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 understand. Could be that there's something going on that neither one of us is aware of.

I should add that some inflammatory bowel diseases could possibly warrant yearly colonoscopies. I have a young relative with severe ulcerative colitis that has them every other year IIRC. She's at high risk of malignancy.

Not to mention that colonoscopies, while a generally very safe procedure, do carry some element of risk (perforation, reaction to sedative if used) and the prep day plus day of procedure add up to lost workdays. I can't imagine any person, workplace or insurance company requiring one yearly unless there was some kind of extraordinarily high risk involved.

OMG seriously, you have to get signed off by a doctor to go to school and uni?

@Aphrathestorm

No, you have the wrong end of the stick there.

Schools and universities require proof of vaccination, for their records.

Why are people on MN so inclined to indulge in paranoia?

I've had UC for twenty years. If I didn't, my insurance surely would not approve my getting scoped every other year.

When my UC was unresponsive to treatment, I had them annually. When I found a med that worked, my gastro changed me to every other year. A lot is based on the results of your last exam.

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.

Now that's an example of manipulating patients.

Horrific.

So unvaxed DC can't go to school or uni in USA?

Again sounds so 'big state' and oppressive.

Where's the liberalism US politicians are always banging on about?

In Italy too. I didn’t need paediatrician sign off for school, but we did need to supply vaccination records. The only time we needed to be signed off was for re-entry into class after chickenpox, we weren’t allowed to self certify for certain illnesses.

nothing wrong with regular check ups, my nephew in the Uk had an issue that wasn’t picked up until he started school, whereas it would have been spotted at the 2 year check with the paediatrician here (friend’s DD had the same issue and ut was noticed and rectified much sooner).

LOL, complaining about insurance companies and how stingy they are is practically a national sport in the US. We just love a good bitch and moan session. Burns calories😂

They're not excluded from school unless there is an outbreak of the disease for which they're not vaccinated. That doesn't happen very often here though because vaccinations actually prevent outbreaks.

We're OK with stuff you label as 'big state' when it keeps our kids safer and healthier. I understand this is strange for someone from the UK where the focus is on more important things like measuring skirt lengths.

🤣

Each state sets its own vaccination policy for school children (state law). These policies cover public and private schools. All states provide medical exemptions, and some state laws also offer exemptions for religious and/or philosophical reasons.

If you are very unhappy about this, and unable to get an exemption, you can move to a different state or choose to home educate.

Wrt oncology, and in this case, breast cancer care... Here's one example of one patient's care.

A friend was diagnosed with breast cancer last summer. She has Medicaid. I drive her to and from her appointments. She was referred through her primary care provider / family practice doctor for her mammogram, which was followed by an ultrasound, followed by a biopsy. There followed a breast MRI. Cancer was identified and confirmed, stage 1.

After a case review involving the oncologist, surgeon, and radiologist, it was decided by the oncologist (who is in charge of treatment) that friend would have surgery first, followed by chemotherapy for three months, followed by one dose of radiation.

Friend did ECG, and had various other procedures, lab tests, and other testing done, including injection of dye before surgery, and insertion of port for chemo before chemo began.

The oncologist's practice employs nurse navigators who deal with insurance companies, provide support/ hand holding for patients, and co-ordinate all appointments. My friend has never had to make a single phone call to make an appointment. The nurse navigator checked with friend about available times (she works part time) for procedure/appointments, so there was never a question of a conflict. She has never had to contact her Medicaid plan admin for anything. The nurse navigator has done all of that, including getting an alternative nausea medication authorised when the first one prescribed caused a reaction. I had offered her this support and it turned out to be completely unnecessary.

On top of all this, she has a dedicated oncology nurse who sees her every time for her treatment. They have developed a good rapport. The level of support offered by the oncologist's staff is exemplary imo. (And while I drive her to and from her appointments, she could avail of free transport directly from home to the chemo centre and back if she wanted it).

Again, Medicaid patient, urban area, blue state.

@Aphrathestorm
So unvaxed DC can't go to school or uni in USA?

Again sounds so 'big state' and oppressive.

Where's the liberalism US politicians are always banging on about?

So many misapprehensions there it's hard to know where to start.

That was my reaction too

I think you'll find that kids in the UK are safer and healthier than those in the US.

This was similar to my mothers care which was a mixture of Medicare and supplemental insurance. In her case the outside care coordinators were automatically offered by her insurance company and provided everything from a 24 nurse line for emergency prescriptions, sourcing medical supplies, home visits by nurses and pt/ot, to a social worker who helped with things like grief counseling and end of life planning.

