Hospitals

[Gardian]

OH went to our local hospital yesterday morning for some routine tests and after the 2nd had been done, promptly got admitted. We think that it's precautionary, although they seem to be 'clutching at straws' a bit over the cause. Without going in to the details, it's certainly not life-threatening and the worst that she's feeling is extremely grumpy about being cooped up, so that's a good sign.

Anyway, it's got me thinking about comparisons between the UK and France over hospitalisation. Happily, not much recent experience of the UK, so I'll confine myself to current French observations. By the way, this is a small-ish town (20k inhabitants, but a catchment area that would double that) and the hospital probably has no more than 80 beds: the rest of the hospital deals with A & E, x-rays / MRI, some minor general surgery, etc.

• Modern building, in a good state of repair
• Instant admission: as in 5 mins
• All chambres are 1,2 or 3 bedded, en suite.  TV & personal phone facilities
• Subsequent administrative process to formalise admission a bit protracted (CV + mutuelle)
• Without poking my nose in to every chambre, my impression is no more than 70% occupancy 
• A perpetual cleaning regime and it shows (or rather, the dirt doesn't)
• Food grim: I had visions of, perhaps, a nice piece of (whatever) meat, with maybe a few frites. "In your dreams", I was told by OH!!  It is manky though, even if 4 courses (incl a sort-of 'Primula' type cheese pack and stale bread)
• Absolutely charming nursing staff and seemingly a high patient : nurse ratio. I reckon that it's no higher than 4:1 on OH's ward, with an additional 2 or 3 cleaning / support staff.
• No car park charges (and adequate parking)
• Absolutely hopeless Physician, in terms of his 'bedside manner' - nothing to do with the possible language barrier. He's just one of those who can't communicate.

That's all I can think of for now.  Would interested to hear of the impressions / experiences of others. 

[Will]

Not had the pleasure of a French hospital stay myself, though Mrs Will has had two minor ops (only one needing an overnight stay). What Gardian says seems to be pretty much the norm, rather higher occupancy in our experience. We have encountered one dreadful surgeon at the first clinic who made a right hash of the op (and apparently, as we subsequently found, is well known for it); the second was fine. The better hospital was out of our département and all seemed OK - apart from the food.

We have been told to avoid our two nearest hospitals if possible due to MRSA - so the NHS certainly does not have the monopoly on infections.

[Patf]

Two years ago I spent some time in a small hospital in Auch, and a huge rambling place in Toulouse. The first was cosy and well equipped. The latter was shabby and seemed underfunded, though the staff were kind. So they vary.

The specialist treatment I had in Toulouse was arranged quickly and efficiently. I know of people who have had to wait months for this treatment in the UK.

I would think one of the best things about french hospitals is the absence of wards - they seem to be mostly if not all single or double rooms.

One of the ladies I shared a room with had one of these mysterious hospital-transmitted infections, so they are in France too. As Will notes in his post above.

[suej]

My husband had a short stay in hospital near here and all aspects of care and cleanliness seemed superb and the nursing staff seemed to have time to spend with the patients. We were very impressed with their own in-house French-English booklet, A4 size with diagrams labelled in both languages and well thought out examples of questions a patient may need to ask  or to understand.

I have also visited friends in hospital both post-operation and otherwise and have nothing but praise for what I have seen in terms of care, cleanliness and calm. When I've remarked on all of this my friends (French) have tended to give me the smiling 'c'est normal' shrug as if they can't imagine otherwise- lucky old them....

I am going in to have my thyroid removed in three weeks time and again have been most impressed with the way in which the whole palaver of appointments with specialists, tests and scans etc has gone so smoothly and I have been treated so kindly.I had a consultation of nearly an hour with the surgeon last week who took the time to do an extra examination with a tiny camera thing, then spent a long time explaining the operation itself very carefully and reassuringly and answered patiently every question I asked. Ofcourse I do have a touch of the collywobbles about it but I suppose that is perhaps natural; having said that, I really do feel well- cared for and well-prepared by everybody, right  from the our Medicin Traitant and his super-efficient secretary to the surgeon and staff I' ve met so far.

I just want to say to anyone who, like me,  finds that they have to face a hospital stay ,that the care really does seem very very good.........just hope they do remember to stitch my head back on!

Sue

[odile]

sadly, French doctors, like French teachers, are not taught to be good doctors - the only qualities valued by the system is theory, theory, more theory - bedside manners and psychology are irrelevant. In fact most French medical students never meet a patient during their training, and promotion is only related to 'concours' and more theoretical exams (same in teaching). Not good for patient/doctor relationships, I'm afraid.

