Going to the Doctor Abroad: France

Welcome to my new Going to the Doctor Abroad series—a series of interviews with expats living abroad about how healthcare differs in their adopted country. The experiences below belong to the interviewees and may not be representative of every person’s experience. Love it? Hate it? Find it useful? Let me know.

Today, my fabulous friend Dani, an American expat living in Paris, a former medical professional, and a new mother who has just gone through the entire pre- and post-natal process in France, is here to tell us about healthcare in France.

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First, tell us about you.

My name is Danielle Tellez Perrin and I am an American in Paris married to a charming Frenchman. Before being whisked off to the land of baguettes and wine, I was a Pediatric Emergency Room Nurse. Due to complications of transferring my nursing license, I changed careers and currently work as a Business English Teacher in Paris. Crossing the pond has enabled me to indulge my wanderlust traveling the world, embrace the café culture people watching, and take my relationship with French wine to a more intimate level.

How is healthcare different in France than in the US?

The most obvious cultural difference between France and America is that heathcare is considered a right. There are no financial restraints or insurance policies that affect your medical care. Social security complemented by a mutuelle covers medical appointments, pharmaceuticals, and all medical treatments.

Another difference is that customer service is not part of the French medical standards. The medical professionals are polite and professional but aren’t necessarily going to go out of their way establish a relationship or offer you a cup of coffee. The French believe the patient is there for medical attention, so the healthcare providers directly attend the medical need at hand and send the patient out as soon as possible. When I had a throat infection, the doctor asked questions relevant to my throat, assessed it, and wrote a prescription…I was out in 10 minutes. There was no small talk, conversation, or asking me if there were any other ailments or concerns.

Another obvious difference is the bureaucratic set up of the French system. In America there is a continuity of care. One good example of this is with pregnancy: the mother-to-be establishes a relationship with her OBGYN/midwife and that person is continually involved throughout the process. In contrast, the French take a bureaucratic approach. I would go to one office for my monthly blood test, another office for my echographs, the hospital for my monthly medical assessments, and local midwife for my preparation/prenatal yoga classes. Then when I went into the hospital to give birth, I was attended by a medical team working the shift, much like an emergency room setting. Your delivery is attended by whoever is on call, there is no prior relationship (though, of course, the hospital provides them with your medical files).

There’s also no medical malpractice here. If you slip and fall at the hospital, you’re responsible, not the hospital.

Talk to us about average run-of-the-mill doctor visits. How do they work in France? How are they different from the US?

Medically speaking, there is little difference between French and American doctor visits, as they are both based on westernized medicine. On a cultural level, customer service is not part of the medical standards. They are polite and professional, but not necessarily friendly like in the US. They are direct to attend to the medical need at hand.

Let’s talk about specialists. How do you get in to see a specialist if you need to?

Neither my French husband nor myself have needed a referrals to see a specialist (dermatologist, OBGYN, midwife, homeopathic doctor), but our experience is limited as we have not needed much medical attention. As a nurse, I imagine that some medical conditions do require a referral for a specialist (this was confirmed by one of my French friends).

Any tips for finding English-speaking doctors in France? How usual is it for doctors to speak English?

The American Embassy as well as other websites like AngloInfo provide a list of doctors and specialists. I found my OBGYN through a recommendation from a coworker. In my personal experience, all the medical professionals I have come in contact with have been excited to practice their English with me or were very patient with my French.

Let’s talk about pharmacies and prescriptions.

The pharmacy process is very similar to the States in that I give them the prescription, they fill it, and then they take my card vitale (social security card) and mutuelle card in order to charge it to my insurance. I have never had to pay a co-pay while using both cards, but I’ve also not had many prescriptions in France, so my experience is limited.

In an emergency situation, what is the protocol in France?

For emergency medical attention requiring immediate hospital assistance, you dial 15 (the French equivalent of 911).

For non-life-threatening, but urgent medical attention, you can call SOS Medecin and a local doctor will arrive at your home to attend to your medical needs. I have not personally used this service, but my elderly neighbor, who was too ill and weak to leave her apartment, was attended by SOS Medecin, which is covered by the securite sociale.

And for non-emergencies where you still need to see your doctor right away, you can come in during certain non-appointment hours where they see people who need same-day treatment. It is on a first-come first-served basis, which can mean a wait. My primary doctor offers hours same-day illness visits from 8:30 -11:30 and I arrived at nine and waited until 11:15 to be seen.

How is a hospital visit different than in the US?

The food is AMAZING! Lamb shank dinners, steamed leeks, roasted pork, rhubarb tarts, fresh fruits, and (of course) cheese with every meal. According to my sister-in-laws, some hospitals even offer wine and Champagne. I also had a private room with a view of the Eiffel Tower and a gothic church…can’t beat that.

Another difference is that it’s not customary in France for for family members or friends to be at the hospital waiting for a baby’s arrival (which is how my mom found herself alone for 20 hours in the waiting room). And the waiting rooms are far from friendly, with small with not-comfortable chairs, no TV/magazines, no complimentary coffee, and not even good lighting to read a book/magazine.

Finally, based on my stay for and after delivery, much like the US, there are set visiting hours for shared rooms (but not private rooms) on the maternity floor. The private rooms also allowed one person to stay the night, providing an extra bed for a €30 fee. Sadly, flowers were also not allowed in rooms…which was a shame.

What about homeopathic practitioners, acupuncture, and other non-medical treatment options? Are they accessible? How do you go about finding them? How are they different from the US?

Yes, all the alternative medical approaches listed above are available. During my first trimester of pregnancy, I saw a homeopathic practitioner without a referral. Acupuncture was offered to pregnant women by appointment by the hospital where I gave birth.

What about health insurance?

