In this thread, it seems like US Doper ladies have regular medical check-ups with their gynaecologists. In fact, I found a site that said it is customary and advised:
In contrast, in the Netherlands there is no such thing as a regular gynaecological visit for young women. Only women in the age of 30 to 60 years are recommended to get a Pap smear every five years, and such visits are paid for by general health care.
I wonder what causes this difference. Are such visits, which are generally unpleasant, medically necessary? Is there any difference in the incidence of gynealogical health problems in the Netherlands compared to the US? It is not hard to suspect a medical money making scheme… Much like the difference in dental cleaning.
Or is the reason that the regular family doctor is uncomfortable with discussing STD’s and prescribing contraceptives?
So, either we Dutch women are deprived useful medical care by our socialized medical care system, or US women are tricked into less then necessary gynealogical exams.
I imagine the reason a visit is recommended that young is to 1) Make up for a lack of sex ed in school, 2) Get to girls before they become sexually active (though honestly I don’t know anyone who saw an OBGYN before having sex, unless they had major period problems), and 3) Because they’ll often still be covered under their parents health insurance plans.
Not all Americans have family doctors, so an OBGYN visit may just mean going to the local Planned Parenthood and seeing whoever’s there. Also, a gynecological exam is required before (most) birth control is prescribed. I’m not sure it’s a moneymaking scheme, as it’s mostly preventive medicine – meaning women won’t end up paying even more later on e.g. if they have an STD that leads to infertility.
Where do Dutch women get tested for STDs or if they suspect vaginitis or a yeast infection (for the first time)? Would a family doctor cover that?
Americans do not usually have a doctor which is exactly like a huisarts.
Kids are usually seen by a pediatrician (closest cognate, a kinderarts) until they are somewhere between 14 and 18. A pediatrician does not generally do pap tests or deal with contraception and other adult issues. A family doctor (which is growing in popularity) might, a General Practitioner in a smaller community might, in some places clinics do them, but mainly pap test = GYN. For many women in the US, their only health care practitioner is a GYN. Also, anecdotally, the barriers to going to the doctor are much higher in the US than in Holland, so the practical way to get folks in to talk about problems they might be having is to have an annual requirement.
I never found pap testing to be particularly unpleasant but that is probably just me. Since the primary cause of cervical cancer seems to be HPV, it seems to me that sexually active young women would profit from having either the HPV test or a pap test (the former seems to be better I gather – or so they say in Nijmegen).
shrug, it’s as likely to be a matter of rationing of care as a money making scheme.
Yes, at least initially. I recently had some bleeding between periods and went to my family doctor, who ran STD tests and some blood work and when they came back negative sent me on to a GYN. * My family doctor performs a gatekeeping or screening kind of function – he takes care of everything that is obvious and sends me to a specialist for anything non-obvious.
Had they come back positive they would have referred me on to a criminal lawyer or a shrink to prevent my killing my husband in his sleep, I imagine.
Here (in Canada) most women go annually, but we have universal health care, so it’s much easier and cheaper for us to go every year.
The reason is just to check up on your vaginal health, I suppose. Much the same as an annual physical can keep other things in check, or an annual dentist visit keeps your dental health in check. Also, a lot of women catch abnormal cells early this way. I had an abnormal pap this last time (ongoing issues), my mother and sister also have had abnormal paps. It usually turns out to be nothing, but sometimes its HPV or cancer or something else.
Also, if you are sexually active in non-monogamous relationships, annual STD checks (or even more often) are highly recommended.
One thing that I learned in an earlier thread is that in the US it is most typical for women to get pelvic exams from an OB/Gyn and in some other countries, including Canada, it is much more common to get them from the same general practitioner that they’d see for general medicine.
I can see benefits to both sides. With the non-US approach, if there is no problem, you’re getting better continuity of care having it all with the same provider. And fewer appointments to make, and probably less cost overall. On the other hand, with the US approach, if there is an issue with reproductive health, the specialist who is treating the issue already has a relationship with the patient. Also, the exam is done by someone who is more likely to be reading the OB/Gyn journals and keeping up with the latest in that field. Also, while a woman is having children and is seeing the OB regularly, she can usually have that doctor by her primary care doctor if that’s more convenient.
However, apparently it is possible in the US to get a pelvic exam from most primary care doctors. I’ve never had one suggest it, though. They usually ask if I have an OB/Gyn and note who it is on my chart.
On some level it probably does represent something of a turf grab by the OB/Gyns. Specialist medicine is some of the big money in the US healthcare system.
So I wonder how much more cancer is caught by a Pap smear every year versus every five years? Does anyone have a cite on that?
