Attitude of NHS doctors with regard to screenings

I'm concerned about what our GP would be likely to do when presented with a laundry list of ailments that have been diagnosed by US doctors. I sense that walking in with medical records, x-rays and a request for screenings, referrals, meds etc. would just get up their nose. 
I know that if a patient presents with a specific complaint the GP will examine and possibly refer to a consultant. But how does one handle regular checkups for specific health issues? For example, the recommended frequency for mammograms in the UK differs from what may have been advised in the US. How much attention will the GP pay to the patient's history, family history and/or US doctor recommendations?

Well, I didn't have a laundry list, but I did have a few niggling issues (ie Vitamin D deficiency, allergies, issues with birth control), and I just walked in with my medical history and had a chat.  He grumbled a bit about vitamin D being the "new thing" people test for, but as I am actually properly low (and have a family history of issues),  he was happy enough to run another test for me and give me advice.

We don't really have regular checkups the same way; people tend to stay away unless they have a chronic issue or are ill. For the chronic issue, you will usually end up with regular appointments, sometimes with a GP (where appropriate) or they may refer you to a specialist. For birth control and pap smears, for example, I tend to go to one particular sister at my practice (as she is awesome) or the local sexual health clinic (if she is busy) as they are also awesome. I don't actually need a referral for that as they are expected (and, with regards to the pap smears, the NHS will send you lots of letters until you get one done. They are very on the ball about that.)

I think if you come in with the information, and then listen to what your GP says, you will be off to a good start. Let them double check things if they need to. (The reason mine ran another scan for Vitamin D was he wanted to check that a) the US was using the same scale to measure it and B) to see if I was affected by the move to Manchester from San Diego) Remember, you aren't "stuck", you could always try a different practice (or just find someone else at the same one). They may have perfectly understandable reasons for the differences (I believe there is some concern with the efficacy of detection with mammograms depending on the age of the woman, for example, and sometimes there are slightly different drugs available).  You may need to advocate for yourself, but I always found it best to remember that this system is built on providing what people NEED and not necessarily on trying a number of tests to see what might be going on, maybe. This doesn't mean that it is all perfect, there are rubbish and obstructive GPs out there, but I think if you are comfortable advocating for yourself and come armed with your medical history, you are in good shape.

Yes, I agree Americans are probably over-screened in general. I was happy with the NHS to wait until a problem appeared before seeing the GP. However, with old age, a host of things rear their ugly heads!  If you've had surgery for skin cancer they want you to be screened every six months here. I suspect the NHS wouldn't go along with that. Or maybe I'm wrong?

Yes, I agree Americans are probably over-screened in general. I was happy with the NHS to wait until a problem appeared before seeing the GP. However, with old age, a host of things rear their ugly heads!  If you've had surgery for skin cancer they want you to be screened every six months here. I suspect the NHS wouldn't go along with that. Or maybe I'm wrong?

I wouldn't necessarily make that assumption. What they might do is a six month visit, then another, then a 9 month, then a yearly appt or something, but I am SURE it would depend on the diagnosed form of skin cancer and other risk factors. Truly, it is worth just bringing your records and asking your GP.

If you've had surgery for skin cancer they want you to be screened every six months here. I suspect the NHS wouldn't go along with that. Or maybe I'm wrong?

I always advise for people to hold off on their assumptions about the NHS.  In particular, I have known folks to have a history of cancer and get great follow up screenings on NHS.  My FIL is one of them.  His treatment and after care with liver cancer has been world class.

Regarding other issues, like mammograms, it is also worth remembering that even in the US, there are NOT always consistent standards for what is reasonable when it comes to pro-active screenings.  Some bodies say once yearly mammograms after 40.  Another, equally important, medical body will say every two years after 50.  However, the patient doesn't normally see this inconsistency because US doctors are quite willing to screen based on the most frequent timetable because it equates to $$$$$.  THe UK doesn't always have it wrong with spreading out its screenings, it just isn't a timeline Americans are used to.  You should also remember that those NHS recommended timetables do go out the window when you have an occurrence of whatever is screened or there is a family link that is material.  

But at the same time, do not walk into your GP and expect the same response to screenings and whatnot that you have had in the US.  Fundamentally the systems are different.

 However, the patient doesn't normally see this inconsistency because US doctors are quite willing to screen based on the most frequent timetable because it equates to $$$$$.  

I certainly agree with you there! And also that the NHS is very good for the more serious conditions like cancer.
What I'm really wondering is if there is any perceived resentment on the part of doctors when confronted with someone with different expectations. In a previous incarnation in the UK, I found our GP was a bit stroppy when I asked about our kids getting MMR immunizations (maybe they do do that now)

Well I think that totally depends on how you approach them.  If someone goes into a GP and demands x y and z without really knowing how the system works for those issues - then yes, I think a GP can/might get irritated.  But if one goes into the appointment asking the GP to help them understand how the system works for certain issues and how it then equates to your own care - well no, I haven't seen a GP be irritated by that.

I'd go in with a 'how will this be handled in your surgery' approach. As in, 'I expect differences, here's my list now tell me how you'd like to proceed'.

If you find any of his/her answers troubling, I'd probably keep it to myself, do some research (here, online, etc) and re-approach the surgery armed with more info if appropriate.

I found some docs were interested in comparing the systems. Others had even worked in the US or abroad themselves. Only a few I had were arsey about it and I usually changed docs if I could.

In a previous incarnation in the UK, I found our GP was a bit stroppy when I asked about our kids getting MMR immunizations (maybe they do do that now)

When was that, out of curiosity?  The UK started their MMR programme in 1988, which was later than the US, but they have been doing them for some time.  It's a standard vaccination that all children (if the parents agree) get at around 14 months, so no worries there.

