I thought it might be interesting to give a account of a patient’s experience of the health service in France.
Peter is a good friend and like many British people he has chosen to retire in France after having fascinating jobs throughout the World decide that they just want a peaceful, calm place to spend the rest of their life. Nevertheless, having been busy all their lives they can’t resist getting involved in organising concerts, ambitious needlework/patchwork projects,making jams and preserves,organising barbecues, painting, sculpture, and house renovation not forgetting writing, fishing, keeping chickens and horses, exploring the surrounding countryside on foot or bicycle and landscaping the land they own.
When friends in the UK say “but what do you find to do all day ?” It is difficult to know where to start. Peter had lived in London and had done various projects in the UK but was finding the incessant aeroplane traffic noise, worked in the City but retired and living under the major flight path was becoming increasingly tedious. He was no longer enjoying the buzz of London and decided to retire to France to build a house. He was initially unsure whether he would ever see the results of his dreams as his blood pressure and cholesterol had been very high despite medication and he knew he was at a high risk of having a cardiovascular event, either a heart attack or stroke. He was overweight and his diet was poor, the only saving grace was that he had given up smoking many years ago.
After 6 months of living outside a quiet village in the Dronne valley in the Dordogne, known as the land of Primitive Man, the house that had been a dream was beginning to materialise but even better news was that his blood pressure was now within normal limits to the point that he stopped all medication, his cholesterol had fallen from 11mmol/l to < 4mmol/l and he only needed to be on very low dose statin. He had lost weight and was enjoying feeling fit enough to do labouring in the way of moving tons of gravel, felling trees and digging foundations for extensions, running water to fountains etc, etc.
When the men ranging in age from early 60’s to late 80’s get together they spend their time discussing tractors, chainsaws, trailers, where the best builders merchant is and the appropriate French word for useful tools or how nails and screws are sized in France. All this is important as they embark and support each other on another project. Interestingly one of the men described how he had had lunch with apache men on a girder in New York – amazing …….
However, on this occasion the subject turned to medical issues and Peter brought up the fact that he had acquired a hernia whilst lopping some branches off a tree which was obscuring a good view down the river when he was sitting on his newly constructed jetty. It wasn’t long before the men in turn laid claim to the fact that they all had a hernia of some sort of other and proceeded to share how and where they had had it repaired recalling their symptoms concerns and described their experiences in graphic terms. That is the trouble if you are a doctor people don’t hold back in giving their detailed descriptions of their medical conditions as they somehow feel you need to have the full description.
Bernard who had bilateral hernias but was in his late 80’s had been treated for leukaemia and various cancers in the past and is always entertaining as he graphically describes his near death experiences in various corners of the world ranging from being before a firing squad, a noose around his neck or being dumped in the back of beyond and having to find a way out all graphically recalled. He was embarking on building a Chinese bridge over a small lake he had created, was fighting for supremacy with his large Sussex cockerel who had dared to attempt to assault his hen (his wife)and was still playing a round of golf twice most weeks thought he would avoid surgery and had persuaded his French GP to prescribe him a truss! I haven’t prescribed one of those for years since I looked after ex-miners who had such bad chest conditions that they were unable to be even considered for surgery.
Roger,who had had open heart surgery previously had been enthusiastically trying to make a perfect lawn of his one and a half acre garden and had acquired his hernia, was wary of French medicine was opting to return to the UK to attend the London Hernia Clinic. The others present had had theirs repaired in various hospitals throughout the World and were recalling their experiences.
What is a hernia?
A hernia (or ‘rupture’) occurs where there is a weakness in the wall of the tummy (abdomen). As a result, some of the contents within the abdomen can then push through (bulge) under the skin. Normally, the front of the abdomen has several layers comprising skin, then fat, then muscles, which all keep the guts (intestines) and internal tissues in place. If, for any reason, there is a weak point in the muscles, then part of the intestines can push through. You can then feel a soft lump or swelling under the skin.
