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?

Also reared 3 children here with minimal prescription of antibiotics and very little of any other long-term prescription.

So did you change GPs?

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?

@Lastnamedidntstick
Thanks to the ACA (Obamacare) most states now have many more insured people than previously.

On top of that, most states run their own medicaid programs dedicated specifically to provision of healthcare for pregnant women and their children up to at least five (to 18 in some states). The normal vaccination schedule is covered in those years.
www.illinoiscaresforkids.org/infant-en/healthy-infant/healthcare-for-all-kids
Example - Illinois.

Most cities, most counties except in certain states, and even some suburbs have their own public health departments where an annual physical exam can be done, vaccinations given, and the necessary paperwork filled out for school.
A couple of examples:
www.dallascounty.org/departments/dchhs/immunization-hours.php
Dallas County (TX)

www.chicago.gov/city/en/depts/cdph/supp_info/health-protection/immunizations_walk-inclinics.html
City of Chicago (IL)

dph.illinois.gov/topics-services/prevention-wellness/immunization/vfc-program.html
State of Illinois
Information for Parents

Children through 18 years of age who meet at least one of the following criteria may be eligible to receive VFC vaccines:

Enrolled in Medicaid.

Not insured: A child who has no health insurance coverage.

American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25 U.S.C. 1603).

Under-insured: A child who has commercial (private) health insurance but the coverage does not include vaccines, a child whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only), or a child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as under-insured. Under-insured children are eligible to receive VFC vaccine only through a Federally Qualified Health Center, Rural Health Clinic, or deputized local health departments.

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

That is an extraordinary assertion, from a doctor.

@Liorae I did, after about a year, which was a pain because we lived in the exurbs of a city and there wasn’t a huge amount of choice close to home. I very seldom need to go to the doctor, luckily, but the office sent reminder emails and made calls saying my DH and I were due for ‘routine preventive blood work’. It was a total racket, but possibly just something this doctor was doing.

I’m just gobsmacked that people are criticizing preventative medicine and specialized doctors . On what planet does that make any sense? No it must be better to have to convince a GP that something is wrong and then wait some indeterminate amount of time to actually see said specialist and then be bounced back and forth between the GP and the specialist (if you managed to get the specialist appt to begin with).

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.

@EndOfEternity

There has been a lot of change in the US healthcare field since the 1980s, notably the ACA, which despite all its faults has been a big improvement.

www.commonwealthfund.org/publications/issue-briefs/2019/aug/did-ACA-reduce-racial-ethnic-disparities-coverage
Racial and ethnic disparities in coverage since the ACA.

www.cancer.org/latest-news/aca-effect-on-access-to-cancer-screening-care.html
Access to cancer screenings since the ACA.

The ACA made a huge difference but many people still protested it. My now-ex DH included, because he was self employed and decently off and his premium went up because of it.

I was in DC in 2010 on the day it was signed. A friend’s husband and his father were kicking off about ‘if people were poor that was on them and it wasn’t his job to subsidise their family’s poor life choices’. Then said her H said he was going to his bible study group. 😂

That story repeated itself in a variety of guises while I was living there… That aspect of cultural difference was ultimately why I came back to the UK.

I get six monthly bloodwork but I have a reason to; I have type 2 diabetes and Hashimoto's. I don't know anyone who has no history of anything and gets it every six months. Adults generally get some once a year at their annual visit. A1c, glucose, lipids, and a basic panel.

@MrsHughesPinny
The dead hand of the Puritan philosophy was very much in evidence at that time, mixed in with the still very strong Better dead than Red approach.

There is an enormous cultural divide in the US. It's north vs south in simple terms, but there are multiple layers involving religious heritage and ethnic origin.

www.usacanadaregion.org/sites/usacanadaregion.org/files/Roots/Resources/Family%20Tree%20of%20Religious%20Groups%20pdf.pdf
In general, every denomination you find to the right of Reformed, and several within the Reformed category, are likely to be more conservative when it comes to the role of government in welfare, in healthcare regulation and provision, and more inclined to be bedazzled by ideas of sturdy self sufficiency.

@RememberNancyDrew

Texas was one of the states where the elected Republicans threw hissy fits over the Affordable Care Act (Obamacare) and refused the required (and I believe largely federally funded) Medicaid expansion.

www.reuters.com/article/us-usa-health-texas-idUSBRE8680O220120709

US person here. US doctors, to my perception, are very much afraid of malpractice lawsuits. The general doctor culture is to cross all your t's and dot your i's so that if the patient gets sick then you can defend your decisions. To make that work, doctors need standardized advice to be available, so they can say, "I treated this patient according to medical best practices which are x y z." So there is a big emphasis on standardizing things, using evidence to support it, etc. IMO that is why we get detailed instructions on when and how to introduce foods to babies, etc. (Also daycare regulations which are a whole other thing).

There are pros and cons to this. The main pro, as i see it, is that medical advice in the US tends to be based on the best available evidence. The con is that the quality of the best available evidence varies, so "best available" does not necessarily mean "good advice" or "correct advice." As facts come in, the advice might get changed but you don't get compensated for (or the ability to sue if harmed by) for decisions you made based on the old, worse advice. Because it was the best advice available at the time!

