To think the US paediatrician system is weird

[shaniahoo]

I'm on a few parenting groups that are American and the way they talk about their pediatrician is so alien to me. The ped seems to have a lot of power. Like, the hard line of these groups is that you always follow your ped's advice and nobody is allowed to question what a poster's pediatrician told them. But a lot of it seems like non-medical parenting advice? Everyone has their ped tell them when to start solids and they follow that - so they might tell you to start at 4 months so you do that or if they tell you to start at 6 months you do that. And everyone has to have their paediatrician "clear" their baby to start solids before they start. And the ped "clears" you to start sleep training or tells you you must do it or must not do it, and you do what they say. I suppose the equivalent here is the HV but you don't see them nearly so much and there's no sense among parents that you must do whatever your HV says.
AIBU to think this takes autonomy away from parents? Or is it great that they have so much advice and support?

I don't know about paeds but it always amuses me here in the UK when people advise "talk to your gynaecologist". I know no one who has a gynaecologist!

Oh I find that weird too. I had an American friend before who said they go to the gynae for the first time when they're 16 for an internal exam?? What the hell are they checking for?

You only have to get the exam if you’re going on the pill.

@CharlotteStreetW1 I’m in the UK and have had three in the last decade. Two privately and one NHS. It takes longer to get a referral to NHS but once you’re in the system you just call their secretary.

@shaniahoo I wonder if it’s money led? Eg I watched a couple of US pregnancy videos on YouTube and they’re always talking about the huge number of tests their OB/GYN is sending them for. My British friend had a baby in the US and they rang her on a Sunday night saying she needed to go in because a test was abnormal. It turns out that it was fractionally so and in the UK wouldn’t have been flagged. But it meant they could claim off her insurance for a second test. In the meantime she freaked out about her baby.

Or some other birth control. It’s just a different culture, OP. It’s all perfectly fine. We American women don’t suffer.

why do you need an internal examination to go on the pill? what are they looking for?

That's cool if you're fine with it but why do you need an exam to go on the pill even?

All three of mine were born in US and saw the paed as their primary doctor. I was never told when to start solids or anything. He was only interested in making sure they were healthy and meeting development milestones and getting peas out of the nose of second child.

I think that’s more an anxious parents thing wanting reassuring from the paediatrician before they do whatever it is (weaning, solids etc) and you can see the doctor whenever you want as long as you pay your co-pay. I lived there when DD was a baby and what you describe was not my experience at all. We went in for all scheduled visits (usually timed to coincidence with vaccines). The physicians assistants took vitals, I did the tick box development questionnaire, nurse came in to do shots, then doctor popped her head in reviewed the questionnaire and asked if we had any concerns to which my answer was always no and we were on our way. When DD was actually sick we went to urgent care (walk in centre) as you’d be in and out before the doctors office would answer the phone.

We have similar in the EU country I’m in. I just nod and smile at the ‘parenting advice’ he gives, may listen or may not but the medical advice is always brilliant. He hasn’t been wrong once with either of my children (he is essentially their GP) and since he sees out patient peadiatric concerns day in day out he knows what he’s doing. On top of that I’ve never not got a same day appointment and as we nearly always see him he knows my children well. My only complaint is that he may be slightly over cautious!

We have paediatricians here in Italy for children up to the age of 14 at which point they get registered with the family GP. It's just a one stop shop really (at least here) in that all those baby check ups that midwives/HVs etc do in the UK are done by the paediatrician plus weaning advice, booking for vaccinations, weight/height checks etc.

Maybe in the US it's the same?

(We also go to gynaecologists rather than GPs for everything you'd see a GP/midwife/nurse practitioner for in the UK- smears/scans/contraception/hrt etc)

@BlueKaftan you’re right, it’s a different culture.

I’ve received or had a relative receive medical care in numerous countries. In one you had to take a ticket and wait your turn to see the equivalent of the GP, could be 5 minutes but could be hours. Then they’d give you a baggy of the exact number of pills you need with no instructions. Once I almost forgot to pay - very embarrassing.

It's not all Americans, we chose a family dr rather than paediatrician and I made decisions based on my personal experience, I certainly didn't ask the dr these things - they charged $15 a visit! But I'm British but was living stateside I suppose. They don't have health visitors at all though, everything was an expensive drs visit.

As for gynae, it was quite bizarre, annual visits??? It's because you pay (or rather your health insurance pays but you are paying expensive premiums so expect some return!) every part of us medicine seemed to be geared to profiting big pharma and top doctors

That’s how a private healthcare system works, it’s a commercial company maximising profits for shareholders. Yes they have lots of facilities, which those who can afford it access, but also means making unnecessary appointments and procedures normal and accepted … to increase profit. While those who can’t afford insurance die early.
We’re used to a system which puts healthcare first, not profit (though that has been significantly eroded over the last couple of decades). However the way the US has General Paeds for kids has benefits, with the equivalent of GPs just seeing adults (I believe). Treating children needs specialist knowledge as they present and react differently to adults. There was a plan in 1980s for NHS to adopt this system but it was blocked.

I had a pediatrician for my children when they were smaller. I'm not in the US, I'm in Europe. It's just like seeing better expert here, why wouldn't you see the specialist? You take advice from them as you would any other doctor, I don't remember getting things signed off like weaning though, I think I just followed the guidance.

I'm in Europe and annual visits to the gynaecologist are what most women would do. We don't have a system of private health care. For us, you go to see your gyneacologist, your dentist, your optician, it's just one of the several things you do to take care of yourself. It's no weirder than a dental check up. It's just normal.

It's the equivalent to taking your damaged car to the garage. If you're paying it's one price but if you're putting it through your insurance it's another very inflated price. The aim of private healthcare is profit first and foremost.

Presumably with the NHS gynaecologist you can only phone the secretary and get an appointment while you still have an ongoing episode of care? Once whatever you were referred for has been treated and you have been discharged from their care, you don't just have open access to phone and get an appointment forever? Unless of course you have a long term or lifelong issue.

Are these paediatricians just like GPs who specialise in children? If you're child has an issue requiring a specialist eg seizures would they be referred elsewhere?

In UK paediatricians are in secondary care, not primary, and tend to be specialists eg in neurology, rheumatology etc

You don't know me, but I've had three.

I’m in the US and never had any of that from the pediatrician - and never heard it from any Mum friends either.

Was just like going to a regular doctor.

What I did like was they had two separate entrances and waiting rooms depending on whether you were there for a general check up or if your kid was sick with a virus etc. So less worry in those days when they are touching all the seats and toys that you’re picking up every virus going when you are just there for vaccinations etc.

I live in the US. This isn’t a thing.

You are reading websites that don’t allow people to contradict medical professionals for liability reasons and have decided that this reflects the US as a whole. It doesn’t. They just don’t want people to follow medical advice from “bestmama82” which then harms their child.

I’m sure there’s also a degree of using medical professionals to justify their own decisions and avoid being attacked on the internet, which is something that you also see on Mumsnet.

I suppose these peads need to do something to justify the thousands they charge.

Yes - they are the regular primary doctor for kids. Some people just go to a regular ‘family’ practice for everyone like in the UK though.

If you need a specialist then there are specialist pediatricians for different areas - as well as general specialists who treat all ages like in the UK.

I’m not at all certain why smears are required before birth control is dispensed. But it got me in the habit of having them frequently. Although I’m in my mid 50s so it’s possible that things have changed.