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?

The thing is that the check-ups (which are not always annual) can catch stuff that is much, much more simple to treat when caught early. The idea that it's always about money is a bit tiresome (particularly in relation to European-style systems).

To provide more context, we use Northwestern hospitals in Chicago and our child’s pediatrician provides primary and preventative care at the northwestern children’s practice

www.nm.org/conditions-and-care-areas/pediatrics?gclid=EAIaIQobChMI1rqG9YSx_QIVyf_jBx10XQLoEAAYASAAEgJ8p_D_BwE

And then you have the children’s hospital where children are referred to when they need more specialized care.

www.luriechildrens.org/en/specialties-conditions/

And we’re happy with the services we have received so far. This is not saying the US system is perfect but it’s just frustrating this constant need on MN to peddle false exaggerated information based on stereotypes.

You’re so confident you’re better than American yet spend your time watching American YouTubers and on American forums so you can come for MN with your aren’t Americans weird questions.

You can have an annual health checks on the NHS. A friend does this.
The people who go though are largely those who do not need 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.

More likely the NHS just doesn't have the budget for regular well child checks.
In my experience the check ups are very good for spotting issues before they get bad. They also serve a safeguarding function, ensuring children are regularly seen by a health professional to potentially spot signs of neglect or abuse, and school age children can see the school nurse without a parent and they get asked about home life so its a good opportunity for disclosures. Risk factors are also checked (I have to fill out a form for some of these check ups outlining family health and eating habits, screen usage, family history of health problems, and DD had her own form to fill out last time).

But your eye prescription can change, you can have early caries without symptoms - aside from a smear (which isn’t done annually and isn’t the same as an internal exam) what can go wrong from a gynae perspective without any symptoms? As a doctor, I genuinely can’t think of anything.

There is no reason for a 16 year old to have an annual internal exam “just in case”. By the time any abnormality is palpable, you’d have symptoms. And advanced gynae cancer would be incredibly rare in a 16 year old anyway. It’s just a weird Victorian throwback/excuse to charge people.

Similarly, annual colonoscopies. Indefensible honestly, when non-invasive FIT tests are so reliable. But you can’t charge $$ for a FIT test.

Ask Jade Goody's ghost, she can fill you in. Preventative care is the norn in the US, unlike the UK.

Yup. I had a check up with my occupational health care nurse the year before last (first time I had one) and they picked up on my anaemia so put me on iron and ordered repeat tests every few months until my haemoglobin was back where it should be, avoiding the need for an infusion like last time I was anaemic. And checked vision and hearing (would never have thought of getting my hearing checked!)

It’s the U.K. that’s out of step. Preventative health care is much more a thing in Europe, nothing to do with making money, just far more sensible.

Annual colonoscopies!!!! What on earth are you on about????

Colonoscopies are every 10 years after the age of 50 and every 5 years if there is a family history of colon cancer. Please get your facts straight before posting rubbish.

Lots of people in the U.K. see a paediatrician for their children too. They pay for them.

I was a lot better off when my eldest (now 21) was a child.

We didn’t have an NHS GP at all, we saw a fantastic paediatrician in London (where we lived at the time) for everything for him. Vaccinations, all his checks. Anything we wanted to see him for.

He did home visits too if they were really ill. We paid for the appointments, although if he ever needed referring on for something (like dermatology once), our insurance covered it.

It’s not the norm in the U.K. but people do it instead of using NHS GPs or health visitors.

Or free. As many of us in the EU have said.

Many Americans have a choice of pediatrician and can choose one that aligns with their own parenting philosophy. That is what we did.

we did not seek permission to start solids or to do anything else.
the only time I ever say “my pediatrician told us to do” is when I am defending a decision that other people find odd. It is basically a way of saying the expert told me to do it this way, even if you made the choice yourself.

i personally only say that when I am doing something that goes against my own initial instincts, like the advice we got that we have to feed less than stellar food to our ASD child. That was hard to accept at first and people give us tons of flack about it in real life. In the early years it was very handy to say, “this is the breakfast her pediatrician recommended to help her gain weight” to get them to shut up.

