in France


Doctors are not easy patients – or so we are told. That must be with reference to people who hadn’t experienced the French health system. I hadn’t either until an artificial hip joint inserted in London sixteen years before needed attention and I found myself consulting a professor of orthopaedic surgery in the ancient city of Montpellier.

I had encountered many professors when I was a medical student in foggy London nearly sixty years ago, then my professors were fierce, unapproachable demigods – with a few exceptions – one I remember well, the avuncular professor of obstetrics. On one of his teaching rounds I presented a case of post-partum haemorrhage – the patient, a wan lady, lay pallid on her bed; I recounted the story of her labour, but neglected to give the actual amount of blood loss – the professor turned to the attending ward sister, “and how much blood did she lose?” he asked, “eight hundred millilitres, professor,” she replied. “millilitres?” said he, “millilitres!” “Sister,” he continued, “this is Mr Larkworthy’s case, can we have it in pints?”

It was two years ago that I consulted the orthopaedic professor in Montpellier; he was an amiable sort with a twinkle in his eye. He replaced my wobbly London prosthesis with difficulty. Bone grafting was required and this meant a long convalescence in a Centre de Re-education, seven weeks to be precise. Four sessions of physiotherapy a day and an added bonus, an immersion course in French; I soon learned that the night time bottle I required was le pistolet and when the nurse asked me if I wanted to put on my baskets she was referring to my trainers.

I met my second Montpellier professor two years later. In the interim I had developed severe back problems due to narrowing of my spinal canal, spinal stenosis. The orthopaedic surgeon took one look at the scans my GP (generaliste) had ordered and referred me to the back professor giving me a reassuring pat on the shoulder as he murmured a less reassuring, “bon courage.”

The back professor was a neurosurgeon, equally charming, looked at my scans, explained in detail what needed to be done, offered me a date, delayed for a month because I had a minor heart murmur and he needed a cardiologist’s opinion.

My generaliste rapidly organised the heart specialist consultation. The heart specialist wanted a coronary angiogram (Prince Philip had one for Christmas); it was carried out two days later, pronounced OK, and I was admitted. Everything was done efficiently and remarkably quickly for a non-emergency situation. The operation and recovery went smoothly; I was discharged after nine days.

FLORENCE NIGHTINGALE SAID in 1859, “It may seem a strange principle to enunciate the very first requirement in a hospital that it should do the sick no harm.” She was referring to such complications as cross infection; she recognised the important role of strict hygiene; today there is the added complication of antibiotic resistance.

The international weekly, The Telegraph reported this that hospital acquired infections in the UK in 2010 reached a record of 42,712, nearly double that of two years previously.

In that hospital in Montpellier teams of cleaners conducted an unremitting war on cross infection. They did it properly, dawn till dusk; paying attention to nooks and crannies and not just a cursory wipe with a damp cloth. France leads Europe in combating hospital acquired infections.

The admirable qualities of the French health system are but one of the advantages of living in France. An article in last October’s British Medical Journal showed that the premature death rate in the United States is double that of France – we are talking about deaths which would not have occurred had healthcare been timely and effective; or put another way, if in the year 2006-7 America had performed as well as France, 84,300 American citizens might still be alive.

And if longevity is a marker, France, with 20,000 centenarians (UK has 10,000) is a world leader. My little town has its share, our two maisons de retraite have a sluggish turnover because their occupants take so long in shuffling off their mortal coils. Monsieur le Mayor says it’s our climat tonique which does it, I agree, but think that the local Côtes du Rhône Villages rouge plays a significant part.

IN FRANCE THERE ARE NO WAITING LISTS – how can this be? The answer, simple…waiting lists are a function of the availability of doctors and the availability of hospital beds. European Commission figures show that France has twenty five percent more doctors than the UK and twice as many hospital beds.

In the past decade The World Health Organisation has placed France first in the league table of quality of government health services – Great Britain came eighteenth and America thirty-seventh. You would think that such excellence would demand astronomical government expenditure, not so, French per capita expenditure on health is half that of the USA.

