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 suspect by "having a gynaecologist" the PP means having a gynaecologist in the same way as people who have a GP. So a doctor who you somehow register with when young, stay registered with for your whole life, can book appointments to see them whenever you have any gynae related health issue or concern, who perhaps has a clinic/doctor's office which is in no way linked to a hospital. Rather than a doctor who the GP has referred you to because of a specific issue, who will see you for a number of appointments for that issue (including maybe surgery), who sees you in an outpatient clinic in a hospital, and who discharges you from their care once your issue has been treated.

I know various people who have had the latter i.e. have been under the care of a gynaecologist for a period of time for a specific issue, but nobody who has the former i.e. have a GP-like gynaecologist who they keep forever and who they can book appointments with whenever needed about any gynae issue at all.

We have a an excellent pediatrician.

Dc go in once a year for a annual check up, she will let us know if any additional referrals out are needed.
She also sees one dc more for their ADHD meds.

Over the last five years she has got to know the dc. Like a GP should. She is really practical and down to earth. Many GP's don't know that much about dc so a specialist is a positive thing.

Don't knock it until you have tried it. It is better than the often changing, hard to reach GP's we had in the UK.

We have paediatricians in Finland too, under 7s go to a special child health clinic for routine things and non-urgent issues though most appointments are with the child health care nurse (I assume a nurse who has had special training in child health care matters) who does the routine check ups (very comprehensive ones, they don't just weigh and measure them but do cognitive tests, check on their development like walking, jumping, throwing and catching, fine motor skills and language skills etc.) and gives advice on weaning etc. with a few more indepth check ups with the paediatrician but if there's any health or development issues you get an appointment with the paediatrician. This is all completely free unlike normal healthcare here. I think its really good because any issues can be spotted early so early intervention can happen, for instance DS was crawling in a weird way, dragging one leg behind him, mentioned it at his one year check up and he got referred to a physiotherapist straight away to make sure there wasn't a physical issue. When DD was having behavioural difficulties again an immediate referral to the child psychologist who assessed her at nursery.
Once they're 7 and at school they are under school healthcare including a check up with the paediatrician during certain school years. Another example of early intervention thanks to this system, DD's very mild scoliosis was spotted by the school nurse because she does scoliosis checks every year when she weighs and measures the children and now she gets check ups every 6 months to make sure its not getting worse or requiring treatment.

Its a good system and something the UK would benefit from.

I'm in an EU country. Most people here see a paediatrician but they are basically a children's GP. Anything requiring further investigation goes to a specialist.

We haven't bothered looking for one because they all seem to have full lists from what I've heard. We just all go to the normal GP which is fine and also allowed. There are no health visitors and you have to arrange immunisations yourself (I think that is a bad idea).

Gynaecology you see a gynaecologist who has a practice like a GP but for women's issues. Although they aren't very interested unless you are having a baby as that's where the money is. The good thing is they have ultrasound equipment there and so if you had fibroids/ovarian cyst or anything like that they can look there and then but I think would then refer you on to someone else for treatment/surgery.

I think you're on a board of self-selected anxious parents who question their child's doctor about everything. My children's pediatrician offered advice if I asked, but not otherwise.

I'm in France and here it's very normal to have a paediatrician for children, and many women (including me) have a gynaecologist who I see for yearly sexual health checkups, smears, breast exams etc. The GP can provide these services but most French people prefer to go to a specialist. There is nothing like the same level of gatekeeping that there is in the NHS, and direct access to specialists is considered normal.

I think you might find that the UK is the exception in this, rather than the norm.

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.

Say what now? You have a nhs gynaecologist that you can make an appointment with at any time just by ringing the secretary? No gp referral? Is this person for life, then, covering all issues? Have you got that with all specialisms?

And here we go again with the watching YouTube and starting unnecessary posts in mumsnet that just descends into another US bashing thread.

Fascinating thread and I'm relieved to read from posters with US experience how it works. I am also on a couple of Facebook groups with American mothers and have thought the reliance on the pediatrician was bewildering. Women on the group do seem to follow their pediatrician's advice slavishly even whilst moaning about it. I even saw somebody advising that a mum needed to have the ped 'clear' her to breastfeed her child whilst pregnant, as though that was anything other than a personal decision and no business of any doctors. And the mother agreed she would ask!
Good to know that it's not all like that.

This is exactly what they mean. In the US I have a PCP Primary care physician equivalent to a GP. I also have an OB/GYN who I started to see when I first started BC.

