Last week, four of my nearest and dearest ended up in emergency rooms across the United States (was it the full moon, perhaps?). My father-in-law waited six hours to see a medic, even though his cut hand required five stitches. My grandmother-in-law, who is 92, waited five hours to see a doctor for acute bronchitis. My sister-in-law waited 11 hours, and spent most of them vomiting. My mother was the only one to be admitted within an hour of walking through her hospital's sliding doors, probably because she lives in an low-population area and had arrived in the wee hours of the morning on an off night.
In the United States, waiting six hours in an emergency room to receive medical care or five days to get an appointment with a general practitioner is so common that Americans have begun to think "it's just the way things are." This bothers me because, having lived in France for nearly five years, I know that it is not the way things are in France and in many other parts of the world, and it is not the way things have to be in the U.S.
In parts One, Two, Three, and Four of À AIMER: Getting Sick, I focused on how much government-run health care costs the French, and what they get in exchange for their income and social security taxes. Today, for Part Five, I'd like to discuss what happens in France when you get sick because I know that, for an American, the experience can be mind-bending. I'll detail a few of my own experiences, which have not yet (knock on wood) included hospital care, although I would like to note that friends who have wound up in France's hospitals were treated very quickly, and the cost of transport by ambulance is very low.
The first time I got sick in France, I had been in the country two months and had not yet purchased French insurance. I was insured in the U.S. by a company that covered so little that I was pretty much not covered at all. When I woke up that morning with a fever, a sore throat, and so much congestion that my face hurt, I knew: I needed antibiotics. I had never consulted a French doctor and I was worried — less about my rocky Français than about the timing: 11 a.m. on a Saturday. What doctor's office would be open on Saturday? In California, it was a challenge to find a general doctor who worked weekends, so I figured that, in Paris, it would be next to impossible. This was, after all, the country with a 35-hour workweek.
Prepared for the worst, I picked up the phone directory for my arrondissement (neighborhood) and scanned it to see if there were any doctors listed. To my surprise, there were a couple of pages of them: pediatricians, gynecologists, chiropractors, and a whole lot of generalists. There were two general practitioners, in fact, within six blocks of my apartment. I dialed the one closest. A woman answered the phone and I stammered that I needed an appointment for a sore throat. She asked when I wanted to come in and I told her, "As soon as possible," thinking, My throat is killing me. I hope I can get in on Monday. She sighed and said that she was sorry, but she didn't have an appointment available right away.
"Could you come in at twelve-fifteen?" she asked.
"Twelve-fifteen on what day?' I replied.
"Twelve-fifteen today," she said, sounding incredulous that I had asked.
An hour and fifteen minutes later I knocked timidly on the door of le cabinet de médecine générale. A tiny, older woman in street clothes let me in and shook my hand before instructing me to sit in the waiting room. The receptionist, I figured, as I watched her disappear into a back room. A few minutes later she reappeared with a man who had a hacking cough and two scarves wrapped around his skinny neck. She told him good day, they shook hands, and he left.
Then she turned to me. "Madame?"
I followed her into what appeared to be a small business office, with a large desk piled with paperwork and two chairs for visitors set in front of it. I stood there, looking for around for a doctor or a nurse, and finally blurted, "I have an appointment to see Doctor X ..."
She cut me off. "I am Doctor X. Please sit down."
I tried to hide my bewilderment as Doctor X took my name, address, phone number, and detailed medical history, typing everything diligently into her Power Mac G4. I answered her questions, but my mind was elsewhere. Where was the nurse? I wondered. Why didn't she have a receptionist? Was this really a doctor's office or was this woman just posing as a doctor in order to take my money?
"Okay," she said, after asking me about my symptoms. "Go into the room next door and get undressed. You can leave your underwear on."
I walked, zombie-like, into the room next door, which was really an extension of her office with a half-wall separating the two. Inside, there was the usual examining table and sundry medical supplies. Relieved, I took my clothes off and sat down. The doctor then joined me and conducted a thorough examination: she weighed me, took my blood pressure, looked in my ears and nose and at my throat, listened to my heart beat and lungs.
"You have a sinus infection," she pronounced. "You'll need antibiotics."
Her pronunciation of that word, "antibiotiques," set off a bell: she was, I realized, the same woman who had answered the phone.
I was so tickled that there was a doctor on Earth who took her own appointments that I hardly heard her tell me to get dressed and rejoin her at her desk. But once I did rejoin her, she asked me about insurance.
I gulped. "I don't have insurance," I told her guiltily.
"Non?" she said, sounding surprised rather than disgusted.
"Well, I have American insurance, but it won't cover me in France."
"Non?" She stared at me sympathetically. "I'm sorry, but I must then ask for payment up front."
"That's okay," I said, but I was really thinking, What's it going to be? One-hundred euros? One-fifty?
"The bill is twenty euros."
A slow, Cheshire Cat grin began to spread across my face. I tried to hide it, especially because I could see that the doctor was confused by my reaction, but I just couldn't help myself.
She handed me a couple of insurance forms that she had filled out, one for the appointment and one for prescriptions.
"Send these to your insurance company," she said. "They may accept them."
"I don't think so," I told her. "It's an American company."
"Are you sure?" she asked, looking terribly concerned. "You should at least try."
I took them, just to make her feel better, but I didn't care about the insurance. Twenty bucks for a medical appointment! I felt like I had been given a gift.
My elation lasted until I reached door of my neighborhood pharmacie. This is where I'll get screwed, I told myself. Weren't pharmaceuticals more expensive in Europe? I thought I had heard that somewhere.
Ten minutes later, I had my answer. Not only had the doctor prescribed antibiotics, she had also prescribed aspirin, a decongestant, and Sterimar, a sort of chic-looking nasal irrigator. It was to be a four-way attack on my sinusite. The total bill, without insurance? Less than €20.
Since that fine day, I have seen several other general practitioners, as well as a few specialists. The procedure is always the same. I call, and I get an appointment that day for GPs and within a week for specialists. The offices are small and personal. Sometimes there is a receptionist, sometimes not. There is never a nurse or a nurse's assistant or anyone with only a high school degree and a 12-week, mostly online medical course behind them. (In France, registered nurses must have three years of schooling in addition to high school, and they work mostly in hospitals.) When you go to the doctor's in France, you see . . . a doctor. He or she interviews you, examines you, and manages the billing. Visits take at least a half-hour, and you are always treated personably and respectfully. I have not once encountered a haughty physician in Paris, the city with a worldwide reputation for haughtiness.
Why is it so different in France? Why are doctors so much more accessible, affordable, accommodating, and sans condescendance?
Myriad reasons, but let me leave you with an interesting comparison:
In the United States, 77,859 general practitioners serve a population of nearly 308 million; they earn, on average, $160,000 per year.
In France, 88,669 general practitioners serve a population of 64 million; they earn, on average, €66,800 per year.
Ideas, anyone?
Sources: U.S. Department of Labor, Institut National de la Statistique et des Études Économiques.