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?

@AnotherBritInTheUSA

In our pediatrician's practice, a receptionist and one of the doctors started hours at 6am, so if you'd been up all night with a sick child, but it wasn't enough of an emergency for an after hours call, they'd get you in and seen first thing. It was lovely.

The one time we had a middle of the night emergency, our pediatrician met us at A&E at 2am.

That's not what the ACOG link says....

. A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. It is recommended by the American College of Obstetricians and Gynecologists that pelvic examinations be performed when indicated by medical history or symptoms.

It’s a common reaction when someone realizes they have less-than someone else. They go on the defensive and try to convince themselves they aren’t actually missing out.

After all, who wants preventive medicine? It’s the US and the rest of Europe who are in the wrong, obviously… 🙄

Our dc have a paediatric consultant under the NHS for a preventive maintenance of a medical issue. We only landed up under them by chance of one seeing one of them when in a and e. They managed to get our child's situation under control and say they will see them yearly until adulthood or before the next appointment if we need to be seen.

I feel there could be a place for them more widespread since GPS are so overrun which is not their fault.

As a doctor, you presumably understand the difference in US vs UK cancer survival rates? Surely some of that can be attributed to preventive health care?

I've also never heard of an annual colonoscopy for anyone.

worldpopulationreview.com/country-rankings/cancer-survival-rates-by-country

When I was living in the US, my GP’s office would ring me every six months to say I needed to come in for a blood test. I asked them why and they said everyone should do a full blood panel every six months.

It’s just a money spinner. That’s the problem when healthcare is a business rather than a public service. Totally unnecessary.

That’s great

Sure

Never heard of such a thing. I don't think that's the norm. You can always change doctors if you think they're too greedy.

@dreamingbohemian I went through about three PCPs in my 10 years there. My exSIL is a doctor and told me a lot of the time they over-test to avoid litigation.

@Saschka
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 know a lot of doctors and I've never met one yet who would refer to a gynaecological exam in those terms. Your opinions and vocabulary are certainly unusual in your profession.

I’ve never had an internal exam in my 15 years here in the US. I’ve been on contraceptives most of that time. I have routine smears every five years.

Neither of my teen daughters had to have an internal exam to be put on contraceptives.

Blood tests at most every two years. Latest ones showed high cholesterol - good to know. I eat well and exercise loads so we’re considering medication.

One colonoscopy at 50. I’m now 54. Those ‘routine annual colonoscopies’ are mythical.

My paediatrician took amazing care of our children - gave good advice which we were free to ignore or cross question.

DD with allergies saw a specialist allergy doc. I ended up seeing the same doc who put me on allergy shots and my allergies have almost completely gone.

Never seen a gynaecologist but good to know they’re there if I have issues with menopause, periods, fibroids, bleeding, endometriosis, pelvic pain, cysts, etc.

Always fascinating seeing how badly informed Mumsnetters are about the rest of the world. Seems like the UK education system fails to teach any kind of critical thinking.

I think it’s different state to state and likewise healthcare system to healthcare system. With my first job in the US, my benefits were tied into one network. The HCPs I saw during my years in that network (Aetna) definitely pushed testing more than the one I was in during my second job (BCBS).

Yes - British people are too keen to assume that all US habits are about money when the UK is the outlier. Preventative visits are actually a financial loss for doctors, and the US isn't unique in doing them. Same with direct access to gynaecology. Having had small children in both I prefer the American system and think it picks up on developmental delays and other issues more quickly. Preventative visits are actually pushed by the system in the theory that chronic conditions will be picked up before they become serious and hence be better treated. I have Type 2 diabetes and it was picked up before I had obvious symptoms.

The US system allows family practitioners (FPs), paediatricians, and internists do primary care (there's also advanced-practice nurses and PAs, but we'll stick to doctors here). Family practice is similar to UK GP training, including OB/GYN rotations, and they're particularly common in more rural areas. After an internal medicine or paediatrics residency, a doctor can go straight to either primary care OR to hospital practice. Or they can continue to subspecialty training such as endocrinology or cardiology. There's also med/paeds which allows a doctor to specialise in either following residency.

American midwives are nurse-midwives who do a master's programme following their nursing degree, and can do primary care, antenatal care, and deliveries. I see one for my well-woman care. (I had high risk pregnancies and saw an obstetrician, but I was also consultant-led on the NHS.)

My children have a regular pediatrician they see for well visits, vaccinations, and if they get ill. But the two with autism also see a developmental paediatrician at the children's hospital.

It also depends on your insurance if they require a referral from your PCP to see a specialist, and some specialists have policies requiring a referral.

Also, gynaecologists have changed their rules on exams--they no longer say 18 year olds should get Paps and the "you need an internal exam to get birth control" is thought to be outdated. the frequency of Paps has also been adjusted now that Gardasil and HPV testing are available.

I’ve been insured by BCBS, Aetna, Harvard Pilgrim and an employer that self-insured, in 3 states.

As a family we’ve been registered with four different PCP groups.

I’ve seen no discernible difference in care, preventative or otherwise.

I’m sure that in a country of over 300 million people we’ve all had a variety of experiences with good and bad HCPs. I worked in the nonprofit sector assisting low income and BIPOC folks in a southern red state and saw a lot of people treated terribly by the system so I’m sure my views are influenced by my professional life as well as my own personal experiences.

I've seen differences from providers but not from the insurance company. Aetna and Blue Cross were very similar.

the exception is Kaiser Permanente, which is both an insurer and a provider and is its own thing. If you're in an HMO like that then it's very different to having Blue Cross which only exists to pay the bills.

An NHS friend visited Kaiser a few years ago on a fact finding trip so the NHS could learn from how they operate.

What if you don’t have insurance?

particularly in cases like pp mentioned where the state requires evidence of vaccinations, yearly checks etc?

do non insured people get the same level of preventative care?

When I was with Aetna, I could only use one hospital system’s providers in my city. It was incredibly limiting. I became a big supporter of Planned Parenthood during that time because I couldn’t access the gynaecological care I needed due to the hospital system’s religious beliefs. That was a shock, coming from the UK.

Other than the religious aspect that actually sounds almost identical to trying to get care in the UK. Incredibly limiting.

It's not required in the sense that you would get penalised for not doing it.

If you are uninsured it depends on where you live. The government helps fund federally qualified health centres and one of the things they do is sliding scale care for the uninsured. But in my state they would work to get you insured if at all possible. The uninsured rate by state varies quite a bit.

No more alien than having a Health Visitor after you give birth. I can’t count the number of times I see on here about the almighty Health Visitor and how their word is the law of the land! For the record I had my Ped. Physician tell me to use a med for our son’s reflux. I did my research that said it might have irreversible side effects. I told him no, he was not happy, but you simply have to use your own mind. Like you would (hopefully) with a health visitor.

@Lastnamedidntstick I experienced helping an insured but lower income person (an educator) who went into a coma for six weeks because they could afford the medication they needed. She will be paying medical bills for the rest of her working life. The system is broken and it's those on low to moderate (too high to qualify for assistance like MedicAid but still living pay day to pay day) that suffer most.