A year ago today I decided that I could no longer explain the pain and swelling in first one knee and then the other as mere old age, wear and tear or the perennial problem with dislocating knee caps. Especially as it had then spread to my ankles and shoulders! So it was off to the doctor. Well, off to find a doctor.
When we moved to France in our early forties I'd always thought that a first foray into the health system would probably be the result of an accident of some sort: falling while skiing or biking or, worse case scenario a crash on the motorcycle. Failing that, it would be five years in and a smear test for me. Ghastly in any language.
So, this post is about the system, how it worked for us, and not the reasons for the visits.
We had done the right thing on our arrival, had all the paperwork in place and had acquired our Carte Vitales which would cover us for seventy percent of our medical costs. We opted not to take out a top up insurance (mutuelle), a gamble, of course. And we had insurance to cover us for skiing and mountain rescue. Well, the second year, anyway.
Finding and choosing a doctor was easy. A perusal of the yellow pages and the internet indicated that there were two Medecin Generalistes, (GPs) in the nearby village, both of which seemed to be resolutely shut when we turned up. Maybe it was because the place is principally a spa resort and December is firmly out of season. Whatever the cause, we turned around, and headed into our nearest small market town, six and a half kilometres away. Here, there was a Cabinet Medicale with three GPs, although when we arrived there was a clean patch on the wall outside where one brass plaque had been removed. Not to worry, they were open, there was a receptionist, she understood my French, but was so sorry, they couldn't possibly fit me until the afternoon!
I felt sick all day waiting for that appointment. What was wrong with me was the least of my worries - would the doctor understand me and me him, how did the system work and would I be able to ski soon were the kind of things that went around and around in my head.
The doctor was young, enthusiastic, running very late, spoke at light speed but was incredibly thoughtful, kind and patient. I gave him my paperwork and after a thorough examination he sent me away with a pile of paperwork of my own. I needed to get blood tests, x-rays and pain relief. Best of all he spent five minutes explaining how the system worked and emphasising that he thought I had a form of arthritis so the early stages of investigation might be expensive. In other words get some insurance!
Armed with the various ordonnance we found a blood lab and had the tests done, collected the results when they were ready - a whole week because of the range being done - and took them back to the doctor. A positive Lyme Disease test resulted in a course of antibiotic injections, so once again I left with another couple of ordonnance, collected a carrier bag full of drugs from the pharmacy and located a Cabinet d'Infimière (nurses' practice) and made an appointment to visit them twice a day for a fortnight, taking my dose of antibiotics with me each time so they could give me the injection.
When it was clear that all was not going well I went back to the GP and he decided a referral to a consultant was required, so he simply picked up the phone, rang the consultant's office and made the appointment for ten days time. I have a former colleague in Britain who is in a similar situation, although she has already been waiting two months to find out when her appointment might be. I've almost always had great care from the NHS, and always from the medical staff, but the waiting was often intolerable. Interestingly, I was tested for rheumatoid arthritis back in 2000 a long time before moving to France. After the test I was asked to call the surgery for the results. After several attempts to get through I was told by the receptionist that she was far too busy to deal with things like test results. Professional, compassionate? No.
The consultant too has been incredibly kind, thoughtful, and patient. At the second appointment she decided she wanted to discuss my case with colleagues in Toulouse and possibly send me there for further testing, so it was left that she would call with an update. Having heard nothing for a while (ten days, so you can see how easily we'd slipped into the idea of things happening quickly in the French medical system) a quick call to the consultant's office confirmed that she was on holiday this week. No problem. At the end of the afternoon the consultant rang and called us into her office first thing the following morning. Now that is service.
Payment seems to work in many random ways. Everywhere I visit they take my Carte Vital and place it in a chip reader, well when the systems is working! At both the GP and the consultant I pay the full amount up front and then 70% is automatically refunded (minus a nominal fee) direct into the bank account. At the pharmacy, blood and x-ray labs (also all private businesses) the Carte Vital accounts directly for the first 70% without the need for payment and refund, so we just had to pay the outstanding 30%. I now have a mutuelle which we took out very quickly (they asked no medical questions) and this is used to pay for the final 30% without the need to claim it back, as we still do at the GP and consultant. I have no idea why there are two systems, although it may be set to change next year.
The final stage of bureaucracy has come following confirmation of a diagnosis of RA: the consultant gave me a letter for the GP confirming the diagnosis, the GP then filled out a form for the state insurers who have just confirmed my status as having an Affection de Longue Durée which gives me 100% free medical cover for that condition for the next five years. This took less than a month to be processed, but it means the mutuelle is now only of any use if something else goes wrong!
One last thing that has impressed me was getting a letter from the blood lab this week asking me to supply some paperwork as they hadn't been paid since June by anybody, yet were still happy to keep doing the regular blood tests.
Of course I wouldn't recommend being ill, but my advice to anyone from Britain used to the umbrella of the NHS is not to fear the French system. So far, it has worked well, and very speedily.
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