Healthcare in France vs. US: Tale of Two Doctor Visits

An anecdotal case for changes to US medical care

A Twisted Ankle

Last April I rolled my left ankle in an exercise class. It was one of those injuries where you immediately know the severity lies beyond a simple twist or strain; an injury that stops you in your tracks. In less than a second, I was in a crouch, my focus directed first toward my ankle, then toward my breath as I realized the pain was not subsiding and oxygen might prove useful. Without breaking stride, classmates and the instructor signaled to see if I was okay. I nodded and waved off their concerns as I limped to a bench.

Once home, I popped some ibuprofen, elevated my foot, and began alternating ice packs and heating pads as Google prescribed. I’ve had so few injuries in my life that I couldn’t rely on past experience to judge the seriousness of the damage. I decided to treat the problem myself for several days before consulting a doctor, and little by little, my ankle improved. This wasn’t a fast process. Three weeks out, I still had visible bruising on my foot, but the healing was going in the right direction. I returned to my exercise class, taking things slowly and gradually increasing the difficulty.

By the two-month mark, I was pain-free unless I happened to put considerable pressure on the lower end of my shin where it connects to my foot. My ankle would swell during the day but shrink overnight. Then one evening, I noticed the swelling was much worse than it had been, and the following morning, it wasn’t much better. My husband suggested I hadn’t been taking it easy enough, but when I considered my activities, I realized that I’d actually been more sedentary than usual. I’d spent much of the week at my dining room table, weeding out clutter in boxes and drawers from various crannies of our house. I wondered if the inactivity had caused the inflammation, and for the first time since the injury, I decided to call a doctor.

I wasn’t in pain and didn’t feel a need for an appointment. I just wanted an answer to a simple question. “Can inactivity provoke inflammation, even months after you’ve had an ankle injury?” Google’s results were inconsistent, so I called my medical clinic to speak with a triage nurse. She asked a few questions and said I needed to be seen. I explained that I wasn’t in any pain, even when I tested the range of motion of my ankle in every direction. I told her I walked frequently, attended exercise class, and that my ankle had steadily improved since I hurt it. She insisted neither she nor the doctor could answer my question about inflammation unless I came in.

When I arrived at the office late that afternoon, on what turned out to be an active day, the swelling had gone down, but the question persisted. I wanted to know whether excessive swelling might recur from time to time and if inactivity might provoke it. The practitioner I saw that day couldn’t answer my question, but she ordered an X-ray.

Two days later she sent me a message—the subject of which was Foot—in which she recommended getting an MRI. This was something we’d discussed during my visit, but an MRI would cost hundreds of dollars (even after insurance), and given the circumstances, I didn’t want to incur that kind of expense. Now she said that she was worried I had a “hairline navicular fracture.” The only way to know for sure whether this was the case was by getting an MRI. However, if I wanted, I could wait a couple more weeks. “If your discomfort is persistent across the top of your foot,” she wrote, “we should get the MRI.”

I’d never said I had discomfort across the top of my foot and when I googled hairline navicular fracture, I learned that none of the symptoms for such a condition aligned with what I’d experienced. So I replied that I wanted to wait. Then came a persistent barrage of phone messages to set up a return visit. The volley of calls and voicemails felt like harassment. I’d already indicated I was going to wait and see. And now our family had a far more important medical concern to attend to: my elderly mother-in-law’s health was rapidly declining.

At least one of these messages warned that if I didn’t act quickly, I could do permanent damage to my foot. What was now a hairline fracture could gradually expand along with increasing pain. Surgery would be required to correct the problem, but all of that could be avoided if I acted fast. My instincts told me that they were barking up the wrong tree. I wondered if somewhere along the line they’d misunderstood something I’d said, or misremembered the details of my appointment, or perhaps had me confused with another patient. To appease my pursuers, avoid the time and expense of an MRI, and hopefully obtain a definitive answer to my question, I scheduled an appointment with an orthopedic specialist.

