Doctor’s orders

IMG_2991A doctor’s prescription is known in France as une ordonnance médicale. The name says a lot about how the French view their prescriptions. Surely if a doctor orders you to take something, take it you must?

My late Belle-mère was a regular at the doctor’s office and could never recover from even a minor head cold without a prescription. Like many French people she did not believe in generic medicines – she considered them cheap imitations and insisted the doctor prescribe the original brand. I tried to convince her they were exactly the same molecule but she turned a deaf ear to my science-based arguments.

Pharmacist's assistant
Me in my Shoppers’ Drug Mart uniform

I used to be a pharmacist’s assistant at a drug store in Canada many years ago, a part-time job that paid for my education while also providing one of its own. I learned that people need to be given clear directions for taking their medication. That certain drugs were best taken with food or on an empty stomach, and that finishing a complete course of antibiotics was essential in order for them to be effective.

I also learned how NOT to pronounce the name ‘Cockburn’ when calling out one man’s prescription over the PA system.

When filling a prescription in North America, the pharmacist takes a massive jar of pills and counts out the prescribed number into a smaller vial, then sticks on a custom label with the patient’s name, the name of the drug, when and how to take it. This system allows the patient to receive the exact number of pills needed and to see at a glance how to take them. You could argue that it leaves room for human error, mislabeling, etc. But no prescription medicine ever left the store without a pharmacist personally checking it against the doctor’s prescription. Always assuming we could decipher the handwriting…we also made a lot of calls to doctors’ offices to double check.

Nothing so simple in France. Tablets come in a prepackaged box of blister packs along with la notice or patient package insert. This document is in accordance with strict regulatory rules that require the drug maker to disclose a lot of information, even for relatively innocuous over-the-counter drugs.

In order to find out how to take your medicine, you have to remove the insert, unfold it, and read through chapter and verse until you get to the relevant section. How much to take (posologie) and how and when to take it (comment prendre ce médicament?)

Your French had better be pretty good in order to glean the information you need from the language contained on the insert, which includes specifics for children of all ages, pregnant and nursing mothers and people with all kinds of pre-existing medical conditions. You also need good eyes or strong glasses to read the tiny print.

One thing that always mystified me was the French obsession with suppositories. I thought this mode of administration had gone out with hot water bottles but they are quite popular for certain ailments, especially for children. I remember having to give my kids suppositories for ear infections. Which not only seems bizarre but is a pretty hard sell for your child once they get old enough to argue.

The French love their system and will hear no criticism of it. They argue that factory-sealed blister-packs of pills are safer and more hygienic, and the details contained on the insert are helpful in case of any potential side effects.

But too much information can be a dangerous thing. Super paranoid patient, I read the whole insert in detail before taking the first pill or administering it to my children. After considering the pros and cons of the treatments vs. serious adverse events like renal failure, allergic reactions or plain old constipation, I ask myself if it’s really worth it just to avoid a little pain? Half the time I don’t end up filling the prescription, or when I do it sits unopened in its package. And most of the time (knock, knock, knock on wood), I am just fine.

Famous last (first) words: Never begin a post like I did last week: “I am blessed with good health….” It is only asking for trouble. Tuesday morning found me doubled over in pain as I slipped a disc just after saying ‘Namaste’ at the end of yoga class. How’s that for irony, peeps?

Chez le médecin

IMG_2965I am blessed with good health, a gift for which I am more grateful with each passing year. (She says, knocking on noggin). This despite the fact that I have spent many long hours chez le médecin.

You cannot raise a family in France without becoming painfully familiar with the doctor’s waiting room. You are given a carnet de santé or health record book that tracks your child’s health from birth to age 16. There are checkups – visites obligatoires – at various ages and stages of development. There are vaccinations, height and weight charts. There are vitamins and prescriptions for every imaginable ailment. You don’t leave a doctor’s office in France without a prescription for something (more on that to come).

But oh, the hours spent in the salle d’attente! The unending, crashing bore of it. The dog-eared, outdated magazines. The stale air and germ-infested space with little to distract a child.

Le toubib, as the doctor is called in familiar fashion, tends to be a lone wolf. Most doctors practice under the category of ‘profession libérale’ which is a fancy way of saying self-employed. There is no receptionist or medical secretary to take calls or welcome you at the door. Le médecin généraliste, meaning GP or family doctor in French, runs his own practice, does the paperwork and answers the phone.

Another reason for the endless wait is that many doctors offer a daily ‘permanence’ or walk-in clinic. The advantage is that if you are suddenly ill you can get in to see the doctor the same day – provided you are well enough and willing to wait.

In our country village outside of Lyon there were two GP’s, each with his own cabinet on opposite ends of the main street. I saw both early on and quickly chose Dr. Fourré, a heavyset fellow (like his name, which means stuffed) with a calm, soft-spoken manner who actually listened when I spoke, and looked me in the eye. The other doctor was younger and more modern with a computer on his desk. He spent the whole time looking at the screen and seemed like a scared rabbit every time I tried to catch his eye.

How well I remember the long hours in Dr. Fourré’s small and shabby salle d’attente. The permanence was in the afternoon and the after-school rush at 4:30 was epic. Sometimes people would open the door, stick their head in to do a quick count, then disappear. I later discovered that some would literally run across the village to the other doctor’s waiting room and go where the queue was shortest. Later on the two doctors got together and coordinated their hours, so that one had permanence in the morning and the other in the afternoon.

I am not a patient person. I simply do not wait well. Which makes me a very poor patient indeed.

But I will always be grateful to Dr. Fourré as he was the one who sent me for the MRI that revealed my acoustic neuroma, a benign but mushroom-size tumor growing in my inner ear. It was removed by a specialist in Paris a few months later with no lasting consequence other than a total loss of hearing on the left side. But it was the simple country doctor who actually listened to my complaint about not being able to understand conversation – the specialist I’d seen a few weeks before had sent me away with platitudes about hearing loss and aging.

French doctors work long hours for little pay. They are the unsung heroes of the healthcare system.

Many GP’s in France still make house calls, surprisingly enough, although these are an increasingly rare species. There is also a service called SOS Médecins. If you’re lucky enough to live in an area covered by them, you can get a doctor to come to you within hours. Unfortunately, where we now live in the Haute Savoie, it’s either the nearest hospital or the waiting room of the local GP.

The first time I went to see a doctor in France, a couple of things surprised me. One was the complete lack of modesty accorded to the patient. In this case it was a gynecologist who had me undress for the physical exam without providing any kind of gown or sheet to cover up. Fortunately he kept up a steady stream of chatter with a lot of eye contact to cover any awkwardness.

Another surprising thing was the fact that the doctor is addressed as Monsieur or Madame rather than ‘Docteur.’ You can call him Doctor if you wish, but not doing so is not the blasphemy it would be in North America, where medical professionals are like gods.

What I found even more embarrassing than being à poil was having to take out my cheque book and pay the fellow (although I was dressed by then). This had never happened in Canada, or if it had I’d always dealt with a secretary. It seemed almost insulting to write a doctor a cheque. Especially for so little.

Unless you see a physician as a private patient, the amount you will pay for a basic medical consultation is 23 euros. Even my hairstylist charges more than this.

How do you feel about le toubib?