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?

This table is quite helpful.

www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Uninsured%22,%22sort%22:%22asc%22%7D

my oldest is nearly 18, so I suppose I've learnt to take whatever doctors say with a grain of salt. Internet groups are terribly unrepresentative. When all I had was a 3 month old baby I was a nervous wreck.

Not surprised to see my former state at the top of the list of most uninsured people! 🫣

I’ve lived in the US 8 usages and never ever been asked for blood test every 6 months, not even once.

Sorry haven’t read the thread but on the screening point, I imagine it’s because the insurance companies figured out it was cheaper to screen people and treat them early than it is to wait for them to get sick enough for them to be noticeably ill. Clearly it’s worth the insurance companies covering it.

It has been much easier to get screenings abroad than it was in the UK for me, yes I had to pay a small excess but it means the difference between the insurance company coughing up for some iron tablets vs an infusion. Catching a diabetic early can save an extraordinary amount of money etc etc.

I recall being pregnant in the uk with a known bleeding disorder. I had blood tests every 3 weeks.

No one ever read them unless I specifically asked them, then they’d suddenly react in horror and start panicking.

It was fucking appalling.

i had them fail to diagnose preeclampsia promptly. A friend also had them miss her preeclampsia because doctors just don't work over Christmas. They also yelled at her for wanting to know her blood pressure when they took it.

There is a lot I won't defend about US healthcare as a system but the antenatal and delivery care I had here, in two different states, was significantly better.

Yes I had pre-eclampsia and suspected HELLP. Honestly I’m surprised DD and I survived.

My Obstetrician (wonderful doctor) worked in the NHS, she was paranoid about pre-eclampsia. She told me she often had women referred to her extremely late (she looked extremely upset when she was telling me so I assume it was very bad).

@Saschka I lived in America for about 15 years with my medical care organised through HMOs centred around two top university medical centres. Annual colonoscopies at both centres are reserved for very high risk individuals. The norm is one every 10 years with greater frequency dictated by risk. I have never heard of any other practice, actually, and I had particular reason to listen on this one.

I'm in Texas where if you are poor it's your fault and you need to just suck it up buttercup BUT I am in a major city where they at least attempt empathy. We have a public hospital where anyone in the County can present themselves and be seen with zero anticipation of having the bills paid. It's a beautiful brilliant facility though and if you need urgent gunshot wound care - that is the place you want the ambulance to take you.

There are also clinics uninsured people can go to and before the bru-ha-ha there was Planned Parenthood for birth control. You can just pay cash too if the doctor will take cash patients - some will and some won't. Sometimes it's cheaper to be a cash patient instead of paying insurance premiums, plus deductibles.

Obamacare is helpful now. There are so many govt credits starting this year that having health insurance is free now for more people than ever. It's based on household income and they raised the limit. Deductibles can be super-high and the patient pays the deductible before insurance kicks in, but you get the "agreed upon rate" for services - as if insurance covered you - while paying the deductible.

I was the benefits person at a job once and the Hispanics that worked there all declined the "free" employer medical insurance - saying it was cheaper to use the County hospital and clinics or go to Mexico for care - by the time you paid the deductible with the employer plan. It may be why Texas has the highest uninsured rate.

The biggest issue in texas is the high poverty rate combined with incredibly stingy Medicaid limits and no expansion. In a northern state the Medicaid changes alone would substantially lower the uninsured rate.

some of the southern states are heartbreaking. Incredible poverty, no investment in public health.

We’re in the US and my children’s pediatrician has been great, she’s never told me what to do, but the children gave annual physicals and she’s given good advice on many issues, including recommending a wonderful counsellor when DS was suffering from anxiety.

Re. Ob/gyn. I have annual examinations, including mammograms now I’m over 40. Something was flagged on my last mammogram that has to be monitored every few months-like @AnotherBritInTheUSA , I’d rather problems are caught very early than find out when they’re advanced.

DD (17) is registered with my gynecologist, but hasn’t needed an examination or screening yet as she’s so young. They’ve just discussed contraception and she can be seen whenever needed-that's why she’s registered with this doctor. DD is going to university in the autumn and they’ll have a pre-college chat before she goes.

It’s overkill, but it’s good for her to have a relationship with a trusted doctor.

My experience of American paediatricians is that the word standing alone signifies a GP for children. My experience of them is mostly very good. Children are a special population and it is worth training to meet their needs. But I don’t recognise this characterisation of paediatricians as gods.

What Brits call paediatricians tend in America to be double-barrelled: paediatric cardiologist, paediatric surgeon, etc.

American adults tend to see Primary Care Physicians who can in theory serve children as well. Insured women often have a gyno. It does sound like a lot once you have adjusted to life in the UK. OTOH I have just had to request a test, based on family history, that turned up serious but fixable trouble. It would have been offered as a matter of course some time ago at my American HMO. The American system isn’t perfect but it isn’t all about profit.

