Saturday 19 February 2011

The French and American Medical Systems

While I was in Paris the other day I needed to see a doctor. This reminded me why I like the French medical system so much, and why I dislike the US system so much.

A typical visit to the doctor in the US goes something like this.
  1. Make an appointment. If you're lucky, you can generally get one the same week.
  2. At the due time, drive to medical centre and find a parking space. The medical centres are the size of shopping malls with similar parking problems.
  3. Enter the vast, overwhelming medical centre, and try to find the right reception desk, out of hundreds.
  4. Give your file number to the receptionist. Don't bother with your name, the computer won't know what to do with it.
  5. Wait. Probably 10-20 minutes.
  6. Nurse #1 shows up and leads you through a maze of corridors to a tiny room, where she tells you wait.
  7. Wait another 20 minutes.
  8. Nurse #2 shows up and takes your blood pressure, temperature, height, inside leg measurement and a dozen other things utterly unrelated to the reason for your visit. You also explain your symptoms to the nurse. Heaven forfend that an actual doctor should have to waste his valuable time listening to a patient.
  9. She leads you to another room, where you wait another 20 minutes.
  10. Doctor shows up. He maybe asks a question or two, gives his diagnosis, and disappears. I don't believe I've ever spent more than 60 seconds in the room with the doctor. His time is just too precious to waste with patients!
  11. Wait some more.
  12. Nurse #n shows up with a prescription, if you're going to get one. Though actually my experience is that they will do all they can to avoid giving you any medication.
  13. Finally you're done. Nurse #n leads you back through the maze to the reception desk, where you pay $50 or so "co-pay". Your insurer will pay most of the cost, which for a simple consultation like this is typically $200-300.
At the end of all this, you've spent an hour or more, seen a doctor for 30 seconds, and in all probability don't have a correct diagnosis or medication, though you are considerably poorer.

Here's how it typically works in France.
  1. Make an appointment, usually the same day. In this particular case, I called, spoke to the doctor himself, who said, "Can you be here in ten minutes?".
  2. Go to doctor's office, which is typically an apartment in a stylish building (in Paris) or a little rented office with parking just in front of the door, outside Paris. Not a terrifyingly huge medical centre.
  3. The doctor opens the door for you - not a receptionist or some one from a vast nursing staff, but the actual doctor.
  4. You sit in the doctor's office, explain your symptoms, and he asks lots of questions, examines you if necessary. He treats you like an intelligent person rather than as a numbered and rather stupid case file. You spend maybe 10-15 minutes with him.
  5. He gives you a prescription - which he writes with his very own fountain pen. You pay, typically $30-50 for a consultation like this.
  6. You're done. You've spent 15 minutes with the doctor, and little or no time waiting. You haven't had to deal with an army of nurses. You have a diagnosis and, if appropriate, suitable medication.
The US is a wonderful country, and I appreciate it more and more as I live there. But the medical system is something I'm afraid I'll never get used to or really even understand. What do doctors do when they're not seeing patients, i.e. 99% of the time? The whole system has one primary objective, which is to pour money into the insurance companies. Yet Americans - especially poor ones who are the most disadvantaged by the system - will fight to the death to prevent it changing, as the "Obamacare" debate and rhetoric shows.