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’d also like to add that the OBGYN, who delivered both my children, was my Consultant all the way through my pregnancies and I saw him at every appointment, unlike the UK. I continued to see him as my gynaecologist after the births until he retired. We had a great relationship and his adult son is now one of my clients (different business)

Same here. In England, I had my last baby privately with the gynae who had done my fertility investigations, since then he has done all my smears and checks, I’m seeing him for HRT, if I ever need surgery he’ll do that and when my daughter needs it he’ll see her too.

@AnotherBritInTheUSA Yes, you can be get to know your doctors here. My Ob/gyn and I discovered that our husband’s knew each other and that we have mutual friends. It’s a relationship built over several years, which I appreciate.

In 2010 the NHS was externally judged the best healthcare system in the world.
Since then the government have run down the NHS making the job more difficult, reducing the pay in real terms, etc. So people move abroad.

That's hardly a surprise to anyone who's experienced the appalling postnatal "care" that the NHS provides.
The NHS is not fit for purpose.
Its only redeeming feature is that it's available to all (as long as you don't die waiting).
Unfortunately British people always assume that our country is better than anywhere else in every possible way, which impedes change.
Personally I'd love to see a gynaecologist annually .... and be able to access a paediatrician for my child at the weekend without waiting in a and e for 12 hours with a load of drunks.
The American system sounds great for those who can access it. If only it could be extended to all...but that's a political issue and nothing to do with the system itself.

I don’t think the US system sounds weird. I would have loved to have a reliable doctor to go to with all baby and kids things when they were young as a sounding board. Would have also loved to have the same obgyn/gynaecologist for years too that I could have chosen. Seems a far better system to me when one person actually takes responsibility for you and your children and knows you really well.

The worst part about the NHS is that it is so difficult to talk to the same doctor and even communicate with them on an ongoing matter. You always have to wait for some referral or random letter and often don’t even see the same person. So inefficient.

I am not sure how accurate the "ask for insurance right away" is either. Maybe it depends on how serious the issue is? We had an emergency situation with one of our children in the US and weren't asked for insurance until after the treatment/monitoring was over. It was part of the discharge procedure. I did however register with the hospital that I wanted to give birth in and provided my insurance when I was in my first trimester.

I’m amazed on some posts where a person has, say, cancer and has never seen an oncologist. When my husband was diagnosed with cancer we chose the doctor we wanted treating him and we saw him for every single appointment and scan result. I can’t imagine just trusting anyone in the system to look after him. That’s why things are so slow and disjointed in the nhs and continuity of care is so poor. People are so conditioned to think that’s the norm and don’t realise that it’s completely substandard

A lot of people told that poster that her assertion simply wasn't true.

You could have googled the matter yourself.

How come it was so believable to you that you leapt to the conclusion you leapt to?

You're now jousting at windmills btw.

From my first response, my objection was to the poster's argument — not to any statement of fact, but to the argument she was making about justifications for someone else's statement of fact (erroneous or not). There had already been plenty of discussion about whether it happens or not by that time; whether it happens was not the point I was interested in addressing, and I deliberately didn't respond to the poster making a statement of fact, or take a position on whether/how much it happens, because I don't want to get involved with that. I don't know much about American healthcare and don't care to get involved in arguments about their preventative medicine practices. The point is that I object to the argument the poster is making about the ethical admissibility of manipulating someone in that way, which is why I responded to the poster making the argument.

And yet you keep harping on about what actually happens in appointments and googling stuff. Why are you telling me? Go after the people stating it happens, if you care that much about it, not the person involved in an entirely different discussion about the medical ethics of manipulating people into having screening. If you're not capable of discussing ethics in an even slightly abstract way, or of understanding why someone would want to counter a bad argument even if it's for a thing that doesn't happen, then I can't think of anything else to say to you. Now please leave me alone unless you're prepared to address what I actually posted about — the bad argument for bad medical ethics.

Nobody's talking about the ethics of manipulating patients into exams except you.

Why do you keep on insisting it's an argument worth having when it is based on a statement that has been shown to be untrue?

Oncology teams in the Uk tend to be multidisciplinary. You won’t see “an oncologist”, but surgery, imaging etc and also specialists depending on the type of cancer.

does your single oncologist do everything from the imaging and diagnosis, to the surgery, chemo, radiotherapy etc? Or is he more a point of contact that refers you to those specialists?

my experience of cancer care in the nhs is not “slow and disjointed” at all. In fact in one case it was far superior to private, where overtreatment led to the patients death after an awful few months of side effects.

on of my friends dc had a lump. They weren’t referred to an oncologist but to the specialism for that body part. It took 3 days to get an appointment, then an hour to get x-rays and onward plan.

