Seeing an OBGYN on NHS

I get what your saying and this issue has definitely been discussed before.  When this issue comes up, I have to wonder if this is the result of one or both of the following: (1) the bad doctors and (2) not knowing how to speak up for youself (and here I mean the royal you not you you). 

When I said the NHS relies on you to know yourself, I was thinking more broadly.  I have a chronic illness and my care is drastically different between the two countries.  In the UK, my GP was happy for me to know myself and tell him when I needed a medicine change or wanted to go back to my specialist, etc.  When I wanted to try a specific medicine, he was happy to prescribe it, or if I needed a medicine change but wasn't sure of the options, he was happy to talk through and agree an approach.  In a nutshell, he was happy for me to tell him what I needed and let me lead my care.  In the US, they are forever forcing tests that I don't want or need.  At literally every visit they want me to do blood work, a physical exam and usually an invasive test.  All of this stuff is to cover the remote chance that I have caught cancer or something equally unlikely and it is nothing to do with my disease or current care.  And then when I need a medicine change, I have to argue why I don't want to go in a particular direction or why I need the change in the first place.  I have to "prove" to them I have a problem (usually over multiple visits).  For me personally, I have grown up with an adversion to doctors, which went away during my years in the UK.  I thought I had just matured but now after being back in the US, I see it is the adversion to the poking and arguing and time-consuming hassle of it all.  And I wrote all of this (!) to essentially say, my UK care wouldn't be great if it weren't for the great doctors that I have had.  If I had a UK doctor that wasn't interested in all that I described, then I could see that I would probably left feeling like I was floating in the wind.  This is why a good doctor is so important, when the system isn't set up to test you and prod you on every issue.  Even I had to switch doctors because my first GP was an idiot!

And as for speaking up for yourself, I have definitely seen people not know how to do this.  If you are used to a system that tests you for every issue and where you sort of agree with doctors unconditionally, then it can be nerve wrecking to say - I need you to pay attention to this issue.  I am trying to remember a poster from a couple of months ago where they were having trouble with their GP but hadn't said exactly what they needed yet!  Just using your examples (and not to pick on you), if it were me, I would be saying exactly "We are just trying different BC pill options willy nilly, I need to understand the approach and thought process involved or should I be going to a FPC clinic" or "this issue keeps reoccurring and is only being fixed with antibiotics, I need a more permanent solution, can you help me or shall you refer me to a specialist."  Now I am not saying that YOU aren't speaking up for yourself but certainly loads of people don't know how to because it is a completely opposite approach.  It doesn't mean the doctor is giving poor care though.

US and UK healthcare is like the old saying: If you hear hoofbeats think horses not zebras.

In the US everything is a ZOMG ZEBRA.  Oh wait, horse.

In the UK everything is a horse.  And your second visit, a horse and your third visit still that horse.  

The problem is that sometimes it is a zebra.  And often, the longer you wait the worse it gets.  And often it is younger people who bear the brunt of this because, usually younger people don't get ill so GPs aren't looking for it.

It is one of the reasons why survival rates for bone cancer in the UK haven't changed for 25 years. 42% of kids make to the 5 year mark in the UK compared to over 60% in the US.  And I don't believe it is because the US has such awesome technology.

Brain tumours in the UK in children take up to three times longer to diagnose in the UK.


The only time I have ever gotten anything solved that has been long term is when I have gone in to see the GP and it has been a foreign locum.  (The office has been fine with things like UTIs).

Even when I KNOW the issue I am not always believed here.  I went in to the GP's last year because I had horrible burning and pain on my scalp and was worried that it was alopecia, which I had in my teens and I was told that "That only affects women in menopause." Ummmm, what?  

I got some over the counter steroid cream and used it on the spots that were troubling me and the burning and pain stopped.  I have no real idea if it actually did anything, maybe just placebo but steroid creams are what I used in the US before the big treatments started.  

Also, changing the overall death rate isn't the end all, be all.

I have never had my blood pressure taken here, even though my mother had hbp from her 40s. (I bought my own home machine.) Hers was only picked up by a check when she went in for something else.   Perhaps it won't extend her life, but I'm sure having her bp under control has improved her quality of life since uncontrolled BP can lead to a number of issues that are unpleasant to deal with. 

US and UK healthcare is like the old saying: If you hear hoofbeats think horses not zebras.

In the US everything is a ZOMG ZEBRA.  Oh wait, horse.