[Russethouse]

Odile - What a cheery comment for the OP and Coops husband, both with loved ones in hospital - [Www][Www]

[suej]

       

 

Can't comment on the training methods here in France, Odile but your remark about patient/doctor relations is not what we have personally experienced. Our medicin traitant is superb, totally professional and focussed but at the same time friendly and well disposed to lighten the day with a gentle tease or some pleasantry.Cardiologues, endrocrinologues, gastroenterologues and other  'ologues' or whathaveyous we have come across could not be faulted...I did once visit a grumpy dentist I was sorely tempted to bite and I once saw a lady 'remplaçante' who was a bit flouncy, she'd have been the same whatever she was doing, she was a born flouncer ( and probably been a tiresome little foot-stamper when she was a child)  

As for teachers, they don't seem very different from teachers that I remember from UK,  i.e the younger , still working ones are stressed, overworked and doing their best in the classroom and the older retirees like me are having the whale of a time enjoying the things we were too tired to do when working in education.

Just my own perspective.....and I'm not usually renowned for rose-coloured spectacle wearing.

[Quillan]

Having a long term illness moving out of the UK was a priority for me especially after the treatment (or in some cases lack of treatment) I received. This has clearly been the right decision for me personally. I don't know if it is luck or what but I can only say that the level of service in my department is excellent and so is the speed of delivery. I am, if one believes what one reads, in the minority amongst the expats in that I pay cotisations which are rather high compared to NI contributions but then I don't mind if I get the service. We get blood results within 5 hours, see our doctor in no more than 8 working hours (usually the same day), an ENT specialist within 24 hours, cardiologist within 4 days (that's non emergency, just for annual checkup), MRI scan and X rays on a walk in basis and leave with the results but the longest is to get an eye test, we have to wait up to 8 weeks but then that's normal I am told.

One thing I am amazed at is the lack of support staff. The X ray department at the local hospital has one receptionist/typist/general dogs body so does the MRI scanner at Carcassonne, so does my doctors surgery (7 doctors), and the dentist. Even the big hospital at Carcassonne has only two receptionists but it does have 6 bursar's to collect the money (obviously got their priorities right).

When I remember my doctors surgery back home I think of little comments made by the staff when you rang up (and when you finally got through after 2 hours of trying) for an appointment like 'are you phoning because you are ill?' followed by 'how does next week sound?' and there were more staff than doctors although at times I swear they only had one incoming phone line.

I tried to discover, with little success, where France came in the MRSA 'league table' after Wills comment but have discovered that it's not so easy as it looks. The latest stats were in 2005 based on 2003/2004. There is more than one strain and the UK has a very particular strain. France has (apparently) a 99% cure for it's version due to some 'muck' (their word not mine) from a volcano in the Masif Central. Greece has the highest rate with England coming in second then a big gap in numbers before you get to Europe. The safest place is either Iceland or Holland. All I can say is that the hospitals and doctors surgeries that we have used in France seem to be very clean and I am sure this helps.

In truth I think it's a bit unfair to pass comment on a countries health care system until you have experience in another country. I have experienced health care in both the UK and France at both first and second hand and as I say to my French friends don't knock the French system to much because compared to the UK its fantastic.Try telling a French person that in the UK you may have to wait a week for a doctors appointment or 13 weeks for an angiogram and that the wards have 6, 8 or even 10 people in each and that they may even be mixed. Watch  the expression on their faces, the look of disbelief.

[odile]

I'm so sorry - doctors in France are very well trained in medicine, and hopefully that is the main concern- but they are not taught bedside manners and much about the psychology of the Dr/patient relationship - whereas in the UK they are (they are scored on this)The selection process for UK applications to medical schools do not just select the canditates with the best grades, but the candidates who show empathy, understanding, and are 'well rounded' - the French system picks the most academic. And that is continued throughout medical training. Medical students in the UK do see patients regularly. Of course there are plenty of French doctors who have excellent bedside manners, etc- but it is not an integral part of their selection or training. Their ability to diagnose and treat is not in question here. Bonne chance et bon courage.