Thank you so much for telling me this. It’s like I wouldn’t have known this during our 3 year cancer journey

The oncologist we chose was a specialist in the particular cancer in a hospital which was an expert in the cancer which was extremely rare. We chose him as he was an expert, had written the papers, done the research and was part of an elite group. The local historical allocated us a very young consultant who had never seen the condition before

whilst yes of course scans etc are carried out by other people the oncologist you choose, gets to know you, makes the decision on treatment and you know that person is the one who is best prepared to make those treatment decisions as you know it’s their niche area. You can also choose your surgeon, as we did, and hacihf your own chosen oncologist that’s who you see in clinic, not a member of the team who reads your notes on the run.

it’s massive psychologically to know that you’re being looked after by who you want, you have no chasing of anything, the speed of everything is hours not weeks and you can. Until you’ve experienced healthcare as it should be you can’t imagine why you would do anything different but I was on lots of FB groups for cancer and trust me. What we got was night and day from what the NHS patients with the same rare condition were getting

When I hear about women's experiences on post-natal wards on the UK I'm so glad I didn't give birth there! Men on the ward all night, having to walk to another room to get your meals so if you're in too much pain to walk tough luck, no food. Obviously tend to only hear the worst stories so I'm sure many have positive experiences but it's off-putting for sure!

The post-natal wards in Finland are two beds to a room so you at most share with one other room, no men overnight, or your room is a family room and your partner sleeps on the other bed. Meals brought to your bed, everything provided like baby clothes and nappies, and a snack fridge in the day room. Uncomplicated births can stay in the attached hotel instead with a midwife available around the clock and comfy hotel beds and have the whole family stay - great if you have other children already.

That is ok. Like the yearly colonoscopy, it's Mumsnet bullshit. Nobody is getting forced gynecological testing. Oh, and we are not driven to bankruptcy by our chosen annual medical exam.

@Liorae In the UK many private consultants will tell you cancer care is better under the NHS than private here. The recommendation is usually to stick with NHS and then pay for top ups as needed from extra cleaners to private wigs.

"In 2010 the NHS was externally judged the best healthcare system in the world."

Can you give me a link for that? I remember it coming in the top 5 or something, but mainly for cost efficiency rather than patient satisfaction.

Most effective system and best in terms of equality of access.
Google it - not being funny but that is all I would do to find a link for you.

Some healthcare systems have far better outcomes for very well off people in the country and very poor outcomes for everyone else.

I am also surprised to see people promoting the US as a good country for preventative healthcare, the stats and research do not bear this picture out. The best country for preventative healthcare last time I looked was judged to be Cuba. Cuba spends relatively little on healthcare but what it does it focuses on preventing illness. Its hospitals are poor, but you are less likely to end up there than in most other countries.

And a multi disciplinary team is not simply a top consultant referring to other services. It is a team working together and adjusting treatments together.
My DD is under a multi disciplinary team. While we were waiting for her to be seen I paid for private physio from someone highly recommended. A waste of time. The physio in the multi disciplinary team has made a real difference as they talk to the consultant about treatments, look at the MRIs and CT scans and use this to guide and adjust treatments. With complex illnesses multi disciplinary teams make a big difference.

It's how a private healthcare system works. All about the money. Nobody needs a medical doctor with umpteen years of training to give them permission to start giving their baby solids, in the UK we obviously are educated on the signs of readiness and take it from there. But in the US parents are encouraged to have their hands held by a paediatrician every step of the way for every little thing. It's super weird. They also encourage 'well checks' as a default thing at all ages which is just so surreal to me, including pelvic and genital exams. I don't think a GP saw my genitals until I was an adult going for my first smear test.

Our post natal care is poor. We do not have enough midwives.
The walking for food though is because medically it is far better to get up and moving. It reduces many post birth risks of complications.

But that's not how it works in the US. The paed doesn't give anyone permission to start solids, they may ask how is it going but only based on info collected like weight and height charts if a child is under or over weight. The Paed never held my hand for anything.
Well child/baby visits were vaccination visits. None of my kids had their genitals checked after their whole body being looked over after birth.
A physical was done before starting school but only a height weight and check on milestones were met and sign off for school. Uni entrance had a sheet to sign off at the doctors and vaccination check to make sure they were up to date too, not even the paed, it was the family doc who saw them.
Other that that they saw the paed when they were ill.

Right, so leaving women too poorly/immobile to get up and walk without food is fine and dandy then?

That's great and might be how it is in theory, but in reality an awful lot of patients have been conditioned to be dependent on a paediatrician for everything. You only need spend time in US centric parenting forums for a little while to see people talking about how their paed has 'cleared them' to start solids, start sleep training etc.

Perhaps it's a class/privilege thing. Very obviously not all families are going to have access to this, but for ones who do or who have very expansive health insurance this is the norm.