What are the types of hernia?
Different types of hernia can occur. The most common types are listed here:
The British Hernia Centre
87 Watford Way Hendon Central London NW4 4RS Tel:…
This is the most common type of hernia. Males are more likely to have inguinal hernias, as they have a small tunnel in the tissues of their groins which occurred when they were developing as a baby. This tunnel allowed the testicles (testes) to come down from the tummy (abdomen) into the scrotum. Tissue from the intestines can also pass into this tunnel, forming an inguinal hernia.
There are two main types: indirect hernias, which are usually congenital and common in boys, and direct hernias, which are more common in adult men. They can occur in both sides of the body.
With the wealth of advise Peter had been given he decided to phone his French GP next morning.” Could you come down this afternoon about 3pm”, the receptionist said. “That’s fine,” said Peter but then muttered that he would probably have to wait about 40minutes as he spends so much time with each patient.
Having then decided to have the hernia attended to in France and Peter proceeded with the necessary arrangements.
Infact, the GP is a Greek doctor married to an English doctor who had been working in Coventry and they had come to France in 2005 as they had been disillusioned with General Practise in the UK. They had asked me to join them but for many reasons including my attachment to the patients at the Avenue although tempted I had declined to take up the offer.
Peter duly went for his appointment and indeed was seen late. I made no comment. Following the consultation the receptionist had made an appointment to see the surgeon the following week and gave him a letter to take with him. He was then asked to pay 23€ for the consultation at the same time the receptionist put the Carte Vitale in the machine. His contribution was 1€ whilst the rest was reimbursed.
What is a Carte Vitale?
The Carte Vitale is the health insurance card of the national health care system in France. It was introduced in 1998 to allow a direct settlement with the medical arm of the social insurance system.
The card itself is not a means of payment, but a means of easier reimbursement. You should normally expect to receive reimbursement directly into your bank account within a week and the amount reimbursed depends on personal factors but everyone pays a small amount. All residents in France are legally required to have a health insurance as a top up to your public health entitlement, whether through public and/or private coverage. The public health entitlement (and other social security benefits) depends on a number of factors, including nationality, residency status, work status and contribution to the system.
Everyone aged 16+ years of age is required to have one. Children under 16 years are included on the card of their parent or guardian.
Where there are excess medical charges (called dépassements) over the official tariffs you may be able to get reimbursement from your voluntary insurer. If not, the costs fall to you.
Vitale card is a microprocessor-based or so-called “smart” about the size of a credit card. The updated version launched last year is more refined with photo and signature included. It does not contain any medical information but all the administrative elements needed to support your care:
your identity and your rights-holders under 16 years of age;
your registration number;
the health insurance plan you are affiliated;
the health insurance fund to which you are attached;
your rights to any universal health coverage complementary (CMUC);
your rights to any exemption from co-payments if you get under a long-term illness (ALD), maternity, accidents at work, etc..
The Carte Vitale is strictly confidential. Except for the owner, it cannot be read by the Health Insurance Fund or the health professional seen, unless they are equipped with a business card which allows reading the card. It includes specific rights such as exemption from from certain payments.
You do not have to submit your Carte Vitale during a medical examination conducted as part of a loan application eg mortgage.
You can access the information contained on your Carte Vitale using ATMs installed in the reception points (excluding information on your rights to exemption). These ATMs also allow you to edit the certificates (eg certificate or certificate of daily duties allowances), and update your Carte Vitale.
I volunteered to take Peter to the hospital appointment partly to translate some medical terms but also because I was curious to experience how it all worked. We set off on the 21km trek by car as there is no public transport except taxi. It was reasonably easy to park with no charge. When we arrived we were directed to the outpatients.
