That’s one thing then in favor of the American system (assuming you have an insurance plan that allows seeing a specialist directly). It is time-wasting and annoying to have to see a primary care doc for a complex disorder that they’re not going to be able to treat (i.e. many orthopedic, dermatologic, psychiatric conditions etc.) just so you can get a referral on to a qualified specialist.
If for example you throw out your knee, what’s the time period involved in the U.K. in getting to someone who can scope it to diagnose the problem?
I’m a bloke too, but I’ll comment that in general the US has an obsession with physicals and other preventive care that’s not shared by the rest of the world. US medicine seems to be more focused on performing as many procedures as possible rather than taking a hard look at what actually improves outcomes.
If it’s serious (and the GP agrees) then you’d probably see a specialist the same day you saw your GP or the day after as I believe specialists keep appointments open for that reason.
This is a little bit of a hijack, but I've never been able to figure out how people figure out A) that the PCP can't handle it and B) which specialist is appropriate in the case of a new problem. I once had what I thought was a pimple on my face. When it didn't resolve itself, I saw my PCP, who called the surgeon down the street and sent me right over , and surgery was scheduled for the next week. My insurance didn't require a referral, but if I had chosen a specialist on my own, it would have been a dermatologist who presumably would have sent me to a surgeon anyway.
If it’s a new problem you go to your PCP and he or she writes out a referral to the proper specialist.
Once you see the specialist you can return directly to that specialist as long as they are treating you on that problem. Additionally, if you develop a new problem in that specialty you can just make an appointment to see them and they will let the PCP know of the issue. (If you mention a new problem and they determine it’s not part of the specialty they’ll tell you to go back to your PCP.)
Lots of paperwork goes back and forth to keep everybody up to date. Around here, every doctor is part of a hospital system that covers every specialty so that records on all problems can go to a central location that every new doctor can draw on electronically.
What a lot of guys might not be thinking of is that it’s OB-GYN - as in, they do regular well-woman pelvic exams and such, but they also handle pregnancy and childbirth.
BTW, for well woman visits and my annual exam, I’m seen by a Nurse Practitioner (roughly, and I hope I’m not being simplistic, a nurse with a specialty who has authority to write prescriptions), not an MD. I believe for people with no medical complications, this is the norm when you “go to the gynecologist.”
I have to say, I’m a lot more comfortable getting a pelvic exam from a NP who does them day in day out, than an MD general practitioner who got a couple weeks of training in medical school and might do one or two a month. It’s NOT a comfortable procedure, I am a nervous patient, and I prefer to have a person with loads of practice. Medically, I’ve found NP’s to be just as knowledgable within their speciality.
And going back to the “for a woman a gynecologist is almost a primary care physician” the last time I needed a tetanus booster, my gyn NP did it.
Certainly in NZ, I had an expectation that my GP would carry out vasectomies and other minor surgeries. I had a sebaceous cyst removed from my scalp by my GP, too, as well as a number of moles biopsied (i.e. removed and sent off for histological examination). I think they enjoyed the hands-on opportunity to slice and stitch.
In addition to all that’s been said above, many uninsured or underinsured American women see ONLY an OB/GYN regularly. They do not have easy access to a general practitioner. Various charities and government entities will pay for prenatal care, birth control and things like that, but are less willing to pay for other doctor visits. For example, a city that does not have a free clinic might have a Planned Parenthood, where indigent women can see a nurse practitioner or doctor.
In my case, if I didn’t have private insurance from my folks, I’m not currently eligible for Medicaid (general government healthcare coverage for poor people) in my state, but I can get something called “Take Charge” which covers birth control and family-planning related doctor visits: http://new.dhh.louisiana.gov/index.cfm/page/232
Hopefully Obamacare should make this a little less confusing. Maybe.
That’s what I do, except for the writing. What I don’t understand is how people who want to go straight to a specialist without wasting time at the PCP for a problem that can’t be handled there know that the PCP can’t handle the problem and which specialist is appropriate when it’s a new problem
What **Capt. Ridley’s Shooting Party ** said plus iif you throw it out badly enough --as in you’re down on your arse on the street and can’t get up let alone walk – then just call an ambulance and go to casualty.
One thing I have noticed which might be a culture difference is in the US it seems like a ritual for some mothers to take their daughter to the GYN at her first period whether a problem exists or not and to then go regularly from then on. Outside the US it seems more common for women to go when they first have a problem or want mirena or get pregnant for the first time, it seems like less a ritual or right of passage or something.
I know my wife has found references to time to take my daughter to the GYN bizarre, for what? The only answer I have is perhaps some women are too shy to talk about menstruation or birth control with their daughter?
PCP’s still like it when you got to them first, even if they don’t need to issue a formal referral (and managed care is going away because people hate it and it doesn’t actually control costs). They get to bill you and they know what’s going on with you and they can send you to a specialist they know and share records with (and is often in the same care system).
I’ve never heard of someone seeing a doctor at the age of first period. I would find it just as bizarre as your wife. Normally the triggering event is wanting oral contraception, or becoming sexually active, whichever comes first (sometimes women who are not sexually active take oral contraception for bad acne) The basics of menstruation and contraception are taught in school, though, in some states its a controversial practice, is isn’t in mine (New York - I had mandatory sex ed in 5th grade, 7th grade and in high school, all with a different focus.). And there are many perfectly good books if a person is shy.
I wouldn’t call it a widespread practice throughout the US, this is the first time I’ve ever heard of such a thing.
I have seen NPs at group practices in 3 different states. Usually its faster to get an appointment with the NP , maybe that’s why. I tend to put it off. I did have one doctor doctor, but that was in a 2-Dr. practice in a rural area.
The flip answer is that people don’t know what’s wrong with them. Getting them to see a competent doctor who understands what symptoms are and knows what particular specialist they should go to is a feature of the system, not a bug.
The US-centric answer is that your insurance will almost never pay for a trip to a new specialist without a PCP referral.
The neutral answer is that few trips to a specialist involve emergency situations. In a true emergency the proper procedure is to go to a hospital emergency room. They have cadres of specialists who can do emergency procedures. Beyond that, most ailments are best evaluated in the context of a person’s overall health, medical history, and medicines taken. It normally doesn’t involve more than a day or two to get in to see a PCP. If there is no emergency problem, you haven’t lost any time in seeing the specialist, which is on the order of weeks or months for a new patient. If there is some urgent reason to go, a doctor’s office will make a quick appointment that would be impossible for an individual.
I know it seems like an unnecessary extra step to see your PCP first, and sometimes it is. But few people have the knowledge to determine that. The majority of the time it’s useful. And many times it makes seeing the specialist unnecessary, which is a boon for everyone.
I suspect the difference is at least partly because you’re going to larger group practices. Of the four doctor-doctors I’ve seen, two practice solo, one is in a 2 doctor practice and the other was a practice with 6 or 7 doctors, but only 2 OB/GYNs. All in Queens.