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?

A smear. A breast check. An internal scan to make sure you don't have ovarian cancer.
Apart from that, nothing much.

Germany. Not privately insured - we have statutory insurance. Our paed is simply our children's GP. Alongside my own GP, I 'have' a gynaecologist and a dermatologist for regular check-ups, also an ENT I see regularly because of a particular issue and have 'had' a pulmologist in the past. Free choice of all of them (limited only by availability of appts - some specialists stop taking on new patients for a while if they're over-subscribed).

You do not need annual scans just in case for cancer. All tests carry risk.
It is evidenced based that breast exams are not good practice unless there is a concern. That used to be the standard when I was a young adult and it led to much unnecessary tests and treatments. The evidenced based approach now is to be breast aware.

Well, you do you. As I'm an English teacher, not a trained breast specialist, I let my gynaecologist do mine.
Do you do your own smears as well?

That's fair enough, but if you have stupidly small and dense breasts like me, it can be hard to know what you're looking for when self-examining and I find it very reassuring to have my gynae have a look annually.

Every time I read mumsnet threads about US medical care, I just shake my head. My son has a paediatrician. He sees her once a year for his annual exam, and far more during the first year. She would offer advice, for example, about when to start weaning, but we could definitely take it or leave it. And, in fact, I was interested to hear why she recommended weaning beginning at 4 months, when I had always thought 6 months was the point (It's to do with new research on allergy development and early exposure).
I like the fact that he always sees the same person, who now knows him well. I also love the fact that he can see the doctor the same day, if anything is wrong. And that our paediatrician is part of a world-class hospital system, so can refer to a specialist, if needed. (And that we will then see that specialist almost immediately, and have any procedures etc, also immediately). Our medical practice also accepts medicaid and CHIP so children without insurance are receiving the same benefits. (Not that the US insurance system isn't deeply problematic, but I've noticed again and again that people on mumsnet presume that nearly everyone is without insurance, when the jobs that they currently have - maybe you are a teacher, maybe you work in an office, basically any job with a salary - will mean you also have insurance, provided by the job.
When I talk to friends in the UK, or listen to my mum talking about how she is on the phone to the GP for hours first thing in the morning, just desperate for an appointment, and waiting years for a necessary procedure, I am glad I am not in that system.

At your first gyne apt you get your first screen, sti are discussed as well as options. You continue to see the gyne for refills or changes. They also do the breast exams.
pediatricians are plentiful and simply children’s GP until 16 or so.
they also have children’s dentist.
in some ways the care is excellent.

Having your children under the care of a pediatrician makes much more sense than seeing a regular GP. Why would you not prefer to see a doctor whose specialty is babies and children?

Here, in the US, I chose my babies’ pediatrician before they were born and he visited them in hospital when they were a few hours old to check them over. If there are no issues, you take them for a check-up when they are one week old, two weeks old, one month, three months, six months, one year, eighteen months, two years and then annually thereafter. All check-ups are covered by your insurance.

I can always get a same day appointment if my children are unwell. Saturday mornings are drop-in. No appointments necessary and the doctor will stay until the last child has been seen. They have three separate waiting rooms, one for sick visits, one for well visits and one for newborns.

I am in Britain and can get a same day appointment fairly easily.

YABU
Pediatricians are great and you'd see the benefits if you'd ever experienced the same kind of system.

There's continuity of care, regular and frequent checkups from a doctor specialised in children who is aware of the child medical history. You can pick the one you like and they're available on the phone or by email for advice during illnesses and for medical advice. I have nieces and nephews in my home country and there's a huge difference in everything involving medical check-ups/issues.

HVs are great, but they're not doctors. It's rare to see the same one more than once and they just tick boxes, fill in a chart and that's it. They give weaning and sleep advice too, and so do GPs. GPs are not specialised in children, our old GP for example seemed to not have much knowledge of certain things relating to children, in the end we had to change practice after several issues/mistakes.

Pediatricians check everything regularly and are therefore better equipped at spotting any issues early. Here in the UK the health checks are not as frequent and not even half as thorough.

