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At the heart of general practice since 1960

legal lessons

Profligate prescribing, the doctor in charge, free access to specialists

Dr Peter Turkie found a GP's life in France to be

a challenging

but rewarding change

Registration

I was dreading the interview, not knowing what would be required. In the event, it turned out to be a five-minute chat with Monsieur le prsident de l'ordre des mdecins who muttered under his breath in a thick Catalan accent, which I took to be part of the test. Did I know that a winner of the Prix Goncourt for literature lived in my village? Why did a British doctor want to practise in the Pyrnes Orientales anyway?

This interview, three years ago, completed the formalities of registration here, which had started a year earlier with the bureaucracy for which France is justly famous. British qualifications are accepted without question within the EU but it does take a bit of patience and a lot of accredited translations.

Finding work

My registration complete, I now needed to find work and wrote to all the local practices offering my services as a locum. Predictably, this yielded nothing.

However, who you know is more important here. My neighbour spoke to his doctor, one locum job led to another, and I now have regular work.

There is a shortage of GPs that varies according to the region. This was precipitated some years ago after the French government gave GPs of a certain age a golden handshake to encourage retirement and then found there were not enough young doctors to fill the gap.

Vive la difference!

For a British doctor language is only one of the barriers cultural differences abound. The expectations of patients are very different. There is less discussion about treatment plans the doctor is in charge. Patients don't expect to wait for investigation, or specialist consultation. They do expect symptomatic treatment in abundance for minor illness. Reconciling my own attitudes rooted in clinical effectiveness with the Gallic need for lots of medicines is still difficult. Although the generic names of drugs are similar, only

5 per cent are prescribed in this way and the trade names often bear no resemblance to British names.

I was shocked by the 'over-consumption', but as a patient here I have been overwhelmingly impressed by the speed and efficiency of the service. This exemplifies the issue that the French government is trying to tackle in its health reforms, which are being hotly contested.

Conditions of work

I have done a lot of weekends on call, which are hard work but pay very well. In my area this consists of receiving calls direct from patients and going to see them in their homes (remember that?). However, in cities out-of-hours work is increasingly covered by 'maisons mdicales' similar to UK call centres.

You are paid for what you do 20 euros for a surgery consultation, 42.60 euros for a daytime weekend call so historically there has been a perverse incentive to visit, which, now that doctors want more time at home, they are vigorously trying to reverse. However, old habits die hard and French hypochondriasis and faith in medicines is still alive and well.

Liberte

Singlehanded GPs are the norm in this area, often practising from their front rooms as in pre-NHS days in Britain. One doctor I visited practised in a dark room under the baleful gaze of a stuffed reindeer. As I have been told over dinner more than once, what the doctors want to avoid at all cost is to go the way of their British counterparts whom they see as mere government employees beholden for all they do.

However, they are slowly having to cede ground with new reforms encouraging patients to register with one doctor, not allowing free access to specialists without referral, and worst of all, introducing self-assessment for GPs.

Teamwork is unusual here and nurses and paramedical professions tend to work on their own. There is some competition for patients and this has led to protectionist practices that still persist.

Egalite

Most GPs see fewer patients and earn less money than their British colleagues. Taxes and social charges are high and the cost of living similar to the UK. Health care is universal and paid immediately by the patient to the provider.

Seventy per cent is reimbursed to the patient by social security and the remainder by insurance, which is usually paid for by the patient's employer. The chronically sick and those on low incomes are completely taken in charge by social security.

Fraternite

Our two children attend the local schools and are now indistinguishable from the local children. The education system provides revealing insights into the national character. Expectations are high and opinions are vigorously expressed.

Family life here is still very cohesive and children's views respected. Our quality of life is very good we live surrounded by peach fields, between the sea and the Pyrnes towering over the plain, snow-capped in winter. The climate is wonderful and the food and wine are daily pleasures.

Our farmer neighbours are kind and generous and we help each other le paysan fixing my chainsaw, and le docteur prescribing sleeping tablets to mix with feed to sedate the wild boar who were trampling his lettuce.

This would, the farmer was convinced, give him time at night to find his gun and shoot them while they were wandering around in a dazed stupor. Needless to say it didn't work but we had fun trying.

Resources

BMA booklet 'Working Abroad' gives detailed advice on documentation needed and addresses of offices in France (each dpartement has a separate Conseil de l'Ordre des Mdecins for registration)

Anglo French Medical Society

useful source of contacts and some jobs www.anglofrenchmedical.org

Chambre de Commerce at the French embassy booklets on buying property and working in France

'Living and Working in France', David Hampshire,. Survival Books invaluable advice on all things French

Peter Turkie is a GP

in Perpignan, France

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