Not everywhere. The local Planned Parenthood happily gives me the Pill after I let them take my blood pressure - there’s no actual medical reason why you should have an exam before taking the Pill.
Oh, I know there’s no medical reason - every place I’ve ever been did it that way for not very directly medical reasons. (Which I do think are sound, generally, considering the way a lot of women treat themselves.) Maybe it’s a state by state thing? I’ve had this in Georgia and South Carolina.
Until I started being seen for infertility, I got my BC from a family practice doctor. In general, I prefer not being treated like a person attached to a womb, but as a person with a womb - so I’ve used GPs, family practice doctors and internists as primary for the most part. I suspect it is much the same as in the Netherlands with the exception being many women prefer to have their primary be a Gyn, and that is allowed. There have never been a lot of barriers going to a general doctor - but I’ve always had decent health insurance - except that my previous internist had too many patients and an appointment for a checkup needed to be booked weeks in advance (he’d make time to see me for anything more urgent much more quickly).
I can speak only of my own experience, of course, but I imagine it is a question of both status and cost. I find that a doctor stateside is in general a more important person than in Holland. The only time I have wanted to see my huisarts that I could not see him within hours of my first contact was when we were in the middle of a flu wave and he was out making house calls. About a third of my contacts with the huisarts begin when I walk by his office to ask a question. He has telephone hours during which you call him for minor or followup problems. When I lived in the US, an appointment within a week was quite good, two weeks was normal, I would not dream of just dropping by to have somebody look at a mole on my shoulder*, the house call is a quaint ancient custom dating from the thirties or forties and otherwise unheard of, and I would have to make it through about three layers of gatekeepers to get to talk to a doctor on the telephone.
Possibly my huisarts is just a casual guy, he has his own practice and so can do more or less as he likes. It is also impossible to guess the income of your average Brabander of his generation since they all act like they are working class with a clearer accent. There is also a great social pressure against the notion of doctor as godlike being here.** Still, I expect he makes less than a doc in the US. Because of this attitude, though, I have the impression that folks here are less likely to defer absolutely to their doctor’s advice and are more likely to either go back to see the doc if they are not feeling better or to get a second opinion if they think the doc is on the worng track. Paradoxically, they are also less likely to self doctor, research their own illnesses, or tell the doc what to do than is the usual case in the US.
I think the question of litigiousness generally and UHC are more closely linked than people generally realize. A fair number of lawsuits in the US (for malpractice and otherwise) are instigated at least in part because someone has been hurt and the measure of pain and suffering and general damages is based in part on the cost of treatment. Here, damages do not even begin unless you have something untreatable – because nobody is going out of pocket in any significant way for the medical costs. In addition, there are doctors in the US who will treat you on the basis that you have a lawsuit pending and they will get paid in the end, even if you have no or little insurance. So in those cases in the grey area, where liability is not as clear, or the damages are relatively smaller, a civil lawsuit is more likely. Here, an administrative action against the doc or hospital aimed at the license to practice is more likely.
- or what have you, I am the poster child of skin cancer risk factors so my incidental problems generally have to do with that.
** Here’s a joke, which may illustrate the point: A man dies and goes to heaven and is standing in line patiently to get in the pearly gates. A guy in a white coat with a stethoscope on walks right up past the line and goes on in. Irritated, the guy says to Saint Peter, “What, is there a special line for doctors?”. “Oh, no,” says St. Pete, “That’s God. He just thinks he’s a doctor”. This joke works if you substitute the word “surgeon” in Holland, but does not if told about regular doctors. Regular doctors stand in line with everybody else apparently.
The thing is, women in the US are much, much less likely to see a doctor for a routine checkup than they are to remember to schedule a yearly exam for a pelvic exam. I posted in the other thread to this effect.
When I was uninsured, I could get a routine pelvic exam from Planned Parenthood for 20 - 50 bucks. A routine checkup from another doctor would have run me 200 - 500 bucks. I had 50. I did not have 500. Many places, you can’t get hormonal birth control without at least a cursory exam (to check for, for instance, high blood pressure). Most generally wrap the yearly pelvic into that exam as it’s a convenient way to check for other more likely if marginally less dangerous health conditions (some STD’s, the aforementioned high blood pressure, etc.) and because if a woman is already sitting in a doctor’s office, she’s more likely to mention piddly complaints to the doctor who’s handy than make an appointment with her GP to discuss them.
Now that I’m insured, I still see my GYN more often than my GP - partially because I like her better, but partially because it takes me a bare minimum of a two weeks to get an appointment to see my GP (which is fairly standard). Frankly, chances are good that for anything short of “Trip To the ER” bad, it’s gonna clear up on its own in that amount of time. What’s the point? Then I’m just sitting in my doctor’s office going “well, two weeks ago when I made the appointment, X was bothering me but there’s nothing to see now!” It’s just not very useful. Also you feel like an asshole making an appointment weeks in advance to ask a question about some trifling matter.
If I have an urgent complaint (flu, persistent cough, persistent fever, etc.), I hie myself to the urgent care facility closest to me and take pot-luck on treating physician. It’s more efficient all around than trying to get in to see my GP specifically. I might get lucky and she’ll be the treating physician at the urgent care (because the one closest to me is affiliated with my GP’s practice group), but probably not. I have a much more consistent relationship with my GYN.
I’ve long suspected the “yearly pap” thing (and the “gotta have an exam to get BC” thing) is essentially an excuse to help ensure women are getting in to see a doctor at least once a year rather than an actual diagnostic and preventative tool. It probably works pretty efficiently for that purpose.