You visit your PCP for routine Dr stuff annual exams, sickness exams, etc. You book specifically with your OB/Gyn for BC, annual exams, pregnancy, delivery. In other words you could theoretically see your OB/Gyn from your first exam at 16 through menopause. (Medical guidance used to be that you had your first internal exam when you became sexually active or at 18 whichever was first and then annually from that point. I think it’s now every 2-3 if no problems)

I think it’s also different here in that midwives aren’t really mainstream. They are available if you want to go that route but not the norm.

To put into perspective at one point a lot of insurers required a referral from the PCP to see a specialist. So many woman just changed their PCP of record to their OB/Gyn that it became meaningless so the insurers exempted OB/Gyns from that rule.

Some people choose to have their exams done by their PCP…that’s fine and no problem, they’ll be referred out if they get pregnant or if anything comes up.

I bloody knew I should have put "IRL" 😂

This is just what happens in a better resourced healthcare system (whether the resources come out of the patient’s pocket or the state’s) and in a model of care more focus on the primary level. I’ve lived in several European countries and always had a paediatrician. It’s much better than a GP for all age groups as they can focus more on children’s issues. Currently we have a paediatrician and then within the primary care centre we see a paediatric ENT, a paediatric dentist, a paediatric pulmonologist etc. When my kids are ill it’s easy to get a same day appointment. If it’s an illness with a longer course like bronchitis she’ll have them back in every 2–3 days until they are better, and if she prescribes a course of antibiotics she wants to see them at the end of the course too to check that the ear infection has completely cleared up. It’s really sad to think that the NHS could have been like this — if it can be done in countries poorer than the UK, for sure it could have been done there too.
Of course the paediatrician will tell you when to wean your baby if you ask, but if you already know, you probably wouldn’t ask. If you are in for a vaccination or other check they might ask how weaning is going etc.

It’s not bizarre to have annual gynecology as visits as it is part of preventive care rather than waiting till you are sick.

And yes pediatricians will offer advice if asked or if they notice something out of the ordinary. My mum used to tell the story how she was told by my pediatrician that she was going to ruin my feet by having me in hard soled shoes at ~6 mo. He conceded she was was right when she plonked me on the floor and I was standing and walking already.

This.

"It’s not bizarre to have annual gynecology as visits as it is part of preventive care rather than waiting till you are sick."

Most women do this where I live and it's definitely not about money. You can go to one who charges the agreed rates so you don't pay much over your regular social insurance payments.
Basically, the NHS doesn't have much money for preventive care - I've personally never gone to the NHS just for a checkup, for example.

It's just a stupid line people trot out to defend a poor parenting choice. Like rice in a newborns bottle is a big one I see on American forums. Obviously a bad idea. It's like how here people will say 'well my health visitor was happy with me cosleeping on a sofa bed pushed 2 inches from the wall next to an open fire so I'll take her advice thanks...' it's just a piece of infor they think noone will challenge

I probably want clear, and it's probably been lost in the quotes, but I know what having a gynaecologist in the US means, I was more pointing out that the person who said they don't know anyone who has a gynaecologist meant they don't know anyone who has a US style gynaecologist. Someone had responded to say "well actually I've had 3 gynaecologists" but the NHS one certainly won't have been US style so they don't "have a gynaecologist" in the way that's being talked about on this thread.

When I was in the US kids had a paediatrician , but not a GP, it’s a different system. Their healthcare is different to ours.

Sorry I should have said somewhere in the post. I was agreeing with you and giving more context to the thread at large.

A pay check.

When it's a private system where the doctor bills for each test, examination or appointment, it's in their own interests to perform an internal exam.

I have family in Switzerland. If their kids are ill they take them to the paediatrician. I would much prefer that approach rather than having to take them to the GP who is not an expert in child medicine.

I was going to say that I thought think the idea of an annual gynaecologist check up is good in the way that an eye test etc. is.

Americans I know have expressed surprise about how our midwife system works. At one time I introduced my US friend to an old friend retraining as a midwife and the US friend was surprised the old friend has never been a nurse or taken Biology at school

America has the highest rate of injuries and side effects from unnecessary treatment and tests.
It is profit driven.
But America is a strange mix of some people getting too little medical care - it has a high rate of maternal death because of a lack of pre and post natal care of poorer women - and over treatment for those who are very well off.

Why would I need an annual visit to a gynaecologist?