Why is there a difference in the the uk to the rest of the world.

Is there a reason why in the uk

a. ladies only have speculum exams and not rectovaginal, bimanuel and anal exams?

b. Stirrups in the UK are highly unusual instead flat on the table thighs flexed? whereas in other conties notably the US you have, feet, knee and even slings.

Do UK women prefer the level of current procedures.?

would other countiries prefer the UK way?

I don't think that the medical profession in the UK are as concerned with preventative medicine as our cousins across the pond and in other countries. We tend to diagnose/treat complaints when they arise. Certainly the type of examinations that you mention would be carried out then.

Yes, I know we have mammography, smear tests, blood checks etc but it does seem as though we pretend the back door doesn't exist, though we are in the middle of a bowel cancer screening drive at present - but only for those aged 60 to 69. Over 70's have to take the initiative and ask for a screening kit to send a stool sample off for checking. It's a 'one off' check and even mammography and smear tests are at long intervals and age dependant.

From reading posts on here from the US members it does seem as though regular examinations, even whole body checks, can be as frequent as yearly in the States. I don't know if the difference is because we have a parlous monetary situation with the NHS whilst in the USA it's more insurance based. Insurers might prefer the preventative route, considering it better than having a potential serious problem arise.

I've read a little on stirrups for examinations. It seems that gynaecologists in the UK have virtually stopped using stirrups for routine checks. It appears that the use of stirrups is considered unnecessary from the point of view of it being easier to examine and that it is considered that women feel less vulnerable. See http://www.rcog.org.uk/womens-health/clinical-guidance/gynaecological-examination-table-query-bank

But even in the US, trials have been done with and without stirrups and indicated that the use of stirrups for routine procedures wasn't really necessary and even that many women suffered less discomfort. See http://www.doctorsofusc.com/condition/document/167642

Not unnaturally the use of stirrups and even leg restraint are indicated for procedures where pain and discomfort from the procedure is likely to be a factor - or where the woman must not move during the procedure.

Like you youngesssentric, I look forward to contributions from the ladies!

In the UK its merely a pap smear not a pelvic exam for NHS provided screening.

In the UK there is much less attention to preventive medicine. Ultimately a screening programme has to be cost effective, is screening for the disease more cost effective then treating it. That is why smears are only performed on woman who are asymptomatic on 25 and over. It doesn't catch enough cases for cervical cancer under that age group to make it cost effective.

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Having said that if you choose to pay for private health care in the UK then you can have what ever you want really within reason. Whilst the NHS is a wonderful institution I do believe private health care is also important as preventive medicine is better then cure, identifying issues early not waiting to symptomatic is important.

I think having blend of both is best. Unlike US where level of health care you get depends what you can afford.

Here if need treatment its there and free at point of care but if you have private cover can have annual health exams if you want to.

I think this sums it up the value of the NHS nicely

https://www.buzzfeed.com/lukelewis/if-breaking-bad-had-been-set-in-the-uk?utm_term=.hxZ8XaZ5R#.inam6e1PL

However ever since I had private care and had my own family have always paid for an annual check up. If anything was discovered I would use the NHS facilities but private cover means can choose the specialist you want.

Does that help to answer of have I just been rambling lol

I am not trying to get political here, but on one hand you say in the US you get what you can afford, than you turn around and say in England your free care does not cover a lot of basic things so you have to pay if you want anything more comprehensive. The statements seem contradictory.

I have a friend in England. He had got a sty on his eye that started hurting. It took 1.5 months to see a doctor who gave him antibiotics. Only by than it was encapsulated and the antibiotics were not helping, he had to see a surgeon to have it removed. 8 weeks wait to see him. By then it was really bad, and the guy botched the job. He is on the mend now, 3 surgeries later.

People bitch about health care in the US, but I suspect that he would have been able to see somebody a lot sooner here and got it taken care of with a simple pill.

@reggind said

I am not trying to get political here, but on one hand you say in the US you get what you can afford, than you turn around and say in England your free care does not cover a lot of basic things so you have to pay if you want anything more comprehensive. The statements seem contradictory.

I think you will find that some things that you as an American will consider "basic" aren't necessarily considered so essential here, both on medical and cost grounds.