In the UK everything is a horse.  And your second visit, a horse and your third visit still that horse.  

I like this!

Do people in the US go to an OB/GYN for smear tests?

When I first started getting pap smears and went on birth control, I was referred to an OB/GYN but only ever saw the nurse practitioner for the exam and the prescription. When I changed my Primary Care, I went to a nurse practitioner who was part of the same practice as my primary care physician.

I always went to PP. 

Usually, thinking horse is fine because 99% of the time it is a horse, or possibly a horse of a different colour.  It is the 1% that is a problem, especially if your GP doesn't seem to be bothered because most people don't want to believe they have a problem anyway.  So if your GP says you're too young for cancer, then you go away and waste months. 

On the other hand, the US tests way too much for prostate cancer.  The 5 year survival rates are better in the US, but the US catches so many cases that would never develop into a problem.

I have never had my blood pressure taken here,

Wow! My surgery is OBSESSED with blood pressure!

I know right! I even went in for feeling faint and they still didn't take it.   

I do know myself and speak up for myself! That's why I have an allergist, for example. But how exactly will I know if I have abnormal cervical cells?

I'm afraid of the situation bookgrl describes where I can't get a proper referral, for example (there's a couple of people on this board now who are having huge trouble getting proper care!) I will definitely be aggressive about finding the right doctor for me (I've already found a Boots that has an American pharmacist. It's at King's Cross train station! She was familiar with all my meds and could easily tell me what was available in the UK,etc.)

Chary- yes, most women in the US go to an obgyn as far as I'm aware (as long as they have insurance, I guess). This is one yearly visit that is seen as preventative (shocking for the US!) and is always paid in full. I've always been seen by the dr, too, not an assistant or NP. She is fab!

(I've already found a Boots that has an American pharmacist. It's at King's Cross train station! She was familiar with all my meds and could easily tell me what was available in the UK,etc.)

Your GP will be able to do this. I think you're panicking in advance when you probably won't have anything to worry about. Yes, there are a couple of people who have had problems, but most of us manage just fine.

But how exactly will I know if I have abnormal cervical cells?

They will tell you when the results come back from the smear test and then refer you for a follow-up appointment. If you haven't already been told in the US that you have abnormal cells and require annual check-ups, then there's no need to worry unless they find some in a future test in the UK... and if they do, they will act on it and refer you.

The UK is pretty hot on cervical tests at the moment, after UK celebrity (ex-Big Brother contestant) Jade Goody died from cervical cancer in 2009 at the age of just 27 - now all teenage girls are given the HPV injection at school to help prevent cervical cancer and there is a lot more media emphasis now on the importance of getting smear tests.

I think the smear is not a problem.  You are getting the test. If there are abnormal cells, you get a referral.

The issue I see, but not for everyone, is that it can be hard to get a referral to get the tests.

But how exactly will I know if I have abnormal cervical cells?

Since you will be in London, if you're truly seriously freaked about it, when you go for your smear test ask the nurse to make a second vial for you. I'm happy to screen it for you (since that's what I do). 

Sara, believe me, I have tried everything you suggest and  more. I also understand that many people get a bit defensive over the NHS when it has been helpful or even life-saving for them. 

I am honestly not anti-NHS, but I work for a medical charity and I know a great deal about how GP surgeries operate (what they get paid for, what they don't, how they are rated and graded, etc). They are run like small businesses and I know that everything I approach my GP about are not measured issues, so they don't have time for me. 

People with more serious medical conditions, pregnant women, elderly patients (to a point) often recieve excellent care because they are more valuable to the surgery.  It's a business and the higher value customers will be given better service. Cancer is a customer buying a Bentley and birth control is a customer buying a used Citron.  Maybe that's ok because clearly a person's cancer treatment is more important than my birth control pill, but I find it very difficult to tell any new expat that the NHS will provide them anything near the same level of service they are accustomed to in the US (assuming they have/had insurance coverage in the US).

Although, OP - don't worry, GPs have quotas for smear tests and will sometimes even beg you to come in for one so they can tell the governing bodies that they have done their required amount.

mirrajay, if your GP has been so bad for that, why haven't you gone to a family planning clinic instead? Their whole job is to listen to you and talk to you to find the best option for birth control.
Also, sorry for being a broken record, but just wanted to remind people reading this thread that the Scottish NHS is completely independent and run differently from the English system, so keep that in mind depending on where you are living!