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?

Who is your relatives insurance provider?

I don't know. They have insurance, but the insurance will not fund the level of preventative check ups and preventative medication like statins that the UK does.
My family there are just ordinary working people, so it won't be expensive insurance.

Sure, early intervention is great. I've had friends whose kids were greatly helped by OT. I wouldn't give up my pediatrician for anything as my own kids have benefited from annual checkups. But your response to my post also reinforces my point. The OP asked why parents in the USA do everything their pediatricians say. Your attitude, which is a normalized attitude in the USA, is why.

And maternal death is shockingly high in the US because of a lack of pre and post natal care. This is essential preventative medicine that only some mothers get access to.

This argument is unnecessary and pointless. Leave Americans to deal with their system and you face your issues in the UK.

These American this American that threads are so useless and ridiculous . The UK has a shit ton of issues facing it so focus on that.

Hopefully people like the OP @shaniahoo will stop this dumb habit of creating US bashing threads on MN, I’m sure the UK has enough issues for you to focus on rather than creating threads that just descends in bashing Americans based on stereotype.

The US is not perfect but neither is the UK yet Americans don’t spend their time asking stupid questions about the UK and bashing bashing bashing. It’s the same on Reddit every opportunity to bash the US by Brit’s is taken with glee with some posts dripping with venom and hatred.

I have T2DM. the quality of care here is very variable and isn't just about insurance. The UK used to be much better at providing a properly coordinated diabetes service with specialist nurses, etc. The quality of the UK service has declined. The UK lags on access to technology such as CGMs and pumps. The US, as is well known, is shocking about insulin pricing. Really high quality care for T2D requires a team approach with high levels of patient education. The US does have dietitians and CDEs (dietitians or nurses who are specially certified in diabetes education) but consistent, long term education isn't set up well. It's down to your doctor/NP as to how well or often they monitor you. There are social inequities such as food deserts that impact diabetics' ability to access a healthy diet. I read one story about a man who lost his sight, his foot, and was on dialysis before 40.

One of the areas my job works with is maternal/child health equity. It is a complex problem. Again there is massive variation by place, if I worked in Mississippi I would be crying. A great deal of the variation is explained by race and poverty and the US fails to address those gaps. If you are a middle class white woman in the USA, your odds are as good or better than the UK. If you are a Black woman, they are very much not, though the UK also has a racial gap in maternal health. There's some work towards improving healthcare access where I live so chronic health conditions are properly treated and women receive care not just when they are pregnant.

The OP asked why parents in the USA do everything their pediatricians say. Your attitude, which is a normalized attitude in the USA, is why.

@aloris
My attitude?

That if free assessment for OT or SLT or any other potentially life changing intervention is offered then why on earth would you turn it down?

I've been here for over 30 years and I've never encountered a single person like the people the OP described.

Parents simply don't live like that. People don't tie themselves up in knots worrying about 'ten page documents' relating to the obligation to report suspected child abuse. I can't imagine why you think they do.

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

Colonoscopies are every 10 years unless there is something problematic found

Yes, unless they have a further specialty, they are primary care providers for children.

Our pediatrician never offered unsolicited advice or clearance to do anything.

OP, don't believe everything you hear on the Internet.

I suspect the push to call a doctor about anything and everything in the US is money led.

@MaidOfSteel

What push would this be?

There are social inequities such as food deserts that impact diabetics' ability to access a healthy diet. I read one story about a man who lost his sight, his foot, and was on dialysis before 40.

The local county hospital treats huge numbers of people whose health issues can be traced to the failure of government services south of the border at the most basic level, people whose healthcare access has been extremely limited in their countries of origin, and who suffer the ill effects of a lifetime spent drinking sugary beverages instead of water, and patchy access to healthcare.

Just because your relative doesnt have great coverage does not mean no one in the US does. I'm a Type 2. My Insurance is amazing. Pays for all my meds (I'm on pills and insulin), I see a Diabetic Specialist (usually around every 6 weeks I have an appt with her) all paid for by my Ins. I even get Freestyle Libre 2 sensor for my arm completely free (no co-pay). I get it every 2 weeks (well, I pick it up monthly but its 2 of them every 4 weeks). I'm sorry your relative does not seem to have great insurance, but lots of us do.

I'm glad I'm not the only one who feels this way. I've never understood why so many people on MN feel the need to big themselves up by posting these goady threads about things in the US that they have no firsthand experience with and don't impact them in any way. No one in the US gives any headspace to how you do things in the UK, which seems much healthier to me.

MN has been full of threads about patients waiting hours for an ambulance and you have concerns about how we provide primary care to children? Really?

The story I was reading was someone who was American, had lived in the Midwest his whole life. It happens. I get excellent care, but I have many advantages in navigating the system.

The Birth-to-Three Early Intervention system is actually a fantastic idea but remember how social services (UK too not just US) has class and race biases. I know I keep banging on about that but the data is so, so stark. So, people whose lives have conditioned them to believe that social services are the enemy are often afraid to interact with the system. There isn't always a clear line between neglect and poverty.

One of mine went through Early Intervention and then to free preschool for special education. The services were invaluable (imagine having the SLP/SLT and OT come to your house twice a week, for free! And then preschool for free, too) but navigating them was a part time job in itself. If you aren't educated or worse aren't fluent in English it's very difficult. I cannot say enough good things though about the care my youngest received. I was able to receive EI starting at 18 months when his paediatrician noticed his delays, he had a formal autism diagnosis before he was 3, and he was seen at one of the best centres in the country--which by the way is in Baltimore, one of America's poorest cities, and takes plenty of children who don't have top tier medical insurance.

