Women’s Health in the States

Another post written last year in the States, before we came back to the UK. Of course this was also during the Obama care era, so things will probably change…

After about 15 months living over here I finally had to find someone to refill my birth control medication. Thanks to an understanding GP in the UK and a couple of visits home I’d managed for about nine months without having to negotiate the US health system, but after that I realized I’d have to make a start at finding a doctor.

I knew that in the States people can choose their own specialist and don’t need a referral from a GP. It’s actually not essential to have a GP – many of whom are known as internalists (specialists in internal medicine). (What’s external medicine I wonder…?) I then found out that the medical insurance we have, from the company that is sponsoring R’s visa, allows us to access either doctors who are in their network, or to go ‘out of network’ without any financial penalty. So now I almost had too much choice as to what sort of doctor/practice to go to, and no real way of knowing how to make the best choice.

I spent probably the best part of an hour scouring the list of in-network gynecologists (or OB GYNs), looking them up on the map, checking to see if there were reviews on Yelp – as if I were choosing a restaurant – and cross-checking with a good online medical service I found called ZocDoc. Weirdly there didn’t seem to be many OB GYNs in DC itself, so I found myself choosing between going to Bethesda in Maryland or North Arlington in Virginia. Based on distance from the metro, some nice Yelp reviews, and availability I chose my practitioner. It hardly seemed the best way to choose – using the same comparison site I use to find good pizza – but at least a decision had been made.

And I have been thoroughly satisfied – and not a little surprised – by my experiences. My doctor works for an outfit called the Physicians and Midwives Collaborative Practice, which I immediately liked the sound of. The office is very clean, modern and comfortable. Everyone is very friendly – more than one of them calls me ‘dear’ (though this is less affectionate and more like a conversational tic). Best of all, I’ve not been charged a co-pay on either of my visits.

The first time I went simply to get a refill of my prescription, though I knew there was a possibility I might have to get an exam (I’ve heard that this is more common in the States). They were good about getting a pretty complete history and wrote me a prescription for 3 months without an exam, on the condition that I make an appointment for a full physical. I had taken my British medication and the information leaflet with me so that the doctor could find an American equivalent, and she made an effort to find a generic version that was as close to mine as possible. As I said, I didn’t have to pay anything that visit, and while my insurance company makes me pay for my prescriptions up-front, I can claim back the full cost.

The second appointment came round and I turned up largely unconcerned – I don’t personally find these screenings at all problematic and actually have more anxiety about having my blood pressure taken (which obviously doesn’t help with the result!). But it turned out there are quite a few differences in practice between the UK and the US! Mostly in the UK the procedure has been done by a nurse, or maybe a nurse practitioner. Only the necessary clothes have had to be removed, and it’s been carried out on a normal GP bed.

Over here – in this practice at least – all clothes had to be removed and I was given a full-on hospital gown, in which I waited for my doctor. Thankfully I’d brought a book, and after about quarter of an hour she arrived. We had a conversation about my plans (or not) to have children, in which it was suggested that at my age I might want to look into getting my eggs frozen(!), and then there was the awkward getting into position on the gynecological table with stirrups that I’d seen in so many American TV shows. After some poking and prodding of various glands, the smear was reassuringly familiar, and after this I was ready to be getting up and heading home. So I was somewhat taken aback to find myself being pushed and prodded further, as she apparently examined my reproductive organs! I finally understand the joke about how gynecologists should probably buy you dinner before the exam – she now knows my uterus better than I do!

Again though, I was pleasantly surprised by not being asked to pay anything for this experience. I have read that recent changes in healthcare law have made all these sort of preventative health appointments free of any upfront charges – the entire cost being covered by the insurance company [Ed – thanks for the memories Obama!]. This must be a good thing in terms of detecting problems sooner as I can imagine that the idea of having to pay for a screening would be that extra reason not to go as regularly as you should. I’d also be genuinely interested to know whether the more invasive and thorough physical exam leads to cancers being found more quickly in the US than in the UK.

In any case, I survived my first experiences with American OB GYNs, and next time at least there should be fewer surprises!

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