Another factor in the US is that there is a LOT of oversight of parent choices by schools, daycares, doctors etc. One of my kids was flagged by the pediatrician for a possible delay in fine motor skills at an annual checkup. If I hadn't accepted the assessment then it would be recorded on my child's medical history as "declined" the opportunity for necessary free services for my child. I was instructed to call a local county provider of assessment in case my child was eligible for free Occupational Therapy (OT). When the assessors came, I was given a 10 page sheaf of paperwork explaining to me that if they observed any indicators of child abuse then they would be obliged to report it to the state. So everything is observed and recorded and at every stage there is judgement about whether you are a fit parent and the fear of being sent to social services, who themselves (the social workers) are afraid of being sued or fired if they miss signs that a parent is abusive. So as a parent you are always being judged and assessed as to your fitness as a parent, by every adult your child comes in contact with in a professional or volunteer capacity.

If you know how to "work the system" (and are capable of doing so) it can be a great. If you don't know how to work the system (or have barriers to doing so) then it can be expensive, burdensome, and stressful.

My American doctors were always very cautious with antibiotics also. Same as the British and preferable to my home country

There's a good deal of hyperbole there, @aloris, and some paranoia too.

The flagging of developmental delays is a good and great thing. In many states it means a child can get the OT or SLT support they need, free or at a low cost. I can't imagine a parent who would refuse, especially as they're going to be asked again if the child can avail of Special Ed once they get to school. I actually think a parent who refuses would need involvement of social services in their family life.

Every provider of services for children (including schools, daycares, and HCPs) and also some services for adults (eg, therapy an adult might seek as a result of living with an abusive partner) come with the paperwork you have to sign agreeing that if there is any indication or disclosure of child abuse, the relevant notifications must be made. This ultimately protects children.

If you have nothing to hide and your children just need professional help with speech or fine motor skills, or services for autism spectrum, why would you even consider 'working' the system?

www.rand.org/pubs/research_briefs/RB9610.html
There are huge disparities in volume of malpractice claims, and the number of claims outpaces the number of payouts by a significant margin in most cases. Pediatric malpractice payouts tend to be high because children damaged by malpractice can face significant costs throughout their lives. This table makes no differentiation between pediatricians practicing in your friendly neighborhood pediatric practice and those working with neonates in a hospital setting.

Actually, mathanxiety, yours is a good example of what I'm speaking of. When I say "work the system" I mean that you have to navigate the system without setting off the dislike and judgement shown by those in authority, for example yours. My child, actually, did NOT need OT. It was, IMO, a pretty silly recommendation. But, fortunately, I consented to the evaluation because, as you yourself say, if you decline then, quoting YOU:

"I actually think a parent who refuses would need involvement of social services in their family life."

Thanks for demonstrating what I mean.

Exactly

@aloris

When I say "work the system" I mean that you have to navigate the system without setting off the dislike and judgement shown by those in authority, for example yours.
So it's not a case of 'working the system' in the sense of gaming it. It's accepting the assessment offered. There is an element of fear in your comments all the same.

I'm not in any kind of 'authority'. I suspect I just see a bigger picture than you do. The availability of free or very low cost and timely interventions for OT, SLT and other issues can make a huge difference in a child's educational progress and thence into their future. Are you able to see that there are parents out there who for whatever reason want to keep their child under the radar? People with something to hide? People with a belief system that places the government and all figures related to it as Enemy? Why would you personally be afraid of dislike and judgement if none of this applies to you?

I suspect the push to call a doctor about anything and everything in the US is money led. Doctors creating their own markets. I'm surprised insurance companies don't do more about it, tbh.

Yes many people can and do. I see my gynae every couple of years for a check up

So that should tell you (and others) loud and clear that preventative costs less than waiting until things are out of control. Let’s be real. The insurance company doesn’t want to spend more than they have to and very often they are the ones pushing for preventative health screenings and a\healthy lifestyle initiatives.

But the bottom line. Having access to specialists like pediatrics and Ob/Gyn’s is better in the long run for health care users.

seriously all anyone needs to do is a casual search here for anecdotal evidence of women who are suffering due to the fact they can’t access a an Ob/Gyn.

I'm a Brit living in the US and love the paediatrician! Much more than the service offered in the UK.

Why? That's completely unnecessary.

Yes and no… it’s a way to gate keep to make sure a large portion of the population are getting preventative care. So in that sense it works…. It is overkill IMHO for an otherwise healthy woman, but again it’s the medical guidance and for sure will identify more costly and health devastating conditions earlier.

@Saschka You are parading your ignorance. I am a born and raised American woman in my 60s. Colonoscopies are not done every year in the US. For people over 50 without a family history of colon cancer, they are done once every 10 years. For people over 50 with a family history of colon cancer, they are done every 5 years. If the doctor finds precancerous polyps, as mine did, they repeat the colonoscopy in 3 years.

I don't mind when people who have experience with the US system criticize it. But when people who obviously don't have the first clue do, it's annoying.

Its funny people saying the US is better on preventative medicine because I do not think this is true. Insurance companies pay for annual check ups because this is what the public want and think will a difference. But I know my relatives in the US with type 2 diabetes do not get the level of preventative healthcare that people do in the UK.