They coordinated between her oncology team and colorectal surgeons and anyone else we needed

This could well be true, but that's not because good preventive care for children isn't effective. My guess is that it would be down to two things:

*gun violence (not an issue in the UK at all)
*appalling childhood obesity rates in the US

All the preventive care (including guidance on weight management) in the world isn't going to do a damn thing if the adults in the room aren't willing to listen and act on it.

On this thread, you've gone from

omigod! the us system is so invasive! to you can't go to school if you're unvaxxed! How illiberal! to kids are safer and healthier in the UK!

So you're just going to keep jumping around about something of which you have little knowledge. That's fine, but it's a poorly structured and not very cohesive argument.

As others have said before, on this thread, comparing the US and UK is pretty fruitless. The US has vast inequalities in medical care. No one is disputing that. Comparing the UK to other European countries with similar social medical systems, so equal care to all, in theory, is what makes sense. And when you do that, the UK comes out worse by far on every metric.

None of this has anything to do with the system of seeing a paediatrician for routine medical care.

I'd also put a considerable about of money on the bet that if you compare US vs UK outcomes, controlling for socioeconomic status, you'd get a very different result.

My annual mammogram is completely covered by insurance. The recommendation for gynecological exams has been changed to once every two years, so that is how often I go now. An ounce of prevention is worth a pound of cure.

Screening tests have no co-pay in Illinois.

That's true nationally, thanks to the ACA.

www.healthcare.gov/coverage/preventive-care-benefits/

Agree. The nhs has it’s issues, but so does the us system.

on balance, i prefer the guarantee of healthcare free at the point of service for everyone, rather than worry about medical bills, copay, insurance etc, and know that some people go bankrupt due to medical costs.

but that’s just my opinion. I am sure the us system works better in some ways, and I’m sure the nhs is the better option for others. I am also (touch wood) relatively healthy, but also have a background in medicine so usually know what I need which makes it easier to navigate the nhs.

It also depends on the type of insurance you have-I’ve had insurance that requires a small copay at time of service (about $20) and currently have one that doesn’t. Even if you have a small copay, the remaining cost of a preventive screening such as an annual physical or a mammogram is typically fully covered by insurance

i choose to have every preventive screening that’s fully covered by my insurance, because firstly, I’d rather have any potential health problems detected early (as they were by my last mammogram) and secondly, that’s what I’m paying for! Why pay for insurance and not use the services it covers? I don’t like wasting money. 😂

But no one makes you have these screenings/tests over here, it’s completely voluntary.

Oh, yes. Never have I tried to say that the US system isn't riddled with flaws and inequalities. Unfortunately, some of them, at this point, are due to Republican politicians in some states being so offended by the idea of any kind of universal health care, that they didn't take the funds available to make it affordable in their states. But that's another issue altogether.

I agree, in theory, the UK system is preferable. The problem is, that in practice, it's failing people in huge numbers. I mean, reading on here I seem to come across shocking tales on a regular basis, people with horrific issues who get put on a 6 month or 2 year pathway to the specialist they need. Personally, we've only used the NHS 3 times. Once it was absolutely shockingly horrific, once it was good and once it was stellar. Those were all emergencies, though, routine and preventative care and access to specialist consultants is where I see it failing people. And the failures, to my mind, aren't due to the system in and of itself, but to terrible political decisions that have been made along the way, from austerity straight through to Brexit.

It will be interesting in 5 years of so to do a comparison, as decent insurance is getting easier to get in the US and the NHS seems to be in something of a spiral. Albeit, both countries are suffering from shortages of health care workers.

All of which is probably not relevant to the initial discussion, which is that having your child's medical care provided by a paediatrician can be lovely and it can be a very beneficial relationship through the years.

I've had 1 C-section in the UK, 2 in the USA.

The meals service in NHS maternity wards is awful and "patients need to get up and move" is rubbish. What winds up happening is that women don't eat. It's because they expect one midwife and one student to take care of the entire postnatal ward, as happened when I had my eldest. They don't have the staff and use this as an excuse. I missed meals because I wasn't yet able to get up and staff didn't notice.

in the US, the meals were brought to me--but I still had to get up to move! They just didn't use mealtime as an excuse.

With cancer, the US is multidisciplinary as well, it just seems to be a difference with who is the point of coordination. It does mean you can choose your surgeon if you want, which some people want to do especially if it's an unusual cancer.