My wife Amethyst has started going privately to a gynaecologist here in England, but that is only due to her mother's history. If her mother hadn't had any issues and instead had a clean bill of health, Amethyst probably wouldn't have been so concerned about inheriting any problems, and therefore wouldn't have sought such a check up.

This is a true story that happened to a fellow district sales manager, when I was one at the same time. He had the Chicago Metro area as his district and I had central & southern Ohio. We reported to the same regional manager. Our Chicago mgr. was vacationing in Toronto and had an M.I.. The hospital imaging showed that he needed multiple by-pass surgery to correct this problem, but the Canadian Health System said he was TOO OLD for him to qualify for by-pass surgery. They said he qualified for meds.only.

His family chartered a corp. Jet and flew up to Toronto and took him back to Chicagoland. He was in an O.R. getting the needed by-pass surgery within 3 hours after landing.

As terrible as Obama care is in the U.S., at least they don't tell you that your aren't worth the expenses needed. Next thing you know, they will be copying the Eskimos from years ago and putting their geriatric population out on ice flows to die.

Socialized medicine SUCKS, no matter where it is practiced!

Socialized medicine SUCKS, no matter where it is practiced!

Hmmm ... not everyone can afford to charter corporate jets, so some form or another of guaranteed health care can be and is often their only option. And the only way this works is to have everyone contribute, sort of the same way that everyone contributes to national defense. And the least expensive way to organize this is to make sure there is no profit motive involved.

Maybe countries could start paying their generals and admirals bonuses when they win battles and dock their wages when they loose or retreat. That would be a way to de-socialize national defense ... 😃 😃

Reggind said:-

I have a friend in England. He had got a sty on his eye that started hurting. It took 1.5 months to see a doctor who gave him antibiotics.

Your friend should have not troubled a doctor, or the NHS, with such a triviality. It's why our NHS is in such dire straights when people do such things as go to A. and E. (ER) with a cut finger that happened a week previously - or a recent case where a man called an ambulance BECAUSE HIS DOG WASN'T WELL.

Yes, it is true.

Your friend should have gone to the chemist (pharmacy) and bought a tube of Golden Eye Ointment ! Do him a favour in case he gets another stye

@BigK said

....... It's why our NHS is in such dire straights when people do such things as go to A. and E. (ER) with a cut finger that happened a week previously - or a recent case where a man called an ambulance BECAUSE HIS DOG WASN'T WELL.

@BigK speaks the truth - that did actually happen, and it isn't the only ridiculous misuse of resources either.

Our Accident and Emergcency (A&E) departments across the UK, which are our equivalent of the American ER, are kept busy with often very trivial complaints such as seasonal head colds and other things that can be easily treated at home. Some people have no judgment about what is an emergency or what needs urgent medical treatment.

Perhaps we should get back to the subject at hand though, as we've strayed quite a way away from comparing UK gynaecology with its equivalents elsewhere in the world.

the NHS, with such a triviality. It's why our NHS is in such dire straights when people do such things or a recent case where a man called an ambulance BECAUSE HIS DOG WASN'T WELL.

Now I can't attest to policy in the UK for such happenings - and yes, I am certain that these kind of silly things happen almost everywhere.

I can say though, that if you call an ambulance in Belgium for an unwarranted situation, for something that was obviously unnecessary, you WILL be presented the bill in full. Which should teach you a lesson if you contemplate something similar a second time.

If you make use of an ER in Belgium for a similar unwarranted, non-urgent reason, then you will be charged an extra supplement for wasting their time. The last time I heard, the fine was 50 euros, maybe not much by US standards, but still almost 10x the actual cost of a doctor's consult. And the list of warranted reasons for an ER visit is strictly narrowed down to, being hospitalized because of an illness or accident or having bones set in a cast without hospitalization. And they are strict about the guidelines.

My wife was once cut up by interfering in a fight between two cats and had a long deep gash on her leg, bleeding profusely. At the ER it was sewn up with several stitches and she was sent home. We still got the fine because of no hospital stay and no cast.

I'm pretty certain no one gets away with such shenanigans as calling an ambulance for a sick dog. There will be some sort of sanction.

Agracier said:-

I'm pretty certain no one gets away with such shenanigans as calling an ambulance for a sick dog. There will be some sort of sanction.