Seated in the exam room, I filled out an intake form on my smartphone, answering questions about my symptoms. It was long. The extensive survey asked me about my level of pain in performing various functions (no pain), what my chief complaints were (no complaints), how I was injured (rolled my ankle), previous injuries (none), impacts to my mobility (none), pain relievers I was taking (none), whether the problem was chronic (no), whether my ability to bear weight was impacted (no), and so on. By the time I finished filling out the form, I was thinking what the heck am I doing here?

The doctor came in and (to his credit) appeared to have glanced at my self-assessment beforehand. He examined my foot and ankle, pressing here and there, and pulled up my X-ray. He pointed at the junction between my leg bone and foot and said I had a small avulsion fracture. This occurs when a tendon or ligament pulls off a small chunk of bone at its attachment site. Swelling could come and go for months and inactivity could indeed make swelling worse. He recommended I continue what I had been doing and then left. His elapsed time in the room? Around 5 minutes, but at least I got the answer to my original question.

Total cost: $1,500 billed to insurance

Patient balance: $717.14

But hey, we have the best medical care in the world.

A Common Cold

My recent posts have centered on my arrival in France after several exhausting months of readying my house for rental and a taxing journey. That first night in an Airbnb outside Paris, when I laid my head on the pillow, I felt more tired than I’d ever been. I was relieved to have reached my destination and committed to taking it easy. I would be in France for four weeks and wasn’t compelled to rush about, visiting museums and monuments while I had the chance. I could take my time and slowly regain my energy.

Two days later, my daughter arrived. She was about to begin a graduate program at Sciences Po. She didn’t need help moving into her rented room and didn’t place demands on my time. She, too, was worn out, would be in France for two years, and wanted to take it easy as she settled into her new life. Nevertheless, we were in Paris, and we hadn’t been on a trip together where it was just the two of us since she was little. So, most days, we squeezed in a short outing and a meal together.

By the end of my first week in France, I’m normally over my jet lag. On this trip, however, I was still fighting extreme fatigue. Around day 9, I sensed the onset of a cold. I stocked up on liquids, broke out my travel packs of Emergen-C, picked up some nasal spray at the pharmacy, and a large container of chicken soup at a nearby Chinese deli. Disappointingly, my symptoms worsened, while my body alternated between too hot and chilled. I didn’t have a thermometer to take my temperature but figured I probably had at least a mild fever.

On a trip to France in 2015, I’d actually contracted pneumonia. I didn’t want that to happen again. The current cold was in my sinuses and throat, but I decided I should see a doctor before it reached my lungs. One morning, a week after my symptoms began, I spent 30 minutes Googling, reading online reviews, and studying appointment calendars until I settled on a Dr. Lemire (not his real name), whose office was close to my place.

Although Dr. Lemire’s appointment schedule showed an opening late in the day, I still needed to call the office to schedule a visit. A woman picked up, confirming I’d reached Lemire’s office. I explained I was a tourist who was on the seventh day of a cold that was getting worse. She told me to call back at quinze heures, 3 o’clock. I confirmed the time and we both hung up. Our exchange wasn’t what I’d expected, but in 2015, I’d already learned that the medical system in France is very different from the one in the United States. It was best to let go of preconceived notions regarding what would/should take place.

At 3:00 sharp, I dialed the phone. This time a man picked up. Allô? Then nothing. Had I misdialed? C’est le docteur? I stuttered. Oui. Then nothing. I repeated my earlier spiel, providing a few more details in the hopes of emphasizing urgency. He asked if I could come at dix-huit heures, 6 o’clock. Oui. Merci docteur. He hung up without even a tout à l’heure.

When 5:30 rolled around, I donned my shoes and wound my way down the long spiral staircase of my apartment building. Lemire’s office was about a half-mile away, but when I arrived at the specified address, I found myself standing in front of a normal-looking apartment building. There was no signage indicating a doctor’s office lay within, just the customary facade of locked double doors, through which only residents with a key gain access.