Everyone in France has basic healthcare coverage via securite sociale. However, to extend our healthcare, my husband I have a private mutuelle, which adds further coverage. Mutuelles cost between €40 – 100/month. And when it comes to payment, you write the doctor a check, they give you a securite sociale form, and you mail the form in to get full reimbursement at the end of the month.

Can you tell us about your experience with the health system during your pregnancy?

Financial support from the French government is a big aspect of socialized healthcare that is different than the US. The French government has a program (CAF) that provides families with financial aid. They give a monthly allowance (based on salary) for the first three years to help cover childcare and/or baby supplies. This program also gave €900 in my seventh month of pregnancy to help prepare for the baby (buying furniture, clothes, supplies) and provides for 16 weeks of paid maternity leave. I also have the option to take up to one year of parental leave and my job will be waiting for me. The father is offered 11 days full paid paternity leave with the option of one year off without pay as well.

Another important difference when it comes to pregnancy is that you have to apply to the hospital you want to give birth in nine months in advance. This guarantees that you’ll have a maternity room and priority care once the little one appears. If you don’t sign up in advance, when you show up at the hospital in labor they can transfer you to another hospital if they’re full…a scenario my mother witnessed a few times while she was in the waiting room during my own labor.

Once you’re registered with the hospital, they provide 10-12 free classes in preparation for your birth. They also provide services like maternity swim aerobics, acupuncture, sophrology classes, and various other consultations. I opted out of the hospital’s services, as it was far from my apartment, instead signing up for preparation courses and pre-natal yoga classes with a local midwife, which was also fully reimbursed. Essentially, the mother has freedom to choose where and what classes she wants to take and it’s all fully covered.

Like the US, I was required to have monthly blood tests and check ups at the hospital but did not pay anything due to my security sociale and mutuelle. This also included my echography, which can be very expensive in the US.

One distinct difference in the prenatal care was a required consultation with the anesthesiologist regarding the epidural procedure. Regardless if you decide to give birth naturally or plan to have an epidural, all mothers-to-be are required to have this meeting in case of an emergency C-section (like mine). During this consultation, the doctor collects your medical history and baseline vital signs as well as educating you about the process. As a nurse, I greatly appreciated this aspect of prenatal care because the anesthesiologist had my medical history and baseline on file beforehand…instead of trying to get it from me while I was in the pains of labor. It is also smart to have this consultation in advance as it empowers the woman and informs her what to expect when and if she decides to have the epidural instead of trying to understand what they are doing as they are sticking a huge-ass needle in your back.

Labor & Delivery
As for labor and delivery, the first noticeable difference on the delivery floor is that there are no wheelchairs. The French view this stage of labor as a natural human process, not an illness or medical condition requiring special treatment. So the woman (and her family) are responsible for getting her where she needs to go, labor pains or no.

The ambiance of the delivery room is also noticeably different. Instead of a warm, welcoming environment where the medical equipment is complimented by pictures on the wall, a TV, and a couch, my room had a cold and sterile medical ambiance with one chair for my husband, no warm colors, no pictures on the wall, a small tinted window, and no TV. Essentially, the French believe that the room has a medical purpose to deliver the baby; that’s it. Luckily, I had downloaded tons of movies into the iPad and had a playlist already set to liven up the room.

Another major difference is that only the husband is allowed in the room, but no one else. In other words: my mom, who flew halfway around the world to assist me, had to wait out my 20-hour labor in the waiting room. Luckily, she was able to assist me during my hourly walks in the hospital courtyard for the first 10 hours prior to my epidural.

Regarding the epidural…one thing I greatly appreciated was the French belief that women have a right to not be in pain and therefore can ask for an epidural as soon as they reach two centimeters dilation. After 10 hours of labor, I asked for mine. The only unfortunate thing is that when they do the procedure your husband cannot be in the room, which can be a bit daunting when you’re stressed with labor pains and they are about to stab you in the back with a huge needle.

The French also have a different approach to cesareans in that no one, including your husband, is allowed to come with you into the operating room. And although they show you the baby for a couple of minutes before whisking him/her off to be cleaned/weighed, you do not see the baby during your two-hour Post-Operation Recovery. Luckily for me, the surgeon was incredibly kind and allowed my husband to join me in the OR…which is unheard of according to my family members, French friends, OBGYN, and midwife.

Maternity Care
If you have a non-complicated vaginal delivery, you are required to stay in the hospital for three days and for a non-complicated C-section, you stay for five days. This set timeframe gives you time to recover as well as bond with your baby with medical staff to support and educate as needed. From a nursing perspective, I appreciate this required length of stay as it allows medical staff time to assess the physical, mental, and psychological state of the mother before sending her home.

As I mentioned before, there are no wheelchairs. As a new mom recovering from a C-section, they had me walking unassisted within six hours after giving birth. From a medical perspective, this is important as it helps empower the mom psychologically with independence. Walking shortly after a surgery also helps with a quick recovery and prevents DVTs.

And remember that maternity care here is not dictated by finances or insurance policies. There is no financial stress. Everything is covered. If you share a room with another mom, it is completely free and a private room is only €90 a night (and without any restrictions on visitor numbers or hours).

Postpartum
Two days after returning home, a local midwife visits the home for postpartum care…to not only do a physical assessment of the baby, but also the mom. Mine removed the remaining staples from my C-section cut and prescribed contraceptives and medications to compliment what was given at the hospital. She also returned a week later to follow up on both baby and me. This support is not only physically but emotionally and psychologically helpful.

One’s sex-life is also considered an important part of health according to the French. Therefore, all moms are offered fully covered perineum rehabilitation with a local midwife. I had 10 appointments where the midwife would educate/exercise my perineum muscles to help with physical recovery from childbirth, prevent incontinence, and return to a healthy sex life.

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Going to France?

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