Regrettably agracier - there is no sanction - and it seems none are proposed.

Our emergency rooms (A&E) are crammed with delays created by drunks, down to those whose nails are ragged - thankfully not many whose proper place would be the veterinary office - but I assure you that such was a genuine reported incident. I gather that the caller was interrogated by the despatcher but the call didn't indicate a canine patient until the ambulance arrived at the address given. Here are two links about it - http://www.manchestereveningnews.co.uk/news/greater-manchester-news/ambulance-rush-to-hot-dog-11639487 and http://www.imaginefm.net/man-in-south-manchester-calls-ambulance-for-a-dog/

Waiting times at A&E are around 4 hours to be seen - and that's just a target time, more often missed than achieved.

Many are the tales about those who live in the vicinity of hospitals - they feign illness to get an ambulance instead of a taxi - and recover miraculously en-route. 54% of calls for an ambulance do not require A&E attention.

That's when you can get an ambulance - 9 or 10 vehicles lined up for hours outside A&E waiting to deliver their patients indoors, because the department is full.

Anyway - we're well off topic here and I'll be getting my collar chewed.

b. Stirrups in the UK are highly unusual instead flat on the table thighs flexed? whereas in other conties notably the US you have, feet, knee and even slings.

... would other countiries prefer the UK way?

In the US every pelvic exam I've had (which always included a speculum exam, Pap smear, rectovaginal, and bimanuel exam) was at with an ob/gyn or a nurse/midwife who was working in a larger ob/gyn group practice. I've occasionally heard of women who get pelvic exams at their family doctor, but it's relatively rare where I've lived. So most pelvic exams are done by doctors who see both pregnant/newly delivered women AND does basic yearly exams every day, in the same exam room with the same setup (and stirrups). I can't imagine it would be easy for a 36 weeks pregnant woman, or an elderly lady with bad knees, or one who's very heavy (and Americans do tend to be heftier than Brits or Europeans) to handle an exam without stirrups/knee rests. So everyone get the stirrups by default. (This is my theory, but I think a reasonable one.) It may be even simpler than that- US doctors started using stirrups at some point, US doctors working at US med schools teach how to give an exam using stirrups because that's what they are accustomed to, US medical students do internships in hospitals with doctor that use stirrups, rinse and repeat.

That said, I prefer the stirrups. While I can imagine keeping my feet flat on the table for a short speculum exam, I can't imagine keeping still like that while the horrid little brush goes inside my cervix during the smear test (uck!) or during the "ok, almost done, now I'm gonna shove a finger up your butt" portion of the exam. I've never had an exam which wasn't AT LEAST uncomfortable, and pain isn't unusual in my experience.

I wonder if, in the U.K., they use N.P.'s (nurse practioners ). or P.A.'s (physician assistants), for routine checkups? In the U.S., these 2 medical specialists are becoming more important in OB-GYN. My wife's OB-GYN practice has 3 female M.D.'s and each has an N.P., who does routine pelvics, ultra sounds, Rx's oral contraceptives, etc. This cuts down on costs, as the N.P.'s don't make as much money and can do the routine things in the office.

I wonder if, in the U.K., they use N.P.'s (nurse practioners ). or P.A.'s (physician assistants), for routine checkups?

No @jimmyt44 on the NHS you do not have check ups that are examinations. It is just a cervical smear every 3 years when you get to 25 but it is not an examination just a test. It is the practice nurse who does that and not an actual doctor. You only see a gynecologist if you think you have a problem. You go and see your doctor first and then you get referred.

I see a gynecologist privately though.

Jimmy in the UK , we have only started to have nurse practitioners ( NP), and only just this year we had a program started something similar to physician assistant (PA). The majority of smear testing is performed either by the GP or their Practice Nurse . They dont have a pelvic exam , just a smear ( Pap) test. Every woman registered with a GP are are invited for cervical screening ( smear) :

- aged 25 to 49 – every three years

- aged 50 to 64 – every five years

- over 65 – only women who haven't been screened since age 50 or those who have recently had abnormal tests

Women under 25 dont have a smear performed or are invited. In the UK we don't have year physicals like the US , and a pelvis exam will only be performed if you have a gynecological problem and usually in the frog leg position, as most GP surgeries ( Office) don't have any examination table with stirrups. You get them for the most part in hospital or private medical offices, institutions or hospitals.