Pediatricians check heart, eyes, breathing height, weight, assess behaviour and many other things (eg hips, testicles in boys etc) these are really thorough check ups. They're monthly as babies and then they get more spaced as children grow older becoming yearly for older children until they are 14.

So nothing weird about pediatricians, they're a wonderful thing when available. And in my EU home country that's all for free, so it's not all about money as some people tend to think.

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

Thank you! I know people love a chance to bash the US but this is the norm in most of the EU too, where preventive care is actually a thing.

My annual gyno visit included:

Breast exam
Smear
Pelvic exam (to check uterus/ovaries)
If any concerns then tests could be done right there, including ultrasound
They would also ask about your general health, check your heart and BP, would do blood tests if any concerns
Obviously take care of contraception

It was amazing, I always read in horror here where women are for example bleeding heavily for weeks and can't get any treatment, back home I would be seeing my gyno same day with no referral

I recall back in the 1980s when I started on BC I went to the local family planning clinic and saw a gynecologist. It was completely free and I think you could just turn up at the clinc for an appointment. I then went back regularly for smear tests and the BC prescriptions etc. It was totally independent of the GP who was an old-fashioned male family doctor that knew my parents - it would have been mortifying to go and see him for BC. Surely this is the same thing as going to a separate gynecologist but I am not sure if these clinics still exist?

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

this is interesting. Is it the same in the us, where a paed would be more of a children’s GP?

in the UK paediatricians are specialised, hospital based and only see children when there is an issue.

specialist GP’s are a thing here, if you look at your practice staff list you’ll probably see some have extra training in women’s health, mental health, diabetes care etc. maybe children’s GP’s within the practice would be the way to go?

mind I don’t see much point in the very frequent checks for a well child or person. More likely to find something to worry about that would otherwise be fine. The NHS usually does the risk analysis and if regular well child checks don’t improve outcomes then there’s no point.

Family planning clinics? Yes fairly sure they still exist.

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.

No, this is nonsense. Nobody I know in the real world actually behaves this way. They may or may not follow their pediatrician's advice, but I've never in my life heard of anyone who waits for the doctor to tell them when to start solids or whether to sleep train their baby.

Here paediatricians are highly skilled and trained. I can't imagine they would be happy to spend most of their time doing routine checks.

The health visitor system has been destroyed in Britain and is basically a safe3giuarding service now. Health visitors were qualified nurses who did additional training on top.

Yes, per pp, the pediatrician can always be contacted by phone or email and if your child is ill out-of-hours, you leave a message and they will call you back within 15 minutes. Not sure if that is the same with GP’s in the UK.

You do still have hospital paediatricians who will deal with complex/specialist stuff, and some 'children's GP'-style paeds who have special interests (so if your child has a certain condition you may choose to see one of them). I've found the paeds we've had over my children's lives to have known more about some things, less about others and happily admit the limits of their expertise. But they are specialised - in children.

So they are basically children GPs?

Oddly, some people seem to think they need various annual medical check ups. Of course, they don't. But perhaps it makes them feel that they are getting value for money for their annual healthcare payments?

Ha not mine. Up 30 minutes on hold where you get told the nurse will call you back but then they never do. Worse than the UK. But at least you have urgent care in the US so can always get seen quickly when you need to.

Yes, with specific specialties in addition often.
So ours runs an ADHD clinic but has referred out to another department for monitoring of another condition to prevent duplication of x-rays.

You have paediatrcians who provide primary care and also those who provide secondary more specialist care so no they are not wasting their time doing check ups or not highly skilled.

shaniahoo ·
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?

A fee!

Strange thing to say. We all have annual check-ups. I think of it as an MOT. They run blood tests and check for high cholesterol amongst other things I can’t think of right now. They weigh you, ask you questions about your lifestyle etc.

I’d rather be told my cholesterol was elevated at a check-up so I could do something about it, rather than carry on in blissful ignorance until I had a heart attack.