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 was commenting less on US practice, which I don't know much about, than on the poster's attitude that if healthcare providers were manipulating women and girls into invasive screening that they might not need, by pretending it was necessary before prescribing birth control, that that was okay because it means more people getting screened.

I see. Yes, that would be completely unprofessional.

That's rank paternalism.
Seriously?

If you want people to get preventative tests and exams, then explain it to them, costs and benefits, make it easy to do, and allow them to make their decision. Don't manipulate them into it by making having the tests a spurious condition of getting something else they want or need. I hope you're wrong about the reasoning behind it. You don't see people arguing for Viagra prescriptions to be contingent on having a prostate exam, purely because it might "work" to get more middle-aged men to accept a digital rectal exam.

@JarByTheDoor

What are you on about?

Don't manipulate them into it by making having the tests a spurious condition of getting something else they want or need.
???

A pap smear is recommended for all women 21 and older or for younger women who are sexually active. This obv includes a lot of teen girls. And it's not merely a screening for HPV in the US.

A routine visit to the gynecologist (or pediatrician) at age 16 will include a discussion of any issues the teen raises or any issues suggested in discussion with the HCP, an external exam, a general discussion of general topics related to lifestyle, relationships, safety, menstrual cycle, STIs, contraception, family conflicts, relationship issues/safety/abuse, and if indicated, a pap smear/ internal exam (chaperone present). School related issues such as anxiety, motivation, sleep, safe driving, screen use, phone use, and online safety are discussed, along with nutrition, hygiene, etc. The patient is assessed for signs of depression or other MH issues. While some of the visit will take place with an adult chaperone in the exam room, the doctor will talk to the girl on her own for a portion of the visit, with no family member present, in order to allow the patient to disclose anything she might not feel comfortable talking about with mum there.

The Pill is not candy. Various different formulations can have different side effects; a family history needs to be taken, and the problem the Pill or other contraception/ hormone regulator is supposed to address needs to be understood. There are other forms of contraception a teen might find more useful or appropriate for her particular needs than the Pill.
It's not for everyone. It's not for every situation.

GPs are also specialists.

As are health visitors.

Family practice / general practice are specialties, but they are generalists.
They provide primary care to people at a wide range of ages, presenting with a wide variety of ailments. They're effectively gatekeepers in the NHS.

@mathanxiety what I'm "on about" is the poster's justification of a scenario that, whether it's what actually happens or not, would be unethical and yes, paternalistic.

Poster 1 says that you only have to get the exam (referring to a pelvic exam, not just a smear) if you're going on the pill. Implying that to get the pill, you have to have the exam.

Poster 2 says that's completely unnecessary. And it is. As you say in your long, irrelevant description of what happens at an appointment, it's done if indicated.

saltinesandcoffecups then says Yes and no… it’s a way to gate keep to make sure a large portion of the population are getting preventative care. So in that sense it works…. It is overkill IMHO for an otherwise healthy woman, but again it’s the medical guidance and for sure will identify more costly and health devastating conditions earlier.

Whether this scenario actually happens or not, the poster is making an argument for "gatekeeping" contraceptive pills by requiring an "overkill" exam before being prescribed them, with the aim of "making sure a large portion of the population are getting preventative care". So, not recommending the exam because "the pill is not candy", but because access to the pill is good leverage to get women to do what you want.

That's the argument she's making and it's a bad, paternalistic argument. I haven't the foggiest idea what they do in American gynaecology appointments for 16yos and TBH I skimmed that bit of your post because it's not what I'm talking about. Even if there is a genuine reason to do a pelvic exam before prescribing the pill, that genuine reason is not what the poster was arguing for.

I'd suspect the higher under 5 mortality rate in the US is more due to the vast social-economic inequality, inequality in insurance rates, larger groups of people who distrust doctors, race inequalities in healthcare and other aspects like that. I don't think regular check ups, especially in populations that don't attend them, can quite make up for those issues. But for example Finland has half the under 5 mortality rate than the UK, better social-economic equality helps a whole lot but pretty sure the regular wellchild check ups help too (certainly the infant mortality rate was helped by the introduction of universal prenatal and perinatal healthcare, you have to attend those in order to get the baby box, hence the concept for the baby box reducing infant mortality when mostly it was about the regular check ups, not just with the midwife but also the ob-gyn)

I worked in the NHS, in cardiology.

Most patients who came for stress tests were either sent for further treatment if there were signs of ischemia, if there wasn't, and there were no other indications then they sere discharged.

