Unsurprisingly, the French health service is different from the British. This blog is not meant to be a practical guide to anything, but you can find a useful overview of how the service works here. The French journalist Agnes Poirier who writes in English for the Guardian and other UK papers, did an intriguing piece about the differences between British GPs and their French equivalents recently.
Fortunately, I have not yet had to make much use of the health service in France personally, but I have had some dealings with it. The first occasion was with an emergency, involving my neighbour Mme Laforet, who was then in her late seventies. I knocked on her door one morning to see if she needed anything from the village, and found her standing over her sink, looking pale, and with a tea towel wrapped around her left hand. She said she didn't want anything, but I noticed blood dripping from the towel. I asked her what had happened and she said that she had been cutting weeds with a sickle and had cut her hand. I insisted on looking at the injury, which turned out to be a dreadful slice virtually cutting off her thumb, and bleeding very badly.
I found a new towel and wrapped it tightly around her hand, and said she must go to the hospital at once. She wasn't keen, but eventually I persuaded her to phone the clinic in the nearby town, the nearest place where she could get suitable treatment immediately. This being France, and the time a little after noon, the clinic was about to close for lunch, but a doctor said he would wait till we got there.
The doctor spent a couple of hours cleaning the wound, stitching it up, and fastening a complex metal brace to keep the join firmly closed. He wanted her to stay overnight for observation, but she refused, because she had to see to her chickens, and the ducks. He made arrangements for a district nurse equivalent to visit daily to check her out, and we left.
A couple of hours later, I wandered down to see how she was getting on, and found her in the garden, with her sickle in her hand, and a plastic bag covering the bandages and metalwork on her injured hand. She said she was bored just sitting still, and the plastic bag meant there was no risk. I think an hour or so later the local anaesthetic wore off, because she went back indoors and just sat there for a few hours. The happy ending is that she made a complete recovery, although her thumb remained bent in a peculiar way.
My other experience had a more sad outcome. A good friend we had made in France, Jean, had some stomach problems that required an operation. We visited him in one hospital, then another, larger one after another operation, and then a third. Ultimately, he was diagnosed with stomach cancer, from which he died.
Seeing him in the different hospitals did show that the standards of care and cleanliness were the same high quality in all three. The food, as one might expect, was pretty good, as always, three courses, with choices, ordered earlier in the day. It was always hot, properly prepared and edible. Unlike my local – teaching - hospital here in London, where half the time there is only cold food or sandwiches, where patients get the choices made three days earlier by the previous occupant of the bed, and where there have been instances of malnutrition in patients who have been unable or unwilling to eat the food, and where even if they have the nutritional content has been dreadful.
Whilst it might seem unfair to compare provision in smaller institutions in the less populated areas with a major institution in a huge city, I believe the French hospitals were infinitely better in terms of hotel facilities – all wards for example are rooms for one or occasionally two patients, with their own showers and toilets. To get to see a specialist seemed to be quick and easy, with no waiting list issues. Obviously, I have no way of evaluating the in patient hospital diagnosis, treatment and so on, but it was always easy to get a second opinion, and the issues were discussed with the patients and their families. I do not believe there is any satisfactory reason why this cannot be done in the UK. When the NHS is spending 12 billion pounds on a misguided IT project that is unlikely ever to be delivered completely, will still cost more than the latest budget, and will never deliver anything like the benefits needed to justify it, I do admit a small amount of despair.
A final example is a friend in London who developed the Dupuytens's Contracture and had waited for over 18 months to see a specialist, who then put him on a waiting list for treatment, which when it happened involved an operation to cut and slice his hands. And it made no difference. By chance, he heard of a specialist in Paris, who had trained under Dupuyten. He rang him, and was offered an appointment in a week.
At this consultation, the doctor explained that the operation was a mistake, and that effective treatment involved a local anaesthetic, and diminishing the calcium build up causing the problem by manipulating a needle in the finger joints. My friend has now had three or four treatments, at a cost of 60 euros per session which he intends to claim back from the NHS, and all bar the his little finger, which has been bent the most severely for the longest time, are virtually normal.
Having regularly been to my local hospital, as an out patient, over the last three years, I can say that in London I feel that this hospital feels full of illness and inefficiency, whereas in France the hospitals are less frightening, more welcoming, and seem to be more efficient. Of course, all this is merely anecdotal rather than evidential, but I have yet to encounter any problems.
If you go to France – or anywhere else in the European Union - make sure you have an EHIC card to get free or reduced cost healthcare. You can apply here if you haven't already got one.
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