[quote user="Russethouse"]Odile - What a cheery comment for the OP and Coops husband, both with loved ones in hospital - [Www][Www][/quote]

[5-element]

I have to concur with that Odile says. Some medics here have an atrocious bedside manner, especially when they get to consultant level where they can be the king and have the nurses and all other staff running around them. I know this can happen in the UK too (and it does), but here you really get both ends of the spectrum; there are doctors/medics who are natural carers,  don't need to be taught how to relate to human beings (my present GP, and 2 top specialists, are in that category). They will listen, they will hear too. Then you get the others. Those others, sadly, need to be taught very basic counselling skills - and here, it is just not taught. One consultant I know has a habit of shouting at patients when something goes wrong,  when it is often he who is at  fault for poorly communicating. This "blame the patient" mode is something I have never encountered in the UK, maybe I was lucky. It can be unbelievably distressing for someone who is already diminished and literally puts their life in this man's hands. He is not the rule, but neither is he the exception.

As far as medical skills, I have come across exceptional doctors in the UK, where there are some truly sensational medics. I don't think that the standard of medical training in the UK is any worse than what you would see anywhere else in the world, quite the contrary. It is very much the same here in France, you will come across some fantastic doctors too, as well as some mediocre ones.

What is much better here, is the ongoing medical care, simply because there has been so much more money spent in the various structures and equipment, and in most  hospitals, the ratio nursing staff and medical staff to patients. Plus, the fact that large wards have not existed in French hospitals for some years now - they are illegal I am told, so it is always a private room, or you share with one or two others. All in all, it can make a hospital experience feel like a hotel in some ways - something I have never encountered in the UK. As for the food, it usually is the usual industrial muck that you get in any institution. But there again, nobody would go into hospital for the food.  

When I first saw Gardian's post (OP) I thought "yes, that is just it" - as it pretty much summarized my hospital experiences too.

[mint]

A bit of a coincidence this topic coming up though my comments are about doctors rather than hospitals.

Yesterday, I met a couple of married doctors in a social setting.  They are Brits, work in the UK, he as a consultant geriatrician and she as a GP.

I was telling them about how little French doctors earn compared to those in the UK and from then on the conversation led to GPs.  I live in a small village in France and I go to our sweet-natured and caring GP in the next village.

Now, I suffer from asthma and so I go every 2 months to see my French medecin for my asthma drugs.  If I were still in the UK, I wouldn't take up the doctor's time at all.  I'd go to the Asthma Clinic which is attached to our surgery and there I would have the usual tests done by our very competent Asthma Nurse Specialist.  She would chat to me about any changes in my condition, how physically active I had been, whether I'd tried any of her suggestions from the last consultion, etc. and I'd go away and not need to see her again until I notice any changes.

Here in France, I go to see Madame le Medecin in order to get a new ordnance for my drugs (the need for them has so far not been reviewed) every 2 months when the old ordnance runs out.  She carefully gives me a bit of a check-up, blood pressure, breasts, etc and sends me on my way with my new prescription.

To be honest, wonderful as my French doctor is, I wonder sometimes how she does all that she needs to do:  seeing patients, writing repeat prescriptions, answering the phone, making appointments for people, popping in and out of the waiting room to call patients into her consulting room, etc. etc.

When, if ever, does she get time to keep up to date with the latest medical research and practices and perhaps attend continuing professional development courses?  Or is her medical knowledge at about the same level as it was when she left Medical School?

This is no complaint of the treatment I have had so far but all this was the topic of discussion with the UK doctors I met yesterday evening.

Personally, I would have preferred my asthma to be treated in the UK way but, if I were to need hospitalisation, I guess I would plumb for a French hospital.

Talk about wanting the best of both worlds................!

Perhaps someone practising as a doctor in France can post something about how they work and develop their skills?

[Quillan]

I know it's nice to have a pleasant doctor tend to your needs but we should really stick with the basics here. You normally go to see a doctor because you are ill and to be honest his colour, religion and bedside manners are of absolutely no interest to me. What I want is treatment for my problem and something that works quickly so I can get on with my life. That's what is important to me.

Sweet 17, I also suffer from asthma and have a checkup with the specialist every year who is, as it happens, located opposite my cardiologist. Its very convenient as I have one appointment in the morning, a nice lunch and the other in the afternoon, makes a nice day of it. I go through a battery of tests for my asthma that take about one hour and the results are compared to the previous ones. The only thing is that I have to remind my doctor to send me, just like I must for the cardiologist. Certain areas of health care in France appear to be the responsibility of the patient, keeping your xrays, scans etc and making annual checkup appointments. I can remember showing my French doctor the xrays he asked me to have done. He handed them back to me afterwards and I said that I thought he would keep them, he said no they are yours, they belong to you, different mind set I suppose. So I would suggest you ask your doctor to send you to see an asthma specialist once a  year for a checkup and ask him/her to make the appointment for you whilst you are there.