I suspect tory paid trolls trying to make the proletariat feel like they have a so much better deal than their peers in the US.

I have had a baby in the US too and much prefer the system in the US (no waiting to see the doctor and could call the pediatrician office 24 hours per day to talk to a doctor). The reason for pediatricians encouraging the start of certain solids in the US is a medical one...its to reduce allergies to high allergen foods. So yes, it does make sense that a doctor would give out medically important information. They aren't going to demand that it happen at 4 months but they will tell you what the current research points to being the correct itme. I was asked about babies sleep and told when the baby should be sleeping through the night. Seems the doctor understood that sleep is an important component of good health and wanted to be of help should there be an issue as again, this is a health issue. Again, no one is forcing sleep training but they do make suggestions based on research. I never felt that my autonomy was taken way, indeed I really loved the check ins and the reassurance that all was well and really loved the easy access to my doctor. I love so much about the UK but really loved the US medical system (as someone with excellent health insurance and access to great doctors).

What on earth are you on about?

You’re being bizarre.

Pediatricians are the same as a GP, just for a child.

I live in the US and my childs pediatrician is treated the same as we would any other Dr. They may give advice during ‘wellness checks’ such as advising signs of readiness for potty training etc, but it’s still up to the parents. A key difference is in the US my child doesn’t have a GP, they have a pediatrician and so that is the equivalent (not a health visitor). My child’s pediatrician also offers 3 monthly (up to a year) and then yearly wellness checks and so we see them then, where they may give advice on weaning etc.

As for the commenter who posted about the amount of newborn testing done in the US. It saves lives. My child is one of the babies who has been saved by a U.S. newborn screening picking up a condition the UK don’t even test for. My child now has daily medication and a full team of specialists. I know many UK families who have lost their children to the same condition.

As for gyn in the US, you would see them if you have any issues in that area. I also saw gynecology in the UK on the NHs and so it’s not as strange as some of you are making it out to be. If you have an issue you go see a specialist.

I have a pediatrician who is truly fantastic, and has seen both my little ones over the years. There’s no HV system here. In my case, we went every month for the first 6 months, every 2 months till 1 year, then every 6 months till 3 and now once a year. It’s very much just standard injections and weigh ins, a chance for questions from parents. There’s been nothing ever pushed on us. We were referred quickly to a specialist when we needed. Any time there’s been a more serious illness, or something we’ve needed a doctors note for to return to daycare they’ve seen us same day. The routine visits cost us nothing as it’s all insurance covered and it is $15 for a medical assessment for a note or something ad hoc. We have an older doctor, great guy and he’s seen it all, so is very laid back in a good way. I honestly really do like the US system, but we have good insurance and are in a major city.

I think this post backfired for OP as so many have said how much the US system is preferential lol

Surely different countries have different health systems so they just do things in a different way. Does it really matter? Does having a paediatrician instead of a gp for your child and them having annual checks when there's nothing wrong, actually make the mortality rate less in the US than in the UK? No. Its 50% higher for under 5s in the US.
At the same time under 5 mortality rates in the UK are higher than most EU countries, the same as a few other EU countries and lower than others, eg France. And lower than Canada and New Zealand. Pretty close numbers, though, that could easily swap around and might even have to do with cultural issues rather than health services. Who knows?

I don't understand this low opinion of doctors. Where does all this cynicism come from?

Insurance companies will not pay for services that are not deemed medically necessary, such as the mythical "yearly colonoscopy". That would only be covered in the case of a genetic condition such as Lynch Syndrome where cancer risk is very, very high.

The US healthcare system has much to recommend it as does the NHS. But both systems fail way too many people to be deemed brilliant successes. There's room for massive improvement in both of these systems.

That's rank paternalism.

If you want people to get preventative tests and exams, then explain it to them, costs and benefits, make it easy to do, and allow them to make their decision. Don't manipulate them into it by making having the tests a spurious condition of getting something else they want or need. I hope you're wrong about the reasoning behind it. You don't see people arguing for Viagra prescriptions to be contingent on having a prostate exam, purely because it might "work" to get more middle-aged men to accept a digital rectal exam.

What are you talking about? No, not everyone in the US gets an amniocentesis in pregnancy. To have an amniocentesis you would have to have a reason that could not be ruled out by non invasive genetic testing. Do you honestly think that an OB would risk the life of a baby by ordering a serious test like an amniocentesis to make more money?! Also, having a gynecologist in the US isn't about making money either, gynecologist aren't just preforming random testing to make money.

I never had to have a vaginal/internal exam for birth control but then I had an OB as she oversaw my pregnancy and the birth of my baby in the US. When I entered my third trimester I had an appointment with her where she sorted out my postnatal care + what birth control would be needed following the birth. It wasn't a big deal, she went through the options and wrote down what I wanted and it was taken care of. The US isn't a dictatorship where healthcare/tests are forced upon you. I also didn't see as many people so ambivalent about seeking out care, doing preventative care like I see in the UK. I don't think I have ever heard of anyone pondering or writing on message boards asking random strangers if they should seek medical care for things like you see on MN. It always baffles me, as if people are scared to bother their GP in the UK or demand proper medical care.