I agree with the others as well.  I think it depends on the individual doctor or practice and how you approach them.  Personally, I found my GPs to be very receptive, but what I did was kind of stock up a bit in the US on some meds I needed and then when I got here, I just took care of the more essential things first and gave myself some time to get to know how it worked and which docs I liked, and then I approached them from a "is this something that can be approached here" sort of angle.

So birth control happened very quickly and the ear infections I picked up right away.  Then I went in once I knew who I liked and asked them about my insulin resistance.  I talked to them about what we had started doing in the US, and it ended up being quite interesting.  As it turned out, there wasn't tons he could do immediately on that as the drugs weren't licensed at that time to treat insulin resistance, but the same doctor did a bit of digging and we ended up figuring out that I also had PCOS, which the drugs were licensed for, so I got the same treatment and also better understood my health in the process. 

That particular doctor actually appreciated me bringing my tests with me, as it was able to show him where I was coming from.  The tests they did here weren't as in-depth when they weren't heavily funded by private insurance companies and pharmaceutical groups.  He also figured out that the measures in the US were different than the ones in the UK, so he copied my results and had me come back another day, so he could have a chance to digest them and really understand what the numbers meant once he had translated them into UK measuring units.  He later consulted with diabetes specialists to talk to them about the best way forward since I was thinking about having a baby at the time and what he read about the meds I was on was mixed. Really, overall, my care was great, even though I didn't get round after round of test screens paid for by insurance. I was happy, but it was definitely different. 

I wouldn't necessarily make that assumption. What they might do is a six month visit, then another, then a 9 month, then a yearly appt or something, but I am SURE it would depend on the diagnosed form of skin cancer and other risk factors. Truly, it is worth just bringing your records and asking your GP.

I still get a yearly MRI 6 years after I got the all clear on the NHS. I don't know how long it will last but I dutifully turn up when called, in fact I went last week, or the week before

I'd go in with a 'how will this be handled in your surgery' approach. As in, 'I expect differences, here's my list now tell me how you'd like to proceed'.

That sounds a reasonable approach.

The MMR request was 30 odd years ago. At that time they only had Rubella vaccine for girls at around age 9. I'm a little touchy on that episode as my son (then 3) did get mumps and subsequent viral meningitis, rushed to isolation hospital for spinal tap and other horrors. Fortunately he was OK -- but very scary.

Regarding other issues, like mammograms, it is also worth remembering that even in the US, there are NOT always consistent standards for what is reasonable when it comes to pro-active screenings.  Some bodies say once yearly mammograms after 40.  Another, equally important, medical body will say every two years after 50.  However, the patient doesn't normally see this inconsistency because US doctors are quite willing to screen based on the most frequent timetable because it equates to $$$$$.  THe UK doesn't always have it wrong with spreading out its screenings, it just isn't a timeline Americans are used to.

Another issue is that the NHS seems to be much stricter about the permitted radiation doses given to patients. A single mammogram, for instance, would be a quarter of my permitted annual radiation dose (and I'm a classified radiation worker with all the medical records keeping that entails!).
They tend to take the position that if you're low risk the chances of a mammogram (or similar scan) causing cancer are greater than those of it detecting it early. This also shows up in other areas of care, for instance where a child has a fall and ends up in A&E they are much more likely to use various forms of imaging in the US than UK. This is largely down to different perceptions of relative risk rather than resource issues.

Another issue is that the NHS seems to be much stricter about the permitted radiation doses given to patients. A single mammogram, for instance, would be a quarter of my permitted annual radiation dose (and I'm a classified radiation worker with all the medical records keeping that entails!).
They tend to take the position that if you're low risk the chances of a mammogram (or similar scan) causing cancer are greater than those of it detecting it early. This also shows up in other areas of care, for instance where a child has a fall and ends up in A&E they are much more likely to use various forms of imaging in the US than UK. This is largely down to different perceptions of relative risk rather than resource issues.

Interesting.

Yes, I agree Americans are probably over-screened in general. I was happy with the NHS to wait until a problem appeared before seeing the GP. However, with old age, a host of things rear their ugly heads!  If you've had surgery for skin cancer they want you to be screened every six months here. I suspect the NHS wouldn't go along with that. Or maybe I'm wrong?

I can confirm that at least in my area, they will completely ignore this. I had surgery to have something removed just before moving here in June 2009. I have seen 4 or 5 different GPs in an attempt to beg to be referred to a dermatologist or other specialist so I can have a check-up/screening to make sure nothing else has appeared (as I suspect it has) but they ignore my requests each time. When I go in to say I think something new has appeared, they tell me it looks fine and say there's nothing more to be done. Trouble is, the new places look just like what I had removed... We're moving back to the US next year so I imagine I will have to wait until we're back there to get a proper diagnosis.

I can confirm that at least in my area, they will completely ignore this. I had surgery to have something removed just before moving here in June 2009. I have seen 4 or 5 different GPs in an attempt to beg to be referred to a dermatologist or other specialist so I can have a check-up/screening to make sure nothing else has appeared (as I suspect it has) but they ignore my requests each time. When I go in to say I think something new has appeared, they tell me it looks fine and say there's nothing more to be done. Trouble is, the new places look just like what I had removed... We're moving back to the US next year so I imagine I will have to wait until we're back there to get a proper diagnosis.

You might want to consider a walk-in clinic.  I had a boob lump a couple of years ago and was actually told to go to a walk-in clinic rather than my regular GP.  The reasoning was that the walk-in clinc (which was affilitated with the nearby hospital) had more on-site equipment and had certain standard procedures for cancer issues (i.e. nearly everyone got a referral). 

It may be the case that my walk-in clinc was just good at the boob cancer stuff but if that reasoning does apply more broadly, then maybe it will help your skin cancer issues.

Good luck.