Health Care in France

I have been reading some horror stories regarding delays in cancer treatment in the UK, so thought you might find it interesting to hear my experience here in France, the country reputed to have the best health service in the world. My worst delay was of my own making, in that I took little notice of symptoms which I first noted in my diary in July 2004. It wasn't that I was "afraid it was cancer" - I have never quite understood that mentality, don't go to the doctor in case it's something serious! It was more that I thought I probably just had piles, and it wasn't a serious enough problem for a doctor's visit to be necessary. It was only in the October, when my sister, who is also a nurse, got to hear of my symptoms and asked me whether I still had my cervix (as my uterus had been removed due to fibroids in 1989) that I realised there might be a more serious problem. I also only then realised that I would prefer to see a female doctor, and once I had located one, off I trotted. Now I know in the UK we believe that in other European countries, as well as the USA, one has to pay for medical treatment or have medical insurance, and that is strictly true. But if one is so poor one is on the French equivalent of Income Support, one gets Couverture Universel Maladie (probably spelt wrongly!) which means one gets free medical treatment. Even richer people get free treatment for Affections de Longue Duree, or longterm illnesses from a list of about 30, of which cancer is one. Anyway, I saw this lady doctor I had chosen one evening, and she sent me the very next day to the accident & emergency department of the hospital of my choice which had a gynaecological dept, with an explanatory letter. There I was asked a few questions then given an appointment the following week with a gynaecologist. He did attempt an internal exam, asked me if I had been playing any "dangerous games" (my mind is still boggling at that one!) then booked me in for an biopsy under general anaesthetic a few days later. I think I did have to wait about a fortnight for the result of this, but at that consultation (on a Friday) I was told I had a serious condition which must be treated as cancer (he never actually said, "you have cancer"), and I got an appointment for the following Monday, ie the next working day, to be seen by the head radiographer at the regional cancer centre - I was given the choice of two regional centres actually. By steaming open the letter of introduction he gave me, I learned that I had a vaginal adenocarcenoma. My partner drove me to that consultation, an hour and a half's drive from our home, but we were told in future I was entitled to my own private taxi/ambulance (what they call Vehicule Sanitaire Leger, or light health vehicle, a car with health trained driver), which I have used ever since, at no expense to myself. So I saw the radiographer on 8th November, proceeded to have numerous biopsies and scans, then when they were finished I started my 28 radiotherapy sessions on 9th December - they actually wanted to start 8th December, but I was in Paris that day celebrating my daughter's 21st birthday, so asked for it to be delayed for one day. My chemotherapy began the first Monday of the radiotherapy (someone took me from the day hospital, drip attached, to the radiotherapy dept) and continued each Monday. Then I had the brachytherapy (internal radiotherapy) as soon as I was healed enough for my body to withstand it. Since then I have had regular three monthly then six monthly appointments with alternately an oncologist and a gynae surgeon. I had a recurrence in May 2005 - went to my local doctor, who sent me to the cancer centre the same afternoon, who did the biopsy immediately. Again a wait for results, then almost immediate hospitalisation and surgery (26 lymph nodes - plus my ovaries, which they hadn't said they would remove, but then I have never had to sign a consent form here). Then an MRI scan in the December, followed by removal of vagina in the January. Then regular MRI scans, and follow-up appointments -all very attentive. I had a biopsy in April after an abnormal MRI - just scar tissue. Then I found a little lump in the mouth of what was left of my vagina in September. Saw my local doctor, who sent me straight to the cancer centre, who organised another biopsy - et voila, the cancer is back. I had a PET scan two days after getting the positive biopsy results, and now this seems to be the longest wait, two weeks before the appointment at which I'll hear whether I'm scheduled for more surgery or palliative care. When I have had hospital treatments I have had my own private room with ensuite facilities, and a phone at my bedside on which friends and family can call me at normal rates, or I can call them. The food is in my opinion excellent, although they don't seem to cater for vegetarians - I just always go for the fish or poultry. Their idea of a light diet after major surgery is a little surprising - cucumber or beetroot in vinegar are fine, vegetable soup is too heavy - and there is no hot drink after mid-afternoon, but there is fresh fruit and always choice, and the food is hot. The beds are all electrically adjustable, and you have a button with which you can call a nurse at any time of the day or night, and they always, in my experience, come promptly. I am told the French health service is heavily in debt, and it's easy to see why. Their staff have sometimes told me France is looking towards the British system for advice in saving money. I really hope they don't! To me, the French provide what the patient needs, all they need do now is work out how to pay for it. Maybe they need to increase the charges for those who can pay or afford insurance? Whereas the British seem to base their service on what they can afford, and somehow meet as many patient needs as that budget allows, with it just being "tough" if some needs cannot be met due to lack of funds. It's not utopia here. If I had a criticism, it would be that I haven't felt as well informed as you seem to be in Britain. I find French society as a whole a tiny bit patriarchal, and it does seem that one is expected to accept the "doctor knows best" and let him carry on without necessarily having had everything thoroughly explained. I don't think this is just because I am a Brit in the French system. There don't seem to be the plethora of leaflets covering the various medical conditions, and I have asked! I get the feeling patients are expected to be more passive here than they are in the UK. Maybe that's because we are not expected to look gift horses in the mouth? For a Brit in a French hospital, the worse thing must be the lack of cameraderie with ones fellow patients. Here we are all in our private rooms, and though we can walk along the corridors and peep in if there is a door open, in the main we never get to see another sick person. Living an hour and a half's drive from the hospita also makes visiting difficult, so I prefer to rely on the phone for contact, which means it can occasionally seem a bit lonely. But on the whole, I feel incredibly lucky to have developed cancer, if I had to develop it at all, in the country with the best health service in the world.