 

[mint]

Thanks, Quillan, for your excellent advice.

Now I understand what I have to do.  Guess I'd also better ask our GP to send the OH to the ophthalmologist to have a check-up on his glaucoma.

It's good to have shared responsibility with the medical bods really because then you are more motivated to take the medication you are prescribed as well as other measures that could help your own health.

[odile]

Quillan  , I agree on your priorities, but surely it's best if you can get both an excellent doctor and an understanding human beeing you can talk to and who will listen.

I do feel it's a shame doctors in Europe are only selected on academic abilities.

Sweet16 DO check on oh'g glaucoma. This is very close to my heart as opticians in France don't automatically check. My mum went for 10 years to local optician and he kept giving her new glasses. when I realised what what going on, it was too late. In the UK any optician, in a supermarket, or anywhere does check automatically- tragic.

[mint]

Odile, thanks for your concern and your advice.

The very next time I go to see our doctor, I will ask her for a letter of referral for the OH to see an Eye Specialist.

[Quillan]

I would prefer a very good doctor with no bedside manner than a poor one with excellent bedside manners. In short I want the best and I think that to select a doctor on the basis of good overall bedside manner is appalling. No wonder the NHS has to keep between a quarter to one third of its annual budget aside for litigation. Think what they could do with the money if they went the French route, think how many women can that expensive drug for breast cancer that's been in the news recently. The money saved could pay for that and a lot more.

The thing with the French is they are different particularly when it comes to fiscal and medical things. They don't go looking you have to ask them for things, its in their mentality. I always refer people to the "60 Million Frenchmen can't be wrong" book which explains, far better then I, why the French are like they are and why you have to ask. The only things I know they currently plan for in our area are mammograms and smears test for women and prostrate test for men over 'a certain age' and its free.

Anyway I am very happy with my French healthcare, much more so than the care I received in the UK.

[Quillan]

[quote user="sweet 17"]

Odile, thanks for your concern and your advice.

The very next time I go to see our doctor, I will ask her for a letter of referral for the OH to see an Eye Specialist.

[/quote]

If I am wrong on this I am sure somebody will correct me.

I don't believe you need a referral letter to see an ophthalmologist in France. What your OH should do is book an appointment and tell them at the same time he needs a test for glaucoma and remind the guy when he gets there for the eye test.

Opticians in France don't test eyes like in the UK you have to see an ophthalmologist who gives you a prescription which you take to the opticians to get made up. There is, I am told, always a wait for several weeks to see an ophthalmologist (round here it's 6 to 8 weeks) as there are very few and they are in great demand.

If I am wrong then I appologise in advance [;-)] .

[Will]

[quote user="Quillan"]

No wonder the NHS has to keep between a quarter to one third of its annual budget aside for litigation.

[/quote]

Where did this preposterous statistic come from?

According to the NHS Litigation Authority - yes, it does exist, and is an official body - £579.3 million was paid out in connection with clinical negligence claims in 2006-07. This figure includes both damages paid to patients and the legal costs borne by the NHS. That's still too high of course. Since you mention cancer drugs, according to the BBC, in the same year the NHS spent £4.1 billion on cancer care alone. I make the litigation costs 14% of that cancer budget, hardly 25%-33% of the total annual budget.

I don't deny that the French health service is very good, though it is not perfect - our own experiences testify to that. It would be interesting to see if similar figures are made freely available for France.

Edit - Quillan is quite right that you don't need a referral from the medicin traitant to see the ophthalmologue. However, in most areas there is a long waiting list and I am sure you will get faster treatment for something serious like glaucoma if you go through your normal doctor. 

[mint]

Thank you Quillan and Will both.

My OH is elderly and he was under the care of an Ophthalmologist (hospital based) back in the UK where he was sent for routinely every 6 months for the pressure to be checked.

If going through the GP is going to speed things up somewhat, then I think I'll go down that route.

It's very kind of you both to take the trouble to advise me and I appreciate it enormously.[kiss][kiss]

[Quillan]

[quote user="Will"][quote user="Quillan"]

No wonder the NHS has to keep between a quarter to one third of its annual budget aside for litigation.

[/quote]

Where did this preposterous statistic come from?

