Shoot me I watch to much American tv.
So this is a “America as seen on tv” question.
Do American women see gynaecologists (sp?) for a smear test? Do children see a pedeotrician (sp?..must they have such titles that are so hard to spell) when they have chicken pox? etc etc.
Or are most Americans reliant on their GP like we are?
This information is anecdotal and two years old (I haven’t had any health insurance since then), but I had a GP that I went to for checkups and illnesses, in addition to going to a gynecologist for PAP smears etc; my infant foster siblings went to a pediatrician, not the same GP as my mother and I had. Generally I think the GP does most things, but refers to specialists for some instances.
In the US, there is the Board Certified speciality of Family Practitioner. It requires 3 years in a certified residency program and gives training in ob/gyn, pediatrics, orthopedics, internal medicine, general surgery, ENT, Ophth, etc. etc. I graduated from such a residency program.
For years I did uncomplicated deliveries, and saw newborns up thru geriatric-aged patients. I do uncomplicated casting, some joint injections, minor surgical procedures such as skin biopsies, laceration repairs, skin lesion removals, and I even take foreign bodies off of corneas. This is in addition to the basic care of people with diabetes, asthma, heart disease, and so on.
I found that I can deal with about 95+% of my patients’ problems. The rest gets referred to specialists.
The designation of GP, or General Practitioner does similar types of practice, but generally only after a year of internship post medical school. They don’t have a Board Certification process, or the requirement for re-credentialing. (I have to take an exam every 7 years to demonstrate my knowledge base is still current to remain Board Certified)
QtM, MD
Thank you. I don’t know how the qualifications work here. I just know that I have never been to a gynecologist and my child has never been to a pediatrician.
We use the GP if he has the flu or I need a smear.
We have a wonderful service called Plunket here, that covers babies till about 4 years old, they are often the first port of call.
Other then that it is the GP unless they refer you to a specialist.
I often wondered if medical care became more complicated if you had more then one doctor.
Qadgop your duties sound the same as what a GP does here. As I said, I don’t know how the qualifications vary though.
It can get frightfully complicated, especially if the docs don’t communicate with each other, and noone takes primary responsibility to coordinate things and give guidance.
Nothing sadder than getting involved in a case where the nephrologist, cardiologist, pulmonologist, and general surgeon are all doing their separate things, not communicating with the patient to find out what the patient wants, and not paying attention to what the other specialists are doing.
Realizing this is anecdotal, and does not answer the question of what “most Americans” do, every woman I know visits her gynocologist for pap tests. It’s not just the test; we get a breast and pelvic exam as well. Meaning no disrespect to any Family Practice specialist, I think a gyno is a better choice if available.
Ditto with the pediatrician for youngsters. Again, a good FP knows this, but children are not just small adults and react differently to meds, etc. Besides, our pediatrician was just more child-oriented. My kids actually liked to go there because they had nice toys. One of mine, when just out of toddlerhood, claimed she had an earache; turned out there was absolutely nothing wrong with her, but she was bored and knew that if she said the magic words “My ear hurts,” that she would get a ride in the car and a new place to play for a while. Cost me $25; in those days childhood illnesses were not covered by our insurance.
A specialist is more likely, IMHO, to be up on the latest developments in her field.
Who is supposed to be coordinating treatment? The GP? How much responsibility lies with the patient?
I ask because one of my grandmothers was seeing several different specialists, as well as her primary care doc, and she ended up with a plethora of medications, some of which were not compatible. She was quite the pill junkie, and a nightmare of a patient, so I’m pretty sure she was rarely honest with any of the docs about what the others had prescribed. So who was supposed to be in charge?
An excellent point; I’ve seen it happen to others as well. When HMOs (Health Maintenance Organizations) first started, you had to get a referral from your selected Primary Care doctor in order to see any other doctor. This was supposed to prevent the kind of situation MissGypsy described, as well as contain costs. In practice, it made both patients and doctors pretty irritated; sometimes you simply knew you needed to see a specialist, but you had to schedule a primary care doctor’s visit first, so she could say, yes you need to see an orthopedic doctor (or whatever). So it made for two visits to pay for instead of one.
That said, it is currently everybody’s (and therefore nobody’s) responsibility in particular. Every doctor I’ve ever visited has asked what meds I’m currently taking, and supposedly they would check for incompatibilities. I always answer factually, and ask them specifically if MedA will react with MedB, though. And I have all my prescriptions filled at the same pharmacy, and I know that pharmacist is very good about double-checking these things. Some doctors are probably more careful and more competent than others. You can certainly fill different prescriptions at different stores, and some are better than others about looking for problems. And sometimes we forget – just recently my doctor asked me if I was still taking a med I had stopped a couple of years ago.