So is France a veritable medical paradise? To an extent, but as is the case with all human endeavours faults are bound to occur and standards will vary, particularly in peripheral and remote facilities. The crise financière is biting, patients can no longer shop around for doctors, they have to nominate and stick to one – their médecin traitant.

I am personally concerned because my excellent generaliste retires this year and there is no prospect of a replacement; young doctors prefer working in the big cities and not in a backwater in the countryside, no matter how attractive.

However, while I’m at it, there is one tip I must pass on to UK expats… keep up your National Insurance contributions. You will safeguard your state pension and if you decide to retire in a European Union member country, like France, you will be automatically entitled to its state healthcare.





“Come sit next to me”, he said with a warm smile as he gestured towards a beautiful Louis XVI chair at his side – honoured I sat – it was Khalid, the king of Saudi Arabia and it was 1979.

   I was a consultant in the royal hospital, The King Faisal Specialist Hospital in the capital, Riyadh. King Khalid had consulted me – he was pleased with the outcome and I was grateful that providentially I had brought from the UK a supply of a newly available drug which solved the King's problem; which although not serious, interfered with his life and royal duties.

   We didn’t talk about affairs of state, he talked about a memorable journey he had taken as a young teenager when after boarding a liner in Jeddah – the great Red Sea pilgrimage port – he voyaged to Liverpool and then by the Royal Train to London.  He’d never seen a steam train and London astounded him. He met the Prime Minister, Stanley Baldwin, and members of the royal family.

   He asked me for my views on his Kingdom, I gave them… but only the positive ones – he beamed and said, “Now you need to examine me”, “Yes, Your Majesty,” I replied, “But I must first pray and then have a siesta. Doctor, you can have a meal”. After the King left the room a heavily perfumed young man took me by the right hand and led me away.

   I found myself in a vast dining room; sitting alone at the head of a table, glass-topped with carved golden legs – it was laid for three dozen, gold cutlery, gold plates and gold goblets even the curtains were gold. I was attended by three smiling negroid male servants in gold embroidered blue-velvet waistcoats and brilliant white thobes -- which contrasted with their jet black hue, “descendants of African slaves, no doubt", I thought to myself. The food was standard Saudi fare: freshly squeezed orange juice, thin spicey soup, one whole goat lying on a bed of rice on a huge platter with its head lolling to one side. For dessert, Umm Ali - Mother of Ali - which was for all the world just like my mother’s bread pudding…




  “Come sit next to me”, said the Saudi police colonel to my wife, Maria, as he pulled a chair towards him at his desk.

   I was in jail on a trumped up charge of making and distributing alcohol in the form of home-made wine. Maria, believed that because she was so much younger than me she could better survive a prison sentence. She had made a written declaration that she alone was responsible for making the wine.

   The colonel was grey-haired, kindly and friendly. He turned to Maria and in almost a whisper said, “If  two people commit a murder two people are executed for that murder. If two people make wine, two people go to jail for making wine. Your husband has already confessed to making the wine. You cannot help him. He is already in jail.”

   He tore up Maria’s deposition.

   “Now I want you to tell me that you didn’t make the wine and never, ever, change your story, no matter what happens, because that is what I am going to put in my report.”

   As Maria sat outside the colonel’s office waiting for a lift home a familiar figure shuffled past, head bowed, wrists handcuffed, ankles shackled, five-day growth of beard. He glanced at Maria; no sign of recognition in his haunted eyes; a policeman tugged at his elbow to keep him moving – it was her husband, her beloved Bill.

“WHAT ARE THEY DOING TO HIM ?” a voice screamed in her head…


Latest comments

09.05 | 00:44

Mike, I am Maria, widowof Bill. I have been out of touch with your mum Plse can i have news if you get this. I had fun with your Dad and pray for him.

16.08 | 12:56

Thank you, and how are you now?

16.08 | 12:00

You were a beacon in my gloomy journey with UC! I loved coming to see you!

16.08 | 11:58

Yes I was!!! I was 7 and a half when I started seeing you for post hospital Ulcerative Colitis and stayed under your care for years till late 90s! Mom says hi!

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