I heard from several doctors (including the ob-gyn my mom dragged me to as a teenager – which I’m glad she did, as the pelvic exam really freaked me out that first time, and it was nice to have her there) that I didn’t have to start having regular exams until I became sexually active, even if I was older than 21. Course, there was the (primary-care!) doctor who didn’t believe that I wasn’t and gave me yearly pap smears anyway. But were they wrong?
Not all school systems are as progressive. When I was teaching, I had an 11th grade female student ask me if you could get pregnant through your nose. She had been confused by a nasal spray that administered birth control.
Even when I was a young adult, there were things that I could ask my doctor that I couldn’t ask anyone else.
Those who live in urban areas take OB-GYNs for granted. Some towns are lucky to have even one general practitioner or internist. Many make do with a nurse practitioner for a couple of thousand people.
By the way, younger women might want to know that pelvic exams get much less painful as time passes.
I was referred to a gyno when a doctor suspected I had endometriosis and wanted further testing done, and again when I was pregnant. Those are the only two occasions in my adult life that I’ve needed their more specialised expertise. It seems like a waste of time and money to see a gyno for something as mundane as a Pap smear.
In every health insurance system, PPO or HMO that I’ve been covered by in my career, women are allowed to identify OB/GYNs as their primary physicians; I believe that many do, because they can then get top-notch care for their female bits and issues, and because for a healthy sexually active woman, that’s the top priority. Similarly, OB/GYNs who contract with these plans often hold themselves out as primary care physicians, I assume because it assures a predictable stream of predictable patients, and they get an excellent shot at early diagnosis of STDs and cervical cancer.
As an additional, Spanish women are told to get a gyn visit (including pap) every 3-5 years if over 18 and/or sexually active, but it’s covered by Seguridad Social and things like vaginitis, or a yeast infection would be seen by the GP (“Family Doctor”) first of all, he’s our “point of entry” if we’re over age 12.
If the GP thinks it’s something complicated, he’ll forward you to Gyn, same as to any other specialty.
In general, for any specialty you don’t ask for a consultation: your GP does it for you. For periodic visits to a specialist, the specialist sets it up (if it’s months away, not on the previous visit but as “we’ll call you in September, if we haven’t by the 15th call us please”). It’s possible to ask for a specialist directly if there’s a reason that makes more sense than going via the GP (“hi, I’d like to request a gyn visit between the 10th and 14th of April… yeah, I’m out of the country and will be there that week only… lovely, the 12th at 8:15, thank you!”).
They actually hold birth control pills over your head to force you to go - you can’t get them prescribed without a yearly pelvic. I think it’s because many women wouldn’t see any doctor if they weren’t forced to see their gynecologists once a year, you know?
I go to an internist. Actually I see a nurse practitioner who works for an internist. I go every year. I get a pap smear every three or five (can’t remember, I’ve never had an abnormal). A mammogram every year (I’m over forty) and a blood test every other year. But I don’t need BC pills.
When I was trying to conceive and then when I did conceive and then for a few years after, my OB/GYN was my primary care physician. But since I prefer to be treated like a whole person, it was only during that time of my life when I’ve had an OB/GYN as a primary care physician. But I suspect for a lot of women, the “birth control, sexual active, trying to concieve, pregnant, post natal” cycle is just simply long enough that they get really comfortable with they OB/GYN and since you CAN have one as your primary, that’s what they do.
**Marienee **already answered Catfish’s question, so perhaps you could also answer mine: why is it that for US women, the barriers to going to the (general) doctor is higher then in the Netherlands? Insurance?
With the whole discussion of the proposed new US Medicare system going on, it is interesting to see the differences, especially in womens health which assumably is the same in the US as it is in the Netherlands.
There is medical evidence that pap-smears, in general, yield too many false negatives and especially too too many false positives to be cost effective when seen in a general perspective. So, a government implementing subsidized evidence based cost-conscious health care might decide to test less often and a smaller group of women, and that is exactly what happens in the Netherlands.
In the US, in contrast, there seems to be more emphasis on risk reducing for the individual, even if that means more risk for false positives. (which docs don’t get sued over, and that might be another reason).
In the Netherlands, BC is prescribed by the general family physician, who treats all the generations, untill he retires. The family physician is the gatekeeper to specialized medical care. He makes the appointment for you, and it is hard to get to see a specialist otherwise.
Routine check-ups are not usual here. People go see their doctor when they have a complaint, and on average they do so once a year or so.
Routine dental check-ups are the norm here too, every six months. But dental cleaning is not done standard, as it seems to be done in the US.