother’s life so that’s all the evidence I need

do you know that for sure? you may be right, but are you familiar with the concept of lead time bias?

@drspouse you can go to the GP and they can direct you to who they think is the appropriate doctor for your problem. But then it’s up to you to find one of those doctors and make the appointment yourself

How does your average patient (let alone one who has some kind of learning disability, mental health problem or confusion) know where to refer themselves?

In France this doesn't happen so much now. The GP has become much more of a gatekeeper. In the past French people did pick and choose when / which specialists to go to - and if they didn't like the response they got from the first, they could go to the second, third etc until they got the response that they wanted or expected. And as all the consultation / treatment / prescription fees were reimbursed by the government, it was costing an absolute fortune! So now, in order to qualify for reimbursements, you need a prescription / referral letter from the GP before you go to a neurologist / rhuematologue / allergelogue / podologue etc. He can decide to try and treat you himself first, and refer on if he feels you need specialist care. Or send you straight to the specialist. Gynaecologists and opthamologists (eye doctors) are the only ones that you can go straight to for an appointment these days, and still be reimbursed fully.

I wish the NHS and GPs took menopause and perimenopause far more seriously, tbh, especially because not everyone can afford to pay privately.

This is a short video which sums up another important point about running tests, they aren’t infallible! Not just blood tests, a physical examination or a scan can miss things or different doctors might interpret them in different ways.

If you don’t know which specialty you need to see then you go to your GP, it’s not as if France doesn’t have GPs.

Direct access to specialists health care systems by far outnumber GP gatekeeper systems, it’s not as if the French invented the wheel. There is no conclusive evidence that either system is superior to the other. They both have advantages and disadvantages, but crucially neither works if underfunded so comparisons are complex.

Now if you really want to have your mind blown, how about this...in France patients are given their test results directly. Blood tests, urine tests, xrays, CT scans, MRIs you get a copy of everything. Anything that requires interpretation you get to see the radiologist for example who interpreted your MRI and you get a copy of his letter to your other doctors.

The UK doesn't do well with breast cancer. I don't think it matters which kind of physician is charged with breast exams, as long as there is one kind of doctor who is doing some kind of annual check on women. I know way too many women with this terrible disease. Also, cervical cancer is on the rise, and that is something that is easily caught with a pap smear. I actually think a lot of women could use more and better gynecological care and have more issues than even they are aware of--that a lot of women are suffering from silent malfunctions that could be addressed, but that haven't been addressed properly because women's pain isn't taken seriously.

This may be something of a different issue, but I think that many women have some kind of pelvic floor pain or discomfort, especially after childbirth. Many women have difficulties with sexual dysfunction. Many women have problems with urinary flow, or fistulas, or other problems that are embarrassing and hard to explain. And even if they talk to their gynecologists, there are few who will take them seriously. I think we are in the dark ages of proper care for women. It's not that the same old thing needs to be done over and over, but that the underlying mechanisms of women's bodies need to be understood more deeply.

In the U.S I get all of my test results directly also. You don't get yours in the UK???

How does your average patient (let alone one who has some kind of learning disability, mental health problem or confusion) know where to refer themselves?

You don't have to diagnose yourself. Of course there are GPs as well as specialists.

£If you don’t know which specialty you need to see then you go to your GP, it’s not as if France doesn’t have GPs.*
But most people think they know what's wrong. How would your average woman know that shoulder pain could mean an ectopic pregnancy?

Conditions are picked up much earlier with yearly check ups than without and that saves lives. My mother's for instance.

They might pick up on cervical cancer or its pre-stages, breast cancer (the most common cancer for women in the UK), cysts and benign breast tumors, HPV or other STDs, ovarian cysts or tumors, uterus abnormalities (polyps, etc).

The UK has a lower survival rate for some types of cancer than other Western European countries and part of this is due to delayed diagnoses.

For breast cancer, survival rate in the UK was 79.2%, slightly below the European average (81.8%) and lower than France (86.1%), Germany (83.6%) and Austria (82.1%).
For ovarian cancer, survival was 31%, below the European average (37.6%) and below Austria (41.4%), Germany (40.3%) and France (40.1%). (source: NHS)

How would an average woman know that shoulder pain could mean an ectopic pregnancy?

How would any woman, in any health care system know this rather specialized, rare situation? Either she has been through this before or she has been warned this is something to look out for. Otherwise anyone who has shoulder pain assumed they have injured muscles, tendons or ligaments.

Should this woman approach the wrong specialist, let’s say she goes to an orthopedic consultant, why doesn’t that doctor have the same chance as a GP of thinking of this rare possibility? Indeed the ortho has more of a chance because he needs to know orthopedics and misdiagnoses in orthopedics, whereas the GP needs to know about zebras in every single field of medicine as he never knows who will walk through the door.

Indeed the ortho has more of a chance because he needs to know orthopedics and misdiagnoses in orthopedics, whereas the GP needs to know about zebras in every single field of medicine as he never knows who will walk through the door.

I was under the impression GPs had to do more training that other specialists.

How would your average woman know that shoulder pain could mean an ectopic pregnancy?

Why would they have to? In the UK, if you have random shoulder pain, then you'd go to the GP, and hope they'd do a thorough enough examination to pick up your theoretical ectopic. Same here in Europe! You don't have to think, 'oh my shoulder hurts, I'll have to make an appointment with a rheumatologist', you go to the GP the same as the UK woman.

I like the uk system. What a worry it would be to try and hunt for a specialist each time you needed a referral. It's bad enough finding a plumber!

I'm incredibly thankful on being referred to the breast clinic I didn't have the extra worry of finding the best one. Finding the best available and one that could fit you in could easily take longer than the 2 week NHS referral wait. And what a worry if you thought you had not got the best.

I suppose it is a very good thing to do to make sure you are healthy. X

I also think a healthy lifestyle might be equally if not more important than going for checkups every single year.

I was under the impression GPs had to do more training that other specialists

Nope. GP is the fastest track to being a qualified, practicing doctor. As far as I know they spend less time doing hospital rotations before specialising.

I've just read those:

To become a GP, you'll need to complete:
1 a degree in medicine, recognised by the General Medical Council (GMC)
2 a two-year foundation course of general training.
3 specialist training in general practice.
https://www.prospects.ac.uk › gener...

So GPs need specialist training and a two year foundation course as well as a medical degree. So 12 to 15 years of study, if I understand correctly.