Margaret and Dick   


August '05: French medicine

“Let’s quit hassling with medical care and just move to France,” I told Margaret today.

The context was a visit to cardiologist Dr Khoury.  During a recent visit to get some French prescriptions, my Limoux internist Dr Barthe recommended I develop a relationship with a local cardiac care specialist.  “You never know,” he said.  I took the hint, as he pointed out my irregular heart rate.  Atrial tachycardia with occasional fibrillation, I've had it for twenty years.  It’s mostly a nuisance but can be serious if not controlled with medication, and it occasionally prevents me from biking.

Some things are simpler when you live in a little town like Limoux.  Dr Barthe is a 5-minute walk from our house.  Dr Khoury is a little further, maybe a 7 minute walk.

I watched Dr Khoury scan my heart with an ultrasonic transducer on my chest.  He zeroed in on both chambers at once, comparing the two main valves.  One valve fluttered as it tried unsuccessfully to close on each beat, while the other half beat cleanly like the engine of a new car.

“Those are the best echo-cardiogram pictures I’ve ever seen,” I told the doctor.  He altered a setting to show in color the back-flow from the faulty valve.  “I have to trade this machine in every four years, as a new and better model comes out.  This is my Ferrarri.  I’d rather have this than a sports car.”  Clearly he was enjoying the powerful tool he had purchased.  “It cost me more than 50,000 euros,” or about $62,000.

“How are you, how do you feel, in general?” Dr Khoury asked.

“Just great, in general,” I replied, “except for days when my heart rate goes crazy for no reason.”

“Are you OK riding the bicycle most days?”

“Yes, though I was pretty slow going up Mt Ventoux this summer.”  He laughed.  Not many cardiology patients try to climb Mt Ventoux.

“Well, why don’t you do something about your rhythm problems?  Nothing you are taking attacks this basic problem.  You have such an active lifestyle.  Let’s consider…”  He launched into an alternative drug strategy that sounded irresistible – and that had never been suggested to me stateside.

I commented to him on the directness of French medicine.  You see the doctor, and the doctor does it all.  In the US, a technician would perform the echocardiogram and file a report with the cardiologist, who would look at it a week later and, when he could get it on his busy schedule, would call me up with a verbal result.  Here the cardiologist was interpreting while both of us were viewing the beating heart on the screen, and he dictated his report while I was sitting there.  “If you’ll just wait in the office a few minutes, I’ll have my assistant type this up for you.”

I later learned that Dr Khoury, a dynamic man in his fifties, is an active member of the local socialist party that dominates Limoux politics and a member of the city council.  We don’t know many socialist cardiologists in the US!

In less than 15 minutes, I had his two-page report to my GP printed out and in my hands, in a neat folder containing my EKG and the color photos of the Doppler echo-cardiogram.  “How did you transcribe all that medical jargon so quickly?” I asked his assistant.  “Oh, we’ve been working together for thirty years,” she replied, proudly.

She asked if I had French medical insurance.  “No.  I write you a check, and if all goes well I can be reimbursed by my insurance company.”  She printed the bill, a total cost of 100 euros ($120) for cardiologist consultation, EKG, and detailed Doppler echocardiogram.

At that cost, I doubt that I’ll bother to file for reimbursement back in the States.  It’s not worth the hassle of translation and locating the correct US insurance codes.  I rarely file for prescriptions filled in Franceeither, since full price in France is about the same as my co-pay for drugs purchased in the US.

I’m not saying the medical picture in Franceis all roses.  A friend with sciatica had to wait several months for a CAT scan, since expensive machines are in short supply.  You’d also have to get in a long line for a complex elective surgery, as high-end procedures are rationed on a need/availability basis in this socialized system.

And don’t get me wrong, I consider my stateside internist to be utterly irreplaceable.

But I’m struck by the strikingly lower administrative cost in France.  The French, otherwise famous for inefficient bureaucracies, simply don’t need a layer of medical office staff to interface with the insurance companies.  We Americans, famous for our efficient systems, are breaking down under the weight of bureaucracy in our medical system.  And nobody in America seems to like our system except…um…the insurance companies.


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