Jimmy I think its the same as the US with regards to cost , as the Practice Nurses are cheaper to use than a GP in most of the larger surgeries. It's only the single GP surgeries that the GP performs the smear.

Hi All,

I have experienced the medical system in the UK and in the US, the UK is what Americans have heard here as the single payer system, the one in the US at present, is a market based health insurance system. Without going off topic, I see the merit of both, but for different reasons. In the UK, all have access to medical care. In the US they don't. In the UK there is also a private market insurance available system BUPA etc. which is available to anyone, however it still is a function within the existing hospital care system. The news floods us here in the US with the reports that have come from the UK and Europe stating that women are screened too often, not to their advantage but to the advantage of the insurance and medical system. In the UK, they are probably screened on the needs of the individual patient depending on family history and current medical needs. I am sure I will be corrected having not lived in the UK for over 17 years. This was how it was when I left. However, I have walked into St Thomas Hospital late at night, on night duty when I was a serving Police Officer to get someone to take a quick look at me when I had an unusual high pulse rate and continually flushed, and they did, no wait, no fuss. There are merits of both, depending on your politics I guess. But I do feel in an advanced society, all no matter who, should have access to medical care especially children and the elderly and infirm ad especially veterans who have served their country and come in harms way.

And for the poorly informed, the ACA or "Obamancare" is only for 15% of the nation, most people are covered through their jobs, the ACA is for self employed, and was implemented to deal with the high rate of uninsured people in the US. I will let history see what its outcome is.

Resaerch accepted in the UK shows that cervical screening 3 yearly provides good protection, i note that in th US there is new guidence about not PAP testing every year. Also from readingother research, rectal anf bi manual exams are not very effective at picking up problems. I think ultrasound is used were there are specific concerns in the UK.

I will add that in the UK if you are considered to be at high risk of reproductive cancer you can have tests done more frequently and at an earlier age - a friend of mine started having smear tests at 16. It may take a couple of months to see a specialist for something that's not urgent but if they have a good reason to suspect cancer they aim to get you to a specialist within 2 weeks. A lot of it depends on your local health service, I once had a blood test at 9am and at 2pm I got a phonecall from my GP surgery asking me to come in to discuss what came up (nothing urgent or life-threatening, but they contacted to me as soon as they had the results and I had an appointment with a nurse a week later). A relative in another area had a test done which had a very urgent result and they literally phoned her at work and said "Where are you, we're sending an ambulance right now because you need to be in hospital immediately." At the same time psychiatric services in my area are particularly poor and it can take many months to see a specialist. It's hit and miss between geographical areas and different specialities.

I often get the impression that there is a general perception in the UK that doctors in the US are just doing loads of unnecessary tests for the money, whereas in the US people think the UK health system is heavily rationed to the point of negligence. The truth I suspect is somewhere in between. Most British people will find something to complain about the NHS given the slightest opportunity, but when it's under threat they will defend it to the hilt and there are a lot of concerns at the moment about the government trying to nudge us towards an American-style system.

My two penneth for what it's worth:

In the uk i think we differentiate between a smear test which is just speculum insertion and smear as described, no bimanual or even an external exam. These are routine if you are over 25 but not annual. They aren't usually done by a gynaecologist but by a nurse at the local clinic or maybe the local gp.

They will give you the full works (fingers inside you etc often referred to as an internal examination or an "internal") if they think you may have a problem but that is usually done by a consultant gynaecologist in a hospital clinic to which your gp has to refer you. Alternatively you can go private which involves paying (usually the same gynaecologist ) to do it but that way you dont need a referral and can jump the queue.

Internal examinations are not routinely done here during pregnancy either so its quite possible for a British woman to go through life without ever having a bimanual or rectal exam.

For the smear test and at the gp's stirrups are never used. However, they are still found sometimes in hospital clinics where it's all a bit more full on. My first examination was in the stirrups at the hospital gynae clinic although that was back in 1993 I think so although i think of it as recent it wasnt really! Getting old!

