I received the controversial form from the social security today: the formulaire de déclaration de choix du médecin traitant.
Unlike the UK, where you are registered with one doctor or doctor’s surgery, who have your file detailing your every ailment from childhood to the present day, the French have always been able to consult whomever they please, whenever they please, as often as they please. There is nothing to prevent someone who is horrified at the appearance of four insolent blackheads on their nose from making an appointment to see a dermatologist directly. Or someone suffering from a mild bout of indigestion from missing out the GP middle-man and opting to see a gastroenterologist instead. No system of referrals has hitherto existed to ensure that taxpayers’ money is not wasted by hypochondriacs electing to visit several specialists for their maladies imaginaires, and soliciting a second, third or even fourth opinion.
The social security system has unquestioningly picked up its share of the tab all this time (the same amount for every patient, no means testing required), while mutuelles, private health insurers, whose policies every worker subscribes to as part of their employment package, pay some or all of the rest. Or very little, in the case of dental work. Serious financial planning is advisable if, say, you need a tooth crowning in this country – you may have to forfeit your holiday plans or that nice Ipod photo you had set your heart on in order to pay the dentist.
The eminently sensible change being wrought by the innocent looking form is that everyone now has to choose a GP to be their first point of contact: their médecin traitant. The only specialists that people will be able to consult without a GP referral are gynecologists, dentists, ophthalmologists, paediatricians and psychiatrists. Other appointments can presumably still be made, but will no longer be reimbursed. Which is very dissuasive indeed.
Understandably perhaps, there is a lot of opposition to this new measure. Old habits die hard, and many people resent having to go and see a GP, who might be a complete stranger, just to obtain a referral to the specialist they have been frequenting for a decade or more.
Personally I’ve never seen a French GP more than once. Depending on where I was working at any given time I tended to see someone close to my office, and I’m very British about ailments like colds that the French invariably to see a doctor about, preferring to dip into my large stock of generic UK supermarket cold cures. Tadpole has a doctor she sees fairly regularly, a GP chosen mainly because the local paediatricians recommended to me were taking on no new patients. She is lovely, and less heavy handed with the antibiotics than most French physicians I’ve crossed paths with, but I have no idea whether she will consent to signing Mr Frog’s and my forms. Doctors are under no obligation to accept everyone, and do not have to give any justification for their refusals. As she happens to be very popular in our neighbourhood, she is undoubtedly fully booked already. The forms have been sent out in three huge postal waves, meaning that people with surnames ending in A – O may have bagged all the available places. Desperate times call for desperate measures: I’ll have to take my chequebook and see if she can be bribed.
Who knows, she may be one of the doctors boycotting the new system in protest at becoming some sort of clearing house and refuse to sign any forms at all.
In any case we now have until July 1st to be ill, visit the doctor and get the forms signed. And if we remain in perfect health, we’ll probably end up making an appointment anyway (at a cost of just over € 20 to the social security system) just to get the signature and coveted inky stamp on the form (the French are VERY attached to their ‘tampons’, and no official form would be complete without several illegible stamps).
If every single French person does this before 1 July, at a cost of € 20 per adult, I think we can safely expect an even bigger social security deficit this year. Thereby defeating the cost-cutting object of the whole excercise, at least in the short term. And creating a swathe of paperwork for the bureaucrats to process.
Atchoum! I feel a cold coming on. Off to the doctor’s I go…
*French for Atishoo! I have actually heard people pronouncing the ‘m’ when they sneeze. I swear.
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petite anglaise 
Smashing, petite. Haven’t you got some work to do?
Comment by backroads — March 16, 2005 @ 1:04 pm
work? me? and there was me thinking I was being paid to blog…
come to think of it my in-tray does look like a disaster area
Comment by petite — March 16, 2005 @ 1:33 pm
I do actually say “atchoum” when I sneeze. Don’t ask me why though…
Comment by Froggie — March 16, 2005 @ 1:58 pm
On the Atchoum / Attishoo thing, I was wondering if “Attishoo” is not an anglicised rendition of à tes souhaits (or maybe just it’s a request for a pocket handkerchief ;-)). Any ideas on where it comes from?
Comment by Iain — March 16, 2005 @ 2:31 pm
I thought for a moment that this post’s title was about scaryduck – the Mallard Imaginaire.
Comment by Tony S — March 16, 2005 @ 2:39 pm
When I started learning French at age 9 I thought ‘a tes souhaits’ was the French pronunciation of atishoo. It was a long time before I saw it written.
Comment by Jean — March 16, 2005 @ 2:44 pm
Something I, as a Brit, found astonishing when receiving medical treatment in France was the concept of money changing hands, even if it is to be reimbursed later.
Like when I came off the back of a motorbike and went to casualty. On the way out, it was: “that’ll be 1200 francs for the x-ray please”. It feels really weird.