It is a public Hospital known as The Centre Hospitalier de Périgueux, public health facility was opened on its present site in 1953. It has 580 beds and has an A&E, a 38bed Maternity unit and 115bed Psychiatric unit. It serves a population of 410,000 and stipulates the following user rights
The user is at the heart of the concerns of the public hospital. It must accommodate all patients without discrimination of any kind. The user rights are specified in the “Charter of the hospitalized person” (circular dated 2 March 2006), which must be brought to the attention of each person hospitalized. This charter is available in seven languages (English, German, Spanish, Italian, Chinese, Portuguese and Arabic).
- The right to access and quality of care
- The right to be informed and to participate in decisions
- Access to health information (medical record)
- The legal protection of privacy
- The management of pain in hospital
More details on the website
It has an extremely low incidence of hospital infection and it is a statutory right of the patient to have pain controlled adequately to the extent that a patient post operatively or undergoing a procedure will be asked at frequent intervals to grade their pain from 1-10.
When we entered the hospital we were struck by the quietness of the hospital and the stark cleanliness of the corridors and the rooms bearing in mind it had been built since 1953 and various additions in the past decade. All staff were uniformed including the admin staff who wore white pyjamas, also nurses wore white pyjamas with coloured bands to indicate their status and the doctors wore white coats. They were softly spoken but professional and helpful. We waited in a waiting area and everybody respected the quietness. The doctor wearing a white coat passed by with a patient acknowledging our presence and apologised for keeping us a few minutes waiting. He then showed us into a stark room with only a desk, several chairs and a telephone. He read the letter and then asked to see Peter in another room for examination. They both reappeared and he agreed it was a hernia and needed surgery. He then took out his diary and asked when would be a convenient date, Peter got out his diary and between themselves they arranged a mutually convenient date. He then explained clearly exactly what he was going to do in a mixture of French and English, showing Peter the type of gauze had he would use and suggested that as he was taking a blood thinning drug that he should stay in overnight and he would also see the anaesthetist. He then dictated a letter to his GP and the anaesthetist. He also answered Peter’s questions patiently. He then sked Peter to write a cheque for 42€ slipped it under the phone with the other cheques and at the same time handed a form to reclaim this charge from Peters health insurance.
A week later we returned to see the anaesthetist. Firstly we had to take a number in the main reception area and when called go to the allocated admin staff (a bit like the system at Perceval House, Ealing ) who then took the Carte Vitale which demonstrates you a resident in France and entitlement for a percentage of medical costs by the state , the remainder of the cost is met by the insurance company and these documents have to be verified before the patient can make arrangements for hospital admission. also it was necessary to produce a photo ID ( passport or ID card)
Following this the proceeded to the area where the anaesthetist was consulting. The receptionist looked oddly at me to come forward calling me Peter. However, it turned out that most of the patients were antenatal and her expression was indicating that not only had I had an unusual female name but perhaps I looked a little old to be pregnant.
The patient established we saw the anaesthetist who quizzed Peter about his past medical history and current medication,examined him and the asked him to go into the next room to have blood taken and an ECG tracing by the nurse.
The nurse then issued Peter with 2 bottles of Betadine to be applied over the whole body including the hair on the evening prior to surgery and the morning of the surgery, no food or drinks from the night before and to arrive at the hospital at 7am.
We were then told to return to reception to make the appointment to see the anaesthetist and receive paperwork and instructions of what to do prior to admission. The receptionist then arranged the overnight stay and if he wanted a single room that would be 4o€ extra to be paid after the stay.