Stirrups are also used for procedures like colposcopy or IVF. I had a friend who did IVF and was whingeing about being in what from her description were knee supports in front of a male doctor.

Finally on the 25 years old for smears thing one other point is that it's not just the cost effectiveness. Apparently your cervix changes a lot up to then and so the earlier tests were throwing up a lot of false positives. That meant a number of girls were being given biopsies etc unnecessarily. The more you mess around with a developing cervix the more likely it is to not do its job (holding the baby in) during a later pregnancy so thats anothet reasn they changed it i believe.

Hi

Thanks for responses so far.

would be nice to see responses from non UK and US ladies. For example European, middle east, Asia?

This was not supposed to be just a straight essay style question 'compare the differences between the US and UK annual/ 3 yearly checkups.'

kind regards

RJ

Thanks

what about other countries... say China and the rest of Asia, the middle east, Africa ect.

Our Chicago mgr. was vacationing in Toronto and had an M.I.. The hospital imaging showed that he needed multiple by-pass surgery to correct this problem, but the Canadian Health System said he was TOO OLD for him to qualify for by-pass surgery. They said he qualified for meds.only.

I call BS on this. For one, he was likely under 65 if he was still working, I've heard of people older than that getting bypass. For another, this wouldn't have been paid for by our health system since he wasn't a resident of Ontario. What he got or didn't get would have been determined by his insurance. Perhaps his insurance co. wouldn't pay for out of the country bypass if he could be sent home for it, I don't know. But he would not have been turned down because of age.

So which countries are similar...

so far what I understand is that the UK and AUS are similar.

in all other countries stirrups are far more common... then there is deviation with nude or partially clothed.

eg. GER- Stirrups, nude form waist down? (no gown)

am I right or is there more variations. to list.

It is possible that the internal portion of the exam will go away in the US. The ACOG basically admits that pelvic exams have no proven value. Other organizations no longer advise doing pelvic exams. This is a really difficult situation for OBGYN's because they may not get paid by the insurance company if they don't do the pelvic portion of the exam -- basically women are being subjected to these exams so the doc/hospital system can get paid by insurance. It's really unfortunate. The more research I do on it really leads me to believe there is little value in the pelvic -- especially with imaging these days.

At my latest exam the doc said pelvic exams are now a "shared decision" which was weird... and didn't offer any other details about that. If a pelvic exam is something that science has proven to be critical why is the decision now shared? Honestly, I went through with it because i'm used to getting them, and felt somewhat pressured to agree to it (after the older male doc said he still "likes" to do them just in case).

From the ACOG site --

Traditionally, a pelvic examination is performed for asymptomatic women as a screening tool for gynecologic cancer, infection, and asymptomatic pelvic inflammatory disease; some obstetrician–gynecologists and patients consider it important in detecting subclinical disease, despite evidence to the contrary. Given changes in screening recommendations and the ability to screen for sexually transmitted infections using less-invasive methods, reevaluation of the role of the pelvic examination for asymptomatic, nonpregnant women is warranted. A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, non-pregnant women who are not at increased risk of any specific gynecologic condition. Based on the current limited data on potential benefits and harms and expert opinion, the decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician–gynecologist or other gynecologic care provider.

The ACOG head said that pelvic exams "are a bonding experience and time of intimacy between the doctor and patient." Uh, that's a really weird statement. We can always bond by talking and discussing health issues.

As a man I cannot possibly comment from experience but I have raised this question with partners and female friends in the medfet space.

I'm the UK and Ireland most gyn exams are as the original poster stated performed on a flat bed with knee flexion. The exam typically includes a speculum examination and a swift internal exam performed with a finger. In general I and know it to be the same with men practitioners seem to stick with the basics unless complaint warrents otherwise.

I know in America there is annual physicals which at all ages are very thorough.

If a pelvic exam is something that science has proven to be critical why is the decision now shared? .

Perhaps encroaching prudish notions and Puritan-like aversion to anything related to genitals and sexual matters played a part in making the change. Much like the way that wearing gowns and the presence of chaperones in the US also somehow became more or less standard.

Never discount societal pressure in such matters. And with the general (medically uneducated) US population being so ready to see impropriety in medical surroundings, it's not surprising that doctors want to cover all their bases re. malpractice or accusations of impropriety.