I’ve had family practice folks do my pelvics before, and I’d be willing to do it again. After all, I don’t have any special conditions to keep an eye on, and I have absolutely zero intention of ever needing any OB care. That being said, a lot depends on the particular family practice doc you’re seeing, and your specific needs. I wouldn’t let my doc get me within a mile or so of the stirrups, because she knows even less about the newer birth control studies than Dr.J does. This is, after all, the woman who responded to my concerns about the failure rate and general inconvenience of condoms with a suggestion that I get a flippin’ diaphragm. :rolleyes:
So instead I found myself a good gyno, so good that I’d almost be willing to travel to continue seeing her after we move next year. Since she was on top of the more recent studies, she was able to offer me a lot more options and discuss the pros and cons of each in more detail.
Some women, like me, choose to go to a gynecologist because their general doc doesn’t offer them adequate care in that area. They have some sort of issue or complication that requires specialized care, or don’t feel the family practioner stays current enough in the field. Other women want to go on and get established with an OB/GYN so they don’t have to start looking for a doctor when they get pregnant or decide to start trying. (It’s almost impossible to find a GP or FP who’ll do OB care these days, due to liability issues and malpractice insurance costs.)
There are a lot of similar situations with pediatricians.
I’m the odd woman out here in the US - unlike most women I seldom have a steady OB/GYN. Well, since the husband and I aren’t having children due to fertility issues on his part and I therefore don’t need birth control of any sort, the only category with less risk of cervical cancer than I have is “virgins”, and my female plumbing has been wonderfully trouble-free all my life I really don’t need anything more than the basic health screenings. I have started a relationship with an GYN because I’ll be coming up on menopause eventually, but it’s hard to have a “relationship” with someone you see once every two to three years.
For me, my allergies are the problem so MY primary doctor is a GP who can help me take care of the mundane allergy problems, the occassional skin infection my eczema allows, and refer me to a specialist when appropriate. (Think that’s happened three times in 20 years - aside from the allergies I’m pretty healthy).
Currently, the same GP is coordinating my husband’s care. A boatload of docs latched onto him while he was hospitalized with pancreatitis and we specifically asked our family doc to coordinate the care. Sure enough - two of the specialists had prescribed incompatible meds, one kept foisting a med my husband was allergic to (he “cleverly” changed the name on the script to the generic version :rolleyes: being sooooo convinced the husband was mistaken about the allergy) and all of them missed that his carpal tunnel had flared up again.
Basically, it’s considered the patient’s responsibility to coordinate care in the US, or to find a coordinator. Truth is, I work for the damn health insurance industry and I still have trouble getting the bills paid, navigating the system, etc. I don’t know how other folks manage.
Ideally the Family Doc should be involved and doing oversight with the entire patient in mind. In reality it doesn’t always work that way. If the patient is really, really sick and in the hospital, hopefully an Intensivist is playing that role.
And the patient needs to be an advocate for themselves, asking questions, understanding (in layman’s terms) what meds they’re on and why, and what to watch out for. I spend a fair amount of time (even in my current job) just trying to convince my patients that they need to know why they have to take these meds/treatments/special diets.
I saw my family doctor for all gyno care up to my first pregnancy, as soon as the test came back positive the doc referred me to an OB. While he was liscensed and capable of providing pre-natal and delivery care, his office policy was to refer out, perhaps for the liability issues mentioned above. Once the pregnancy was completed, somehow all my regular gyno appointments stayed at the specialist instead of going back.
Similarly, it never occured to me to have my son treated anywhere but a pediatricians office, I’m not even sure my GP’s office even takes pediatric patients.
In some cases, the decision to have ob/gyn stuff or ped care at the GP might be dictated by the terms of the insurance company. My plan allows me to designate my OB/GYN doc as my primary care physician and my boy’s pediatrician as his and bypass a family practitioner altogether. I almost did that, thinking it’d be simpler somehow since neither of us have any chronic health issues but I’ll always need girl stuff done, then I was told that the terms of coverage varied depending on which doctor was my primary, so I didn’t. Doesn’t make a lot of sense, but there ya go.
I have several different unrelated problems, so I see several specialists, as well as a GP. I see it as my responsibility to make sure all the uh, “musicians” know “what page we’re on.”
I can see this wouldn’t work with a hypochondriac, nor with anyone not able to comprehend the medical jargon. It frightens me to think about all the people who fit in the latter category. What’s more, I think it’s increasing. That’s because medical science is developing at an astounding rate (especially by comparison with everything prior to WWII). I don’t say that any intelligent and determined person cannot learn it all, but it takes considerable motivation to pursue self-directed study of such a topic successfully. And too many people seem to believe they’ll never need it. Good luck to 'em, is all I can say.
I see a OB/GYN (or more accurately, I see a Nurse Practitioner in a dedicated OB/GYN office which is a satellite wing of a Teaching Hospital associated with a Major US Medical School.)
ahem.
It goes like this:
When I first graduated college. I moved to a state I have never lived in and in which I had no family (and only 1 or two friends), and, thus, no ties to the local medical community. I did not need a GP since I am really very healthy, but I did need a gynecologist to keep my birth control scrip current. Ergo, I sought and found a gynecologist.
I probably lived here 6 years before I aquired a general practitioner. And I have seen her… um… twice? in the past 2 years.