Unless they were private patients of one particular consultant, they were advised, "nothing abnormal, but just in case come back next year".

A routine visit to the gynecologist (or pediatrician) at age 16 will include a discussion of any issues the teen raises or any issues suggested in discussion with the HCP, an external exam, a general discussion of general topics related to lifestyle, relationships, safety, menstrual cycle, STIs, contraception, family conflicts, relationship issues/safety/abuse, and if indicated, a pap smear/ internal exam (chaperone present).

Hang on, so you take your child to a paediatrician because they specialise in children, but then you allow the Paed to provide Gynae services?

Something they are presumably not trained in.

in my homeland too check up for teens, bloodtests for hormones,blood count etc,US to check uterus (bicornuate),ovaries for things like pcos etc.

more bizarre that uk dosent do basic checks

Noo they are not, GPs are general doctors who cant even prescribe safe medication like melatonin for a child. GPs cant also assess or treat congenital disorders.

Health visitors are ped. nurses,not specialized in anything. One told me to start weaning my 3 month old onto toast from exclusive breastfeeding, good thing even as a first time mum i thiught that advice was insane

Many reasons why 16 year olds should be seen by a gyne, in my homeland its basic visit as well- gyne deals with hormonal issues and does a fulll check up, they also check for uterine abnormalities with US,things like pcos, testing for blood cootting disorders (important if the young person goes on hormonal birth control) ,etc.

NHS is cutting corners as usual.

As an American in the UK (for many years), I attribute it to dying empire syndrome.

And for anyone talking about shocking inequalities in US healthcare (yes, they absolutely do exist), this UK life expectancy chart by council makes some interesting reading.

www.health.org.uk/evidence-hub/health-inequalities/map-of-healthy-life-expectancy-at-birth

@sashh

So is your ill-informed ranting against American healthcare or one particular private consultant in the UK? What do the two have to do with each other?

Hang on, so you take your child to a paediatrician because they specialise in children, but then you allow the Paed to provide Gynae services?

Something they are presumably not trained in.

Our paediatrics practice had a doctor who had a speciality in paediatric gynaecology who conducted any necessary or desired exams or provided advice. Our own paediatrician was an infectious disease specialist, one of the others, ENT and one of the others gastroenterology. All paediatric. It was the most fabulous group practice and I missed them for years after we moved to the UK.

I have no experience with the NHS, but my experience with child care here is that it's brilliant. My DD was born shortly before Christmas. The pediatrican came to the hospital to do her neonatal exam. On Christmas day she developed jaundice. I rang the pediatrician's off-hours number and the doctor told us to come in. He opened the office on Christmas day to check her bilirubin levels. When I had my first child, they were incredibly patient and available to answer all of my fist time mom questions and concerns.

As an American in the UK (for many years), I attribute it to dying empire syndrome.

I think you've nailed it, @w10mum3.

An insurance company that won’t pay the less than $10 a month it costs for statins?

Pull the other one…

Yes this.

Sexual Health Nurse here.

There is no contraception that you need to get a pelvic exam for - other than a coil or diaphragm.

That's incredibly disturbing to hear. No woman should be given an unnecessary intimate examination.

But you don’t have to have an internal exam to be prescribed the pill in the US.

It’s something that someone incorrectly said at the start of the thread and it’s just not true.

What’s ironic is that under the NHS I was forced to have an internal exam at 16 to get the pill, and I was (illegally) forced to have a smear or be taken off my GP’s register in my 20s.

Neither of these things has happened to me or my teen daughters here in the US.

it’s just not true

Along with a lot of other "not true" nonsense that's been posted on this thread.

All pregnant women have amniocentesis: Not even close to being true.
Routine blood work every six months: Not true
Colonoscopy every year: No

And the list goes on.

Any minute now someone’s going to tell us eggs are $18/dozen because they read it in The Guardian.

I'm sorry that happened to you, its certainly not the norm in the NHS now, and hasn't been for decades (I'm 50 and never had to get a pelvic exam starting the pill when I was 16).

Annual pelvic exams do seem to have been mentioned as a current practice by a few EU and US posters. It seems to be down to the individual clinician.

They are an option if you choose to have them.

But to say they are required is inaccurate and outdated.

I have no direct experience of the US system, except when my Nan had a stroke on holiday out there and they refused to treat her until the insurance company had given the ok- not an easy task when it’s the middle of the night UK time!

but I have had some experience of over treatment in the private sector here, and that does scare me.

That is an EMTALA (1986) violation.