That's important. Me & DH are 'guilty' although we were helping manager friend meet her quota, too. The Americans with most access and most engaged so therefore lowest risk, have the least need. :(

Americans get much more direct access to specialist care. The BMJ runs a lot of articles about over-treatment as its own problem. British doctors will also mutter about over-investigation. it matters less in USA system where patients are overt customers who get what they demand, but health care in NHS is inherently rationed (because of funding model) according to need not want.

Yes but in the UK you would only have a gynecologist if you had been referred for a specific problem. People with no gynae symptoms don't go for random gynae check ups like in the USA. There's definitely a lot more intervention, probably because it's monetised. Eg everyone gets amniocentesis in pregnancy not just high risk people.

There's more intervention but it's not just money; cultural biases are also in play. If you compare the UK to other countries then you see that the UK is really at the low end of the spectrum.

Also not everyone is offered amniocentesis. Women over 35 are routinely offered. Under 35 they use non-invasive testing and follow up with CVS or amnio if problems are indicated.

@adulthumanfemalemum It’s more accurate to say that pregnant women have the option to have amniocentesis in the US, you absolutely don’t have to have it if you don’t wish to. I know people who’ve opted for and against it, it’s completely your choice.

The gynecological checks ups aren’t “random” either, you can choose to have an annual checkup if you wish. Personally I think it’s a good idea as they ask you about any gyn. issues you may have experienced over the last 12 months, discuss your contraception, etc.

The best part is that problems can be caught early-if my friend’s cervical cancer hadn’t been caught extremely early, before she had any noticeable symptoms, the outcome might have been different. As it is, they could remove the cancerous cells and she’s been cancer-free for 15-plus years now.

They do? Evidence?

Taking money and insurance out of it, having children's doctors see children makes sense.

I am a paediatrician (UK, NHS). I am 10 years trained out of university in paediatrics and just become a consultant. I used to spend my nightshifts seeing snotty children in a and e with completely normal obs because many GPs are scared of making decisions with children. Similarly, simple things are often sent to outpatient clinic that might be managed in primary care (again, not all GPs)

GP training includes 4 months of pediatrics and best will in the world, they often end up doing lots of admin tasks while paeds trainees do much of the clinical stuff. There is rarely time for them to go to clinic because of pressures on the wards. Don't get me wrong, some GP trainees are great with kids but many have very little hands on experience.

Why not have two training pathways. GP training is 3 years (compared to 8 for paeds) but surely if they just did 3 years of paeds, then only saw kids, this would be much better. This would potentially reduce pressure on specialist paediatricians and mean that some of the horrible waits could be reduced.

You don't necessarily need to have super regular check ups, but easy access to someone who understands children's health, seems like a good idea to me.

I think people have to really remember that before a procedure is performed the insurance has to be checked for coverage. The insurance company is only going to pay for stuff that they think worthwhile (i.e. saves them money in the long run) so no they aren’t going to ok stuff for absolutely no reason at all.

My insurance will only cover so much (and it’s pretty comprehensive but again I’m not in the USA). My doctor can’t just draw up a random list because it has to be okayed my insurance and stuff can and does get declined. The amniocentesis for example, the doc would have to write a note saying exactly why they thought it was required, if the insurance company disagrees it’s refused, they can’t just stick it on a laundry list of billable procedures.

The antibiotics stuff is not the norm, I have always had drs in the US who are extremely reluctant to give antibiotics for anything unnecessary and this is the norm these days. Maybe there are some drs who hand them out for everything but that goes against standard medical practice.

@weatherthestorms that sounds extremely atypical.

Eg everyone gets amniocentesis in pregnancy not just high risk people.

@adulthumanfemalemum

Nope. Not a thing.

I agree, @mathanxiety , not my family’s experience at all!

We are in the US for nearly 30 years. My kids' paediatrician was lovely. All of the kids' care was through him - vaccinations, weigh-ins, etc. I think he may have talked to me about weaning once - as in he handed me a sheet of paper with suggestions for weaning and told me the latest advice was to wean to solid food at 6 months. I certainly didn't feel like he - or anyone - was telling me how to rear my child.

I've had annual smear tests here with an obgyn since I was about 35. Colonoscopy at 50 and as it was fine, no need to come back for 10 years. No idea where the idea of the annual colonoscopy had come from?

DH has a family history of bowel and breast cancer so he got colonoscopies every 3 years since his dad died of it - so did his siblings in Ireland. I get a mammogram every year. An eye test every year. All of my very fair-skinned children have had dermatological scans (as do we) every year or so. one had something removed.

I'm at a loss to know what is wrong with this. There is a lot wrong with the US health care system (and honestly from my reading of MN there seems to be a fair bit wrong with the NHS too) but preventative care is not where I'd start the reformation.

Oh and 3 pregnancies here in the US, no amniocentisis for any of them. I didn't want one so I didn't get one.

The poster who got her bloods done every 6 months in the US must have had some hell of a health insurance package. I don't know anyone who has had that.