Health in France: We want another opinion

I came to live in France nearly three years ago and while I have begun to appreciate the importance of food and the early morning philosophical chats in the school playground, I still find the obsession with health slightly unnerving.

I am about to see the doctor about a black fingernail I shut in the garage door. It's not something I would normally worry about, but my neighbours are concerned. They have given me the name of three specialists in the centre of town, and someone else has slipped a recommendation under the car windscreen wiper. "It's not so bad," I told my friend next door, but he looked horrified: "It's not the fingernail - it's the reforms."

New health reforms coming into force this year are designed to curb some of the excesses of the French system, particularly patients going directly to more than one specialist. France has traditionally been very generous to its patients and its pharmacists, which is why a lot of people are hoping that the new reforms will fade away and they can continue to be ill as in the good old days.

Of greatest impact to the average French person is that everyone must register with a médecin traitant by July 1 this year, meaning they have to nominate a single doctor, thus making the system a lot more "British". Patients will be able to change their doctor, but will need to notify the social security office. The government also hopes that patients will gain access to specialists only following a GP referral, instead of going directly to see a consultant based purely on their own personal hypotheses.

It is not going down well. The French are conditioned to believe that they need to visit the doctor after experiencing even the slightest sensation of discomfort. At the front line, this means waiting rooms full of relatively healthy people with minor ailments. Chaffed palms, clicking fingers, sore shins, general malaise - they're all there for a long prescription of pharmaceuticals. Indeed, such is the desire to medicate patients that some 10% of hospital admissions are for accidents médicamenteux (drug-related accidents). And it is this Hippocratic generosity that is partly to blame for the spiralling of the French health deficit towards €12bn (£8.3bn).

However, being ill in France is not the discouraging grind it can be in the UK. There is no waiting around in doctors' surgeries thumbing Reader's Digests from the 1980s, there is always plenty of home help and the amount of medication on offer is eye-watering. In France, health and wellbeing are regarded as a divine right, as is the entitlement to a cure.

The best example is the casualty department, which has undergone a major overhaul since 2003. Many departments were unable to cope with the large number of patients suffering in the record-breaking heatwave. They are now well-staffed and filled with state-of-the-art equipment, often at the expense of other hospital departments. They have an air of discreet competence about them.

The first time I visited a French casualty unit was in a city hospital when I thought I had fractured my wrist. It looked more like a country house hotel than a hospital. The coffee machine in reception was broken but they had set out a line of cafetières and a plate of mini croissants for patients.

But there was no time for coffee. I was taken straight into a large white room, where I had a 20-minute consultation, which included questions about my diet, bowel movements and water and vitamin intake. I had an x-ray, another consultation and got a prescription - all within an hour.

The last casualty visit was a few weeks ago when my one-year-old son fell over on the patio and cut open his forehead. We rushed him to our local hospital, near Aix-en-Provence, where he was given three stitches. They were amazed we had not been to hospital with him before. This minor procedure cost £33, of which we had to pay £10. However, the prescription for recovery was astounding: three creams of varying viscosity, two types of plaster, two packs of suppositories and an antiseptic spray.

When we returned to see the paediatrician a week later to have the stitches removed, she gave us a prescription for an additional two creams and warned us that we must keep a plaster on his forehead throughout the entire summer to protect the scar tissue. (He pulled the first plaster off about five minutes after leaving hospital.)

At the chemist, my refusal to buy the second cream - it sounded identical to two from the first batch - was greeted with a mixture of disdain and incredulity. Neurologist Laurent Renié, who works at Aix hospital, told me that his patients "expect" medication and it takes him much longer to explain why he may not be prescribing something than to go through each of 40 médicaments.

Healthcare has a much more visible profile in France than in the UK. Besides the chemists, even small villages have clinical analysis laboratories in the high street, where patients go to present samples and have injections and blood tests. Chronic complaints, diabetes, going on the pill, anything from bronchitis to pregnancy, requires you to make regular trips to the "labo" for a thorough testing.

My wife, who had a baby in a French hospital at the end of 2003, went 25 times in nine months to the analysis laboratory. Having had her first child two years previously in a hospital in west London, the obligatory six-day lying-in period after the birth was particularly welcome. Otherwise, the main difference with the pregnancy was that in France, you see the gynaecologist each month for the first six months and then the obstetrician every few weeks; there is a free choice of hospital, and regular x-rays as well as ultrasound and free vitamins. There is also a monthly test for toxoplasmosis.

The approach to the birth is also very prescribed. We had brought out some childbirth manuals with us: "Tell your doctor you don't want drugs ... think about uplifting music and incense ... discuss your birth plan with your obstetrician ... " Not in France. Apart from a few select hospitals, birth is performed the French way and there is no further discussion.

When our son was born (I was ordered into the corridor), they wrapped him in a woollen tricot and sprayed him with eau de cologne. I thought it might have been some kind of disinfectant or something to promote breathing, so I asked the delivery nurse what it was. "It makes the baby smell nice, non?" she said.

At this particular hospital, nurses wearing pink were there just for the baby and those in sky blue were there just for the new mother. The day after the birth, the gynaecologist arrived to see my wife for a discussion about when she could "return to sexual congress". He was concerned that the four-week recommendation in the literature was rather long.

Things are altogether more private in France: hospitals don't have wards (two beds per room maximum) and patients can deny doctors access to their medical histories if they wish. From next year, however, all patients over 16 will have a carte vitale, which will include a photograph, and patients will have computerised medical records so doctors can call up information and check how many times they have requested the same test.

Around 80% of people have some form of medical insurance (mutuelle) which tops up what is left over from state contributions, which are usually 70% of the fee. Financial reforms to the healthcare system include an increase from €13 to €14 (£10) a day for staying in hospital, and a €1 (70p) charge for every medical service, such as a consultation or laboratory test. The charge for seeing a specialist will increase on average by €2 (£1.40) in July this year and by another euro next year. The government hopes that patients, as opposed to their insurance companies, will pay. However, to a French person, health is everything. The reforms - for those apparently small price increases do add up when you are seeing multiple medics - may prevent excessive visits to a series of specialists, but they will do nothing to change their views of the sacredness of their bodies.

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