Petite, do the French have to pay at point of treatment too (and then get reimbursed later)? I never quite worked that out when I lived over there…
I do like the way you can just wander into a surgery though. No messing about with unhelpful receptionists for an appointment in two weeks’ time…
Comment by witho — March 16, 2005 @ 3:27 pm
Dutch doctors are very much “gatekeepers”. Recently, there have been a lot of complaints about their overzealousness in blocking access to necessary specialist care. Makes me wonder how it’s going to work out here.
Comment by Sierra — March 16, 2005 @ 3:36 pm
witho – you do pay up front, and then get reimbursed in about 10 working days by the Sécu if you and your dr use the carte vitale chip card thingy. Then the mutuelle pays a little later, automatically receiving the details from the secu, so I rarely have to do any form filling these days and am not out of pocket for too long.
The local pharmacy even have a system whereby once you show them your mutuelle thing and the register you on the computer, you don’t pay at all, they get the money direct from the third parties. Which is great!
But the walking in off the street thing is not necessarily true. Depends on the popularity of the dr and whether they operate by fixed RDV or just a casual come along and wait (and wait and wait…) system.
Oh, and I’ve turned to leave many times, only to hear the dr cough politely to remind me to get my chequebook out…
Comment by petite — March 16, 2005 @ 4:02 pm
Thanks for the reminder… we got these forms quite a bit ago, and lord knows David hasn’t thought to try and get it sent back in!
Comment by kim — March 16, 2005 @ 4:37 pm
I obviously went to quite an unpopular one then :???:
Comment by witho — March 16, 2005 @ 4:38 pm
Right everyone, I NEED to know how you get those great little photo/image thingies next to your names. I want one!
Comment by céline — March 16, 2005 @ 6:37 pm
céline – you need to go here!
Comment by petite — March 16, 2005 @ 9:06 pm
Do french doctors still like to perscribe medicine that is to be taken other than orally…..?
Comment by morphess — March 16, 2005 @ 10:42 pm
Hell yes… I believe my first ever post was about that!
Comment by petite — March 16, 2005 @ 10:57 pm
Ohh, what’s it filed under? Hang on…do I really want to know?
We took our holidays in France every year throughout my childhood – and I continued to take my family there. I really, really tried never to be ill…
Comment by morphess — March 17, 2005 @ 4:39 am
“Ã vos souhaits”
Comment by proko — March 17, 2005 @ 7:46 am
The exact same system was introduced in Norway, where I live, a few years ago. People were very sceptical, but it has all worked out fine and the system is up and running. As you predict, people/media here were predicting that no one would get the doctor they had chosen etc. After som testing and failing, it seems that most people are happy with it and somehow it feels safe to see the same doctor every time you need to. So hang in there!
Comment by Pussycat — March 17, 2005 @ 9:18 am
As an American who lived for YEARS without health insurance, (Try paying between 50 and 70 dollars just to LOOK AT THE DOCTOR’S FACE – and God forbid he prescribe you anything or run tests…) the French system has seemed like a WONDERLAND. I amm ‘getting fixed’ all the things I neglected for so long.
Not to say that I don’t find some things strange. In my village I once visited a generalist who (I am sure) would have given me MORPHINE if I asked her to prescribe it for my head cold. And ‘l’arret travaille’? SHE asked ME how much time I felt like not working!!
Comment by sammy — March 17, 2005 @ 9:46 am
sammy – that’s why my British employer is so sceptical of people being signed off. I get myself signed off for far longer than necessary and then come back early for brownie points.
proko – thanks for that – I note that the French used to say ‘bless you’, just like the English do.
morphess it’s here. Re-reading it, that first post seems like such a long time ago. But it was only 7 July 04…
Comment by petite — March 17, 2005 @ 11:24 am
Sierra, that’s assuming that you actually get to see a doctor in the first place. Any time I ring a doctor here (Holland, and it’s thankfully once in a blue moon) I can never get further than the receptionist who pulls some hocus-pocus diagnosis out of her arse and tells me to take a paracetamol and the day off, whatever the symtoms. I have friends who were told they had various conditions from diabetes to epilepsy when they rang to complain about injured knees and headaches. I’m amazed there aren’t people dropping dead all over Holland due to misdiagnosis. Or perhaps there’s a secret codeword that only the natives know, which allows them to see the wizard…
Comment by reachy — March 17, 2005 @ 12:10 pm
Pssst … Reachy – the codeword is particulier verzekerd.
Comment by Ria — March 17, 2005 @ 1:18 pm
Ria, you said it! Unfortunately, private insurance was beyond my means.
Reachy, you’re right, I should have mentioned the receptionist as the first hurdle. And I’m sure there are people dying or becoming more ill because of this kind of thing. But who’s going to complain? What would be the point?
But the more I type the more I’m tempted to rant about the hidebound Dutch medical system, so I’ll shut up here. :-)
Comment by Sierra — March 17, 2005 @ 2:11 pm
rant away sierra, I don’t mind. unless you want to do it on your lovely blog of course.
Comment by petite — March 17, 2005 @ 2:18 pm
Petite, thanks for that….much as I suspected….
Here in NZ NO ONE says Bless You – my children frequently comment on it – didn’t they have the plague here?
Comment by morphess — March 17, 2005 @ 10:21 pm