Tuesday, April 27, 2010

French Healthcare Experience #2

At the beginning of April, I had another miscarriage. (For those who don't know, I had one in 2006 before Owen). Obviously it was a sad experience, though definitely not as difficult to deal with as last time. And the purpose of this blog isn't to talk about the loss, but to talk about my experience with the French healthcare system as a result.

Pro #1: It was easy to schedule an appointment with an OB/Gyn
In France, you basically call any doctor's office and say, "Je voudrais un rendez-vous" and they will see you. None of this, "what insurance do you have" or "we aren't taking new patients". I had gotten a recommendation for an English-speaking OB/Gyn from another American I met who has lived her for several years. When we found out I was pregnant, Sean made an appointment for an ultrasound when I would be 7 weeks along. I never made it that far. (Technically, this is called a chemical pregnancy).

When I started bleeding at just over 5 weeks pregnant, Sean was in California at a conference and I was home alone with Owen. I called the OB's office and told the receptionist what was going on (in French which made me feel quite proud). I was told to come in the next day at 10am and the doctor would see me.

Con #1: I am not suited for the laissez-faire attitude of the French medecin (doctor)
- At the appointment, for which I had to wait over 45 minutes to see the doctor, she was extremely nice and her English was excellent. But it was definitely a very different experience to an interaction with a doctor in the US. First, her office is an actual office. Not an exam room. A desk with chairs for the patient. Separated from the waiting room by a heavy (but not sound-proof) door. We sat facing each other and she I told her my medical history. She wrote it all down ON PAPER! There was not a computer to be seen! When I told her about my previous miscarriage and complications that arose and then the possibility that I was miscarrying again she nodded and said, "yes, well miscarriages are quite common." Not, "I'm sorry" or even the the sad head nod you expect when someone is being told difficult news. Just, a very "medical" approach to patient care. "Just the facts, ma'am. Just the facts."

-Then, we walked to her exam room which was attached to her office. She did leave while I undressed which was nice I guess. After her physical exam she said, "ok, let's go to the sonogram room." It was another room on the other side of her office. She told me to leave my clothes there and just walk. It was only 15 or so steps but it just seemed silly to me. I mean, I'm not a prude but as least offer me a towel or a gown or let me put my socks on so my feet don't freeze on your tile floor!

Pro #2: Modern technology
- I know this sounds lame but I notice these things. Her ultrasound machine was a newer model.

Con #2: Find your own lab for the blood draw and call us with the results
- After the ultrasound, it was clear that I was likely having a miscarriage and she wanted to confirm with a beta-HCG (pregnancy hormone) blood test. She wrote me a script and said, "just take it to any lab. If they are still elevated, go back in a few days. We'll talk once the results are back." Fortunately, I have a friend here who has a baby in December so I called her to ask where I could get my blood analyzed. Turns out, in France, there are specific Laboratoire d'Analysis, offices for the soul purpose of drawing blood. So, after lunch (with Helen who SAVED THE DAY by coming along to look after Owen) and a nap at home, off I went, with Owen in tow, to have my blood drawn. When I got to the place, I had to take a number and wait. The phlebotomist came and got me, drew my blood, then handed me a receipt. "You're results will be ready tomorrow afternoon, we're open until 7pm. Bring this receipt to get the results."

Wait, what? You don't call my doctor's office with the results? "No, we can fax them to the number on her prescription form but we cannot be responsible for whether she gets them." Uh, ok.

PS - never heard from the doctor but got the results myself and because of my previous pregnancy experience and the help of the wonderful ladies from my miscarriage support group site, I was able to interpret them on my own.

Pro #3- I paid virtually nothing!
- In the US, when my miscarriage was confirmed, the doctor's office sent me a bill for over $300. Apparently, my insurance company would not pay their fee for all the ultrasounds and blood work to confirm the miscarriage since, because the miscarriage was confirmed prior to 12 weeks of pregnancy, the insurance company did not consider that I was pregnant. UGH! That still makes me mad to think about almost 4 years later!

Anyway, in France, I had to pay 90Euros for the ultrasound because we haven't gotten our insurance card yet but we will be reimbursed at least 70% once we get our act together and mail in the form. I did not have to pay anything for the blood draws or the office visit itself.

Con #3: Did I mention that the doctor never called me back?!

Con #4: For some reason, I have a mental block about being able to find doctors' offices without taking a wrong turn on the incredibly windy roads in France. So, yes, we were 15 minutes late for the appointment.

Pro #4: No one cared that we were late and I was still seen. Even though they schedule appointments in France, I have yet to have an experience where I am seen on-time. But, if you show up at some point within an hour of your scheduled appointment, it seems that you will be seen.

So, all in all, it has been an interesting experience. I have now started to go to acupuncture which has also been quite different than my experience in the US. Primarily because, in France, in order to perform acupuncture, you must be a medecin. So, many of these same issues apply to the 3 times that I have seen him so far.

I have had to wait 2 of the 3 times for 45 minutes to be seen. The first time because, even though I was on-time for my appointment, a woman who was 15 minutes late for her appointment showed up just before the doctor came to the waiting room and I felt insecure about demanding to be seen first. Plus, I'm not really sure I would have known how to defend myself if the lady had started an argument over it.

I missed my first appointment with an acupuncturist because I couldn't find her office. Though I like the guy I ended up seeing so maybe it was meant to be.

The medecin de homeopathie that I am seeing now for acupuncture also has a desk in his office where we sit and go over my history. And he writes everything down on paper. Though, there is a computer on his desk. He uses this to schedule appointments and to log onto WordReference, an online dictionary, which has come in handy a few times. Though, for my part, we do about 90% of the session in French. But back to his record-keeping. In fact, all his records of all his patients are stored in manila envelopes in his treatment room for anyone to rummage through. And once he even had the previous patient's record open on his desk when I came in. Total HIPAA violation! :o)

What I like about this guy, however, is that he comes to get the patient personally. He has a "secretary" (I believe it's his wife) who answers the phone and helps schedule appointments but once you come to the office and are seated in the waiting room, he comes to greet you himself and he even escorts me back to the waiting room after the appointment.

So, like most of the experiences we've had during our transition to life on the "ex-pat planet" (thanks Concetta for the new phrase), our French Healthcare Experience continues to be filled with pros and cons as compared to our experiences in the US and, all in all, balances out. And, in the end, it gives us something to talk about (and hopefully laugh about) with our international friends.

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