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?

@Saschka that first internal exam can diagnose if the uterus is tilted and a discussion about your menses if they are heavy/cramping discomfort etc, and any sexual discomfort.
a young person may have been sexually active even prior to the visit requesting contraception and indeed already be pregnant.
i can certainly think of a few good reasons for an internal vs a phone chat.
all of which is helpful because mn or your own mother for that matter might just not be the best place to ask.

Interesting, back in around 1973 when I went on the pill, part of the check up was an internal exam. Also every time I got a new 6-month prescription, until 2006 when I left the UK. Has this stopped?

@So1invictus I was speaking specifically about routine annual internal exams. Which are not the same, at all, as smear tests.

Of course I am not saying people shouldn’t have smear tests (or mammograms). I am saying a 16 year old does not need a hand shoving up her fanny on an annual basis if she has no symptoms. I hope that is clear enough for you.

Risk factors are also checked

This can also include whether there are firearms in the house and how they are stored.

I am in the states - American - if you are employed and have medical insurance through your employer, you get 1 "free" health check-up a year. I do mine with an internal medicine doctor (I've never had a GP) and separately with a gyno. I take HRT so I have to see the gyno once a year in order to get my HRT prescription refilled. I could do mammograms and have, but it's a pretty big $$$ racket where a high percentage of women are called back for more testing including invasive tests $$$$$$. The initial screening is free, so they don't make money off that.

Since medicine is a huge for-profit industry here, there are commercials for new expensive drugs for very specific ailments and the commercials tell you to see your doctor and tell them you have very specific symptoms - they give you the language - and people actually show up to doctors asking for a drug they heard advertised on TV.

Pediatricians have philosophies so it's good to match one with yours. Mine (in the 90s) did not like vaccines but was willing to give them as late as possible for school purposes - so he went off-script from the recommended schedule. He also didn't believe in ear tubes we caused problems for us. This "being cleared" stuff - I don't know - that's just weird but I can believe it because this for-profit medical industry is based on instilling fear, so you are afraid of anything health-wise. Fear leads to profit.

Some doctors can be very specialized. Once I was a teenager, I changed from pediatrician to a female doctor who only saw teenage girls and she did that first pap/smear test which was required as part of going to university. The schools required girls to have it before attending. It was so stupid.

My son saw a doctor who only saw school-age children struggling in school. He got his ADHD meds from her. She was cash-only though and not his regular pedi.

Yes, preventative healthcare costs a lot less in the long run too.

I’m not understanding the UK posters deriding regular check ups. Just in case something is found? Surely that’s the whole point? If there is something untoward surely it’s 1000x better getting it caught at an early stage instead of drastic measures when the issue is advanced?

Years ago, in the early/ mid 80s, we had something like a family doctor on the NHS as in that was the Dr we, as a family always saw. He was part of a larger health clinic but we always asked for and saw him. He treated us for minor things too rather than the nurse. Or at least he triaged us.

Lovely gentle man I remember. Probably was younger than I am now!

Obviously the NHS was better funded then so this has now been done away with but something like a family doctor definitely existed in my area of west London in the dim and distant past.

I'm 60. I've never had a hand shoved up my fanny in an annual exam. Perhaps it's different in the UK, NHS and all that. Gyno exams use a speculum.

No one in the Us has an annual colonoscopy! It is every 5 years at most starting at age 45. So many misconceptions about US healthcare. Preventative care is about making money, typically these visits have no cost to the patient. Maybe it ia about saving money down the line but I have no issue with that. The problem of course is that the people who most need preventative care tend to be the ones who avoid going to these appointments so our system ends up burdened by the costs of treatments that could potentially have been avoided but that ia a different story and os a similar case to the UK

I'm part of a FB group that's about the medical condition my daughter has.

From what I can gather from fellow American parents, some any way, they research what they think is wrong with their child and then contact a surgeon etc that deals with the condition to test. Couldn't see that going down well on the NHS or my daughter's own consultant even me suggesting a test. My daughter's condition is quite 'niche' so not really a general paediatrians field.

@Liorae a proper exam, once the speculum is removed or maybe before will involve a manual exam to feel the uterus and ovaries.
it’s almost sad reading this post, so many are accustomed to sub par care.