On the day of the surgery we set off at 6.15am by car in pitch black down country lanes and only the occasional lorry or car to the hospital. As we entered the town the only activity was bakeries selling bread and the bar tabac selling coffee and newspaper and cigarettes. When we arrived at the hospital we trailed down endless corridors into the silent stillness of the hospital to be welcomed by 2 nurses ( one of which turned out to be from the next village)who showed Peter to his room. He was asked to robe in a gown and the a careful inventory was taken of his belongings including watch, mobile phone including the make (although of antique value only) whether there was a charger,rings, money- notes and coins and items of clothing. He was then asked to show ID ( passport, DVLA or ID card ) He was then challenged as to whether he had washed with Betadine evening and morning ( after admitting he had used deodorant under his arms he was sent to the bathroom to apply Betadine under the arms). He was quizzed as to when he had last eaten, whether he wore glasses and how many pairs he had with him, did he have false teeth, similarly if he had a hearing aid and as he some dropping of the mouth from an old nerve problem whether he could manage normal food. Also asked if he wanted to use the TV and then was shown how the mechanism of the bed operated. This was all documented .
I was asked to leave to learn the room, whilst the nurse attended to him. He reported that they had asked him if he had urinated that morning and then proceeded to shave him from the level of the umbilicus to the the mid thighs and everywhere in between! He was then given a tablet to relax him as he began to doze and adorned with mop cap a porter soon appeared to take Peter to theatre and I made a hasty retreat.
He told me subsequently that when he arrived in the theatre where he was then asked to transfer to the operating couch and wheeled into theatre and didn’t remember anything until he woke in his bed feeling parched. Eventually the surgeon did his round at about 6pm checked his wound and gave him permission to have a light supper – three course as the usual in France and all in sealed containers.
The view from the window was merely other hospital buildings but he was entertained by the starlings gathering on the communication wires constantly jostling for position until an unbeknown signal gave rise to a sudden departure in a large black cloud.(mobile phones are useful to capture these moments!)
He was able to phone me to say all was well so far and he was in no pain (there is a hospital policy,as stated in their brochure to aim to keep patients pain-free). He had a poor night but he found the nurses attentive and reassuring. The next morning breakfast arrived a few biscuits with butter and jam and a bowl of an apology for tea!! He was then told he could wash in the ensuite bathroom and dress but again with an offer of help. Throughout this experience he felt nothing was too much trouble for the nurses and they were thoughtful and reassuring. He was someone who had experienced previous hospital admissions and had been fearful on this occasion, which is normal as people get older and are aware that there can be complications, which friends are only too glad to share!
He rested during the morning and after the three course lunch soup, celeriac and paupiette de veau followed by a yogurt all in sealed packaging. The surgeon arrived to discharge him after further inspection and advise regarding driving and completing the hand written records and a prescription and instructions for the nurse to remove the clips after 10 days.
I arrived to collect him and the nurse passed over the papers and he was told to collect the prescription for dressings and painkillers from the pharmacy and then phone the nurse to visit him at home to attend the wound. Then we went to the hospital administration to make the final settlement including paying for the overnight stay in a single room which would have been 37€ but as all the rooms for It is of note that nurses have a practise run from their own surgery premises and can ask patients to attend but usually they visit the home post operatively.
On arriving home he rang the nurse’s home to arrange the visit. He had previously seen nurse Leblanc for home nursing and asked to speak to her and she replied it was her speaking but strangely did not know his house and sounded different… All was revealed when it turned out Nurse Leblanc who he spoke to was the daughter-in-law and Nurse Leblanc had divorced and remarried. The male nurse had been dismissed as he had made fraudulent claims all because he wanted a fast car and a bigger house! Sounded like something out of a soap opera…..
The nurse called at the house every other morning with both nurses alternating. They left their instruments in a well used tin case at the house and sterilised them by wiping with Betadine and did not use gloves. Nevertheless, the wound healed beautifully and each visit the nurse advised gentle mobilisation. Unbeknown to them he had driven the tractor around the garden!
At the end of each dressing each nurse recorded the visit by putting the Carte Vitale into a card reader and a cheque was made out for 30€ most of which is reimbursed.
The wound healed very well and after 6 weeks he was seen by the surgeon for review. He was satisfied that the operation was satisfactory and he was discharged.
Overall, this was an extremely satisfactory experience and an insight into French medical care.
More insights into how the Hospital is organised can be found on the link below