With a FIT test though, if it picks up blood, you already have polyps that are bleeding and could be cancerous.

With a colonoscopy, you can find the polyps when they are small, remove and tear hopefully before they become a problem.

I’m not saying everyone should have a yearly colonoscopy they are, shit. I have them 5 yearly since the age of 35, family history.

*test, not tear.

You can have free annual checks on the NHS.
They really are not necessary but some people do have them here.

That’s a smear. An internal exam is putting a hand inside you to feel your uterus - if it feels abnormal, unfortunately the cancer is pretty advanced by that point. You would have symptoms long before the tumour was big enough to feel through your abdominal wall.

I’ve had a paediatrician for my kids since the eldest was about 6 months. I’ve used him over the years for anything over and above general kids illnesses ash infections such an allergies, rotavirus, lumps on the kids, unexplained pains, development concerns.

i also have. Gynaecologist. He did all my post birth checks, my infertility investigations,delivered my youngest, fixed dodgy scar tissue on an episiotomy, does an annual smear in between the NHS ones, and I’m currently talking to him about HRT.

I’ve also got a breast consultant who does an annual mammogram and ultrasound as I’m too young for nhs one and I have had lots of lumps. I’ll stick with him in between NHS mammos when they start

But you're conflating what others have said and rolling them all into one Othered poster.

A smear test can save your life. Are you actively discouraging women to not have them? Annually or otherwise? I know that in the UK now, smears "only" test for HPV but are you saying not to bother? Until you have "advanced gynae" symptoms?

As a doctor, (medical?) do you disagree with ovarian cancer being called the silent killer? Because, rare though it is, by the time it's caught it's almost invariably too late?

The poster talking about a 16 year old having a gynaecological exam before receiving BC didn't mention the possibility of said 16 year old having cancer. You did.

In all the rubbish you're spouting, the most dangerous however remains "what can go wrong from a gynae perspective without any symptoms? As a doctor, I genuinely can’t think of anything."

I seriously fucking hope you never tell any women patients that. I seriously hope you aren't a doctor.

what can go wrong from a gynae perspective without any symptoms? As a doctor, I genuinely can’t think of anything

Good news, we can cancel all routine mammograms! Can't possibly have breast cancer if you don't have any symptoms.

A huge number of women in other countries only find out they have breast or ovarian cancer because of their annual gyno exams, because the doctor notices something very small or vague symptoms like fatigue and bloating.

If I call my GP in the UK and tell them my periods are a bit heavy and I'm tired, they'll tell me to jog on. If I mention it at my annual gyno, they will ask lots of questions, take a family history and do some tests on the spot if necessary. Because sometimes those are the only symptoms of very serious things early on.

@So1invictus they are definitely not a doctor

Yes, YABU.

I know nobody who would ever have the attitudes you've described. Either you've got it completely wrong or the people in these online groups are a bunch of utter weirdos.

I'm from a European country with universal healthcare and every child is under the care of a Pedeatrician until the age of 16.

The have regular checks and otherwise act as a normal GP for every child.

I also had a Gynecologist and an internal gynecological exam when I was 16 (in the 90's though, not sure if that's still the case).

Perfectly possible to miss polyps on colonoscopy as well - there’s up to 5% risk of missing a lesion. All depends on how good the bowel prep is, and where the polyp is located.

Five yearly colonoscopies for high risk patients is one thing. I was talking about the U.S. practice of doing an annual colonoscopy on patients over 50 who have no symptoms or personal risk factors whatsoever - in that group, given the relative risks of colonoscopies vs FIT tests, I don’t think it is defensible to go straight to colonoscopy without screening with a FIT test first.

Of course if the FIT is positive or there are red flag symptoms (or as in your case, if there are other risk factors), the risk/benefit calculation changes.

Annual gynae checks would save lives I reckon. Especially when looking for ovarian cancer which is usually diagnosed too late. I wish we had this here.

That always makes me laugh. I mean surely you don’t need a regular one? Very strange.