We use both our government health service as well as private medicine depending on what we need to see the Dr for and what waiting list times are likely to be. In the health service you see the person you’re assigned to on the day but in the private sector we have the pediatrician, gynecologist, family surgeon, physician etc etc that we’ve chosen. I’ve had a few major surgeries these last few years and I split my care between both systems but if I wanted to see my gynae-oncologist outside of my government appt schedule I’d go and see her at a local private hospital the day she’s there. Her rule of thumb though is that she’ll chat/re-assure etc at the appt but she’ll only treat within the health service and she’d then arrange for her nurse to sort out an appt for me at the government hospital. If I felt I needed to see her urgently for an investigation or blood test I’d just go to the government hospital and ask to be seen at the end of a clinic or an appt would be made for me asap.

the reason why most people find the whole gynae /Paed routine checks bizarre is because the American med system is preventative. Yes it is all private and costly but by having routine checks like yearly smear test, pelvic ultrasound sound etc… you can catch medical issues early on and therefore treatment straight away. Many countries do this.
while we on the other side will wait for something wrong to happen to ask to be checked over. Think of it as yearly dental check, but for other parts of the body.

That isn’t a bimanual pelvic exam then.

If you aren’t having one, great, your gynaecologist obviously agrees with me (and the ACOG, as it happens) that they aren’t indicated in the absence of symptoms.

Some truly gobsmacking tosh there.

My DCs were registered with the practice of the hospital pediatrician who saw them from birth. They saw the pediatrician from birth to age 18. He was great, very supportive of breastfeeding.

Initial visits were 'well child' visits, beginning with a two week checkup, and at these there was weighing, measuring, and beginning at two months the mandated vaccination schedule kicked in. Iirc, they went at 2, 4, and 6 months, and again at 12 months, for their growth and development check and for shots/ boosters.

After that, the schedule of visits followed the vaccination schedule until maybe age 4, when annual checkups became the norm. Proof of an annual physical exam is mandated by the state I live in, along with proof of an annual dental exam, in order for a child to attend school. Proof of vaccinations is also required.

My DCs did their annual exams every summer all through school as high school required this too. They played sports in high school and the state schools' athletic board required a sports physical - the sports physical sufficed for the school/ state requirement iirc. They got some booster shots in their teens, gardasil, and also meningitis shots in their late teens (required by universities).

The pediatrician we were registered with was a professor of pediatrics at a local medical school. His practice saw a huge number of children and we always had residents ( qualified doctors learning their specialty) at the visits, doing the physical exams, and being questioned by the pediatrician.

There were experienced pediatric nurses at the practice who fielded phone calls and liaised with the doctor, if something came up. They dished out advice over the phone and basically did phone triage, with the aim of keeping office visits to a minimum.

We had an acute asthma attack and a few ear infections that needed same day attention over the years. Plus one occasion when toddler DS stuck a staple into an electrical outlet a week after we moved into our house, and got an electric shock. There were many years when we only darkened the door of the pediatrician once, for the annual checkup.

Pediatrics is a primary care specialty in the US, as is OB/gynecology.
There are also family practitioners, who see people at all ages and stages of life. Managed care health systems tend to employ family med providers, who refer to specialists as needed.

I have a family practice physician at this point of my life - she referred me for a battery of recommended tests last year (colonoscopy, mammogram) and all follow up testing and procedures were ordered by her too. She also ordered blood tests for various menopause related symptoms. The office phlebotomist did the blood draw and the sample was sent to a lab. My doctor does my annual pap smear herself.

That is horribly misguided and probably the reason why the UK lags other western countries in catching and curing cancer.

Annual colonoscooies are only done on individuals with known risks.

I had one last summer, my first. They will see me again in 5-7 years.

The parent of a friend of my DS has one every year because of his specific health issues, what they found when he had his first one done, and family history of colon cancer.

Absolutely! 100% agree.

Mine was just changed to every seven years due to a change in family history. Mumsnet is a mine of misinformation regarding the US. I guess if they can't afford salad then they need to deflect in some way.😂

My US family with money/insurance are OBSESSED with all things medical,
particularly their kids doctors. It’s a status thing I think.
but listening to them their children sound over medicated ( they’re healthy other than colds etc) but are given antibiotics at the drop of a hat.
the doctors make a fortune from these visits and prescriptions and interventions.
My DN 14, has antibiotics for a sniffle, pain meds for routine sports aches that would fell an elephant, pills for anxiety -
not particularly anxious IMHO, and pills to help sleep - partly because of the anti anxiety meds.
it’s mad.

Thank you for the extremely long and very detailed response to my uncertainty re the current system in the US.
I’m guessing you were not contradicting private insurance companies having share holder profit as their primary concern, or the contents of debates at BMA House in the 80s.

STOP REPEATING YOUR LIE. There is NO “US practice of doing an annual colonoscopy on patients over 50 who have no symptoms or personal risk factors whatsoever”.

Colonoscopies are EVERY 10 YEARS for that group and every 5 years for those with family history

I think you are absolutely right. It’s extraordinary the things some people are coming out with.

They should change doctors. It's quite easy.

and getting peas out of the nose of second child.

the first and third children being left with an assortment of mixed veg in their noses 😁
made me laugh