[/quote]

C4 News Night

I also quote from their own website

"The NHSLA estimates that its total liabilities (the theoretical cost of paying all outstanding claims immediately, including those relating to incidents which have occurred but have not yet been reported to us) are £9.09 billion for clinical claims and £0.13 billion for non-clinical claims"

More than double the figure you mentioned spent on cancer treatment.

[Will]

I take the point, but that is an estimate of a theoretical figure, whereas the figure I quoted is an actual cost.

[Gardian]

Well ............ have been particularly interested in the contributions, particularly those that suggest that our experience has been pretty typical. 

OH was 'released' this afternoon, after an event that was a good deal more serious than either of us thought at the time.  I think that I may have originally said "Not life-threatening": it's now clear that, potentially, it probably was - pulmonary embolism.

Re the Physician and his communication skills, I'm sorry Quillan, but this bloke really has to do better (but  will probably never change his spots). It was the Senior Nurse (Sister?) who told OH what she'd had and it was me who had to pin him against the wall to check what ongoing restrictions she has and whether he'd consulted with her Neurologist (she has MS). Answer, none in particular & No. On returning home via our GP, she checked her tome and found that OH's MS drug does have a history of embolisms, so more than a clue.

Anyway, all's well that ends well and all that.  None of the above changes a positive experience, insofar as any hospital stay can ever be positive.    

[auxadrets]

Two years ago, in a clinic in Nice, my husband was operated on for an enlarged prostate. When his admission date was discussed with the specialist's secretary, she said 'Et un lit pour Madame?' I turned round to see who she was talking to then realised she meant me. I was not relishing five days of a long, return drive to Nice from the Var, so accepted her offer. We arrived on the appointed day and while my husband was shown to his hospital bed in a single room, I spotted a folded z-bed in a corner. The next few days were exhausting for both of us. He was, inevitably, checked at all hours of the night and day, with the lights full on. I felt every pain that he felt, except that he was high on pain-killers. I couldn't sleep and the food was awful. I took to going and sitting in a nearby park and lunching out. He was 'let out' on a Friday afternoon, but was back as an emergency admission by the evening with a blood clot preventing him from urinating. Once again I stayed with him, too worried to sleep. In the morning I asked if I could have a towel. No I couldn't, I hadn't paid anything. I was advised to dry myself on a sheet!

The staff were very good with my husband, and the emergency was dealt with efficiently, but I felt surplus to requirements. It had seemed a good idea at the time, but I would never go this route again, I would look for a B&B nearby. I think it would have been better for my husband too.

Angela

[Weegie]

As a bit of an aside and following on Auxadrets post, the CHU at Limoges has a hotel/hostel adjacent which is open to relatives of patients.  The accommodation is basic but clean and includes en suite facilities.  It is also very conveniently placed. 

It is necessary to get a note from Hospital Reception confirming that a relative is having in-patient treatment to be able to use it.

May be of use to someone with a patient in Limoges Hospital (Other hospitals may do the same).  The details of how to use it etc were on  a notice on the back of the, 2-bed,  ward door which was usually kept open so it wasn't immediately obvious.[:)]

As I said, may be of use to others.[:)]

[opas]

[quote user="odile"]sadly, French doctors, like French teachers, are not taught to be good doctors - the only qualities valued by the system is theory, theory, more theory - bedside manners and psychology are irrelevant. In fact most French medical students never meet a patient during their training, and promotion is only related to 'concours' and more theoretical exams (same in teaching). Not good for patient/doctor relationships, I'm afraid.
[/quote]

I am sorry but i beg to differ.

In theory they are probably taght parrot fashion , just are the kids in school, but when all is said and done the doctors are humans.......you can meet a misserable shop assistant and a very helpfull one within the same store! same goes for doctors.....we met a few misserable ones in Uk and the same goes for some French ones.

 

I have to say with honesty though that over the years that we have had to go to see Proffs, doctors and nurses with our daughter we have met human beings.........the exception to this being the "Boss"!  the receptionist at the Orthetics dept at la peyronne , Montpellier, boy is she a dragon and even our daughter now has her guard up when waiting our turn and she is on duty.

 

Our daughter has had a few stays  in hospital both in UK and France, we both prefere French hospitals as we get single/double rooms and not a ward with every child watching/listening to either a different dvd/video/playstation game[blink] untill all hours. The food from what I can remember is also far superior in France and eaten in a more civilised way....on the childrens ward in Uk we had to have it at our bedside table, in France the same can happen if bedbound but if not can be enjoyed in a communal area with a very civilised glass of wine for the adults!

She is penciled in for another Op for October, she is very possitive about her impending visit, I shall stay with her.