As a child I went to a “Family Practice” type place for well-child visits and booster shots. I was also an extremely healthy child so visits were infrequent.
I think one thing that affects American’s choice of specialists is the mobility of the population. When you move to a new place frequently and don’t have lasting relationships with doctors, I think you prefer to work with someone who specializes in their field. (They don’t know you from adam but at least they know what they’re doing, being the line of thinking). I have definitely thought this way myself when relocating.
I see my OB/GYN for PAP smears and pelvic exams every year. She also saw me through my last pregnancy and delivered my son.
My kids see a pediatrician (or, actually, any one of the three in their practice.) I’m sure our internist could diagnose most childhood illnesses, but I think there really is something to be said for seeing someone who looks at hundreds of babies and children all the time. For example, our pediatrician was able to take one look at my son at about one or two months and recognize that he needed physical therapy to correct an imbalance in his neck muscle development.
My husband and I go to an internist for everything else. He will occasionally refer to a specialist.
My husband also sees a dermatologist regularly, because he has had skin cancer.
My fiance and I see the same doctor - for everything. She does my smears and other female exams. She also is working with my reflux but I may need a specialist for that soon. She takes care of my knee problems. She takes care of Mr. Congo’s asthma, thyroid problems and up until he needed surgery, she took care of his back. She only handed off care to the surgeon. She also takes care of infants, kids, teens and seniors. If she stays in practice, I’d be happiest staying with her until I die. Mr. Congo feels the same way. When I do finally decide to have kids, I wouldn’t want to see anyone but her.
The doctors at the office I go to are very thorough and well trained. They all take care of every aspect of their patient’s lives.
Broomstick, I wouldn’t care to rate your chances of developing cervical cancer based on that…many, many women develop cervical cancer as a result of having the Human Papiloma Virus (the genital wart virus) and never know they have been exposed to the virus. So unless you are absotively, posolutely sure that neither you nor your husband (or any past sexual partners) have, or have been exposed to HPV, please don’t assume you are at no risk for cervical cancer. Continue to get annual pap smears, please! (You’re a poster I really like, can you tell?) 
Personally, I use a gyno and have my entire adult life. When my gyno moved away, I used my family practice doctor for smears, one year, but my “problem” returned, and I got referred to a really nice new gyno. I coordinate my care between the two of them myself, but they also work for the same huge clinic and most of my records are sent to both (like my mammogram results.)
Up to this point I’ve gotten my gyn care from Planned Parenthood, from nurse practitioners, and have been generally happy. Due to my apparent inability to continue on the pill (and probably any/most other hormonal forms of BC) and a few other medical issues that complicate the whole thing (getting pregnant for me would very possibly be unsafe) I want to find an actual gynecologist to talk about all of this. What I really want is to get fixed…if I could only afford it.
I’m due for an exam anyway. Oh, I hate those exams.
I’ve always gone to a gyn for my exams and PAP smears, etc. It never even occurred to me to do otherwise.
I have a problem with frequent ear infections. It got to the point that I wouldn’t even bother to go to the doctor unless I was in a certain amount of pain - otherwise I’d just wait it out. Eventually I got one that was so bad I went through two rounds of antibiotics without them even beginning to help it, and the doctor sent me to a specialist. That infection was cleared up in a couple of weeks, I narrowly avoided surgury, and within a few months I was hardly getting any ear infections at all. Specialists definitely have their uses.
:rolleyes:
I knew someone was going to come up with this if I told the truth.
No, I do NOT have HPV. I have had ZERO std’s. In fact I have had ZERO infections of any sort associated with either the vaginia or the bladder. Zippo. Nada. As I said, the female plumbing has been wonderfully trouble-free.
In the case of women with no history of HPV or similarr risk-raising std’s, who have a low-risk family history, who are monogamous or celibate, and who have a history of normal pap smears, the frequency of screening can be reduced to every 2 to 3 years. Am I at NO risk? Of course not. But I am at extremely low risk. The only way for me to be at lower risk, as I said, would to still be virgin. I check for breast cancer, too, but I don’t expect to find anything - I have had no relatives with breast cancer. Likewise, I get screened periodically for diabetes, although I have no blood relatives with diabetes. I don’t expect to come down with either cancer or diabetes, but please be assured I do keep an eye out for trouble. Life, after all, is dangerous and risky. But screening more frequently than necessary serves no purpose, and in the case of false positives, can actually cause harm.
What I am at risk for is heart disease - pre-1970 death in the mid-40’s due to heart attack or stroke was common in my family. Now, it’s coronary bypass in the mid-40’s with heart attack or stroke in the 60’s or 70’s. So really, my focus should be on watching for heart disease. Fortunately, I did not inherit the familial hypercholestemia that has killed so many of my family, but that still leaves me at risk for heart disease. The good news is that, outside of heart disease, my relatives have tended to live into their mid-80’s to late 90’s in fairly good health. So far, my cardiac health has been very good, better than most women my age at this point, but that’s no reason to become complacent. Heart disease IS a major killer of women.
All of which is just another example of knowing your family history and personal health risks - your mileage will vary.