I scanned the list of tenants next to an intercom, found Lemire’s name, and pressed the button to be buzzed in. Only there was no buzzing sound, no click of a bolt retracting, nor did anyone speak to me through the intercom. I wondered if I should text the number I’d called earlier to say I was outside, but first decided to test the door only to discover it had silently unlocked and was easily pushed open.

Now standing in the building’s foyer, I again searched for some indication of where to go. The address of the office hadn’t included an apartment number. There were no signs indicating which way to head, just a wall of mailboxes. One was labeled Lemire, but held no clue as to a floor or room number. Just as I was about to text the office, an old woman came in and as she retrieved her mail, I asked if she knew where the doctor was located. Premier étage (the second floor), so up I went.

When I reached the landing, I faced another locked door with a buzzer that once pressed, provoked another completely silent unlocking. I pushed and entered what looked like a normal apartment corridor with a few doors on either side. Once again, there was no indication of where to go or that I was in a doctor’s office. To save me some typing, you can assume from here on that the walls were basically bare. There were no medical posters or mounted notices asking if you feel safe; no privacy assurances, check-in windows, or masking guidelines; no directional arrows or biohazard warnings; no handwashing instructions or reminders to get vaccinated. Rien!

As providence would have it, through the first door on the right was a small room with a few people sitting inside. A waiting room, about 6’ x 10’—and this one was spacious compared to the one I was in, in 2015. A mother and daughter sat on the far side of a coffee table piled with magazines, the teen whispering in her mom’s ear. Another woman fixated on her phone at one end of the coffee table. I picked up a magazine and sat in a corner at the opposite end. To say I was away from the group is a stretch considering the size of the room but I was as far as I could get, not wanting to spread germs.

As we sat there, we could hear the doctor talking to a patient in a room down the hall. No doors had been closed. Focusing on a story about Afghan refugees, I was able to avoid eavesdropping, but if I’d put my mind to it, I suspect I could have determined the reason for the visit.

As the patient was leaving, the doctor poked his head into the waiting room and surveyed his charges. Are you the woman I spoke to on the phone? he asked me. Yes, that’s right. He beckoned to the screen addict and the two headed to his exam room. A third woman arrived. And when the doctor returned for his next subject, he explained that he would treat everyone else first, saving me for last. They would be faster and I was his last appointment, he politely explained. They also looked perfectly healthy while my shriveling airways felt ready to rip.

Finally, it was my turn, but in fairness, I’ve had to wait longer for some appointments in the United States, even when made months ahead of time. Anyway, I wasn’t surprised when le bon docteur led me through his office—past a large antique desk with two visitor chairs—to a side room that had an exam table. All doors between rooms remained open.

There was no monkeying around. No weigh-in or changing into a gown. Lemire tore off a fresh piece of paper to drape over the exam table and asked me to install myself atop. So began the exam. Much of it was familiar, like the wooden tongue depressor that provoked a gag as he shined a light in the back of my throat and the blood pressure cuff he wrapped around my bicep (a task that is way beneath the pay grade of a U.S. doctor). Surprisingly, he didn’t take my temperature. But he did listen carefully to my breathing to see if he could detect signs of an infection in my lungs. What do you know? Apparently, those stethoscopes can hear just as well through a blouse as they can a hospital gown.

He asked many questions and listened carefully. Unlike my appointments in the US, none of this was being recorded. He wasn’t writing it down. He wasn’t typing into a computer as I spoke. He was looking me in the eyes, listening intently, and sizing up the situation, plumbing the depths of his seasoned white skull to decide a course of action. The verdict was a sinus infection that had not descended into the lungs but was wreaking havoc on my throat, ears, and trachea.

We returned to his office and he motioned for me to sit while he positioned himself behind his computer, entering me as a new patient. “How tall are you?” he asked. Wait a second! He actually expected me to know my own height? This was unbelievable. In the United States, height is an extremely vital parameter that cannot be screwed up!!!! So important in fact that, at the clinics I go to, a trained medical assistant measures every patient (from newborn to centenarian) on every single visit.

I found the inquiry endearing. He actually trusted me to know something about myself without verifying. I rarely get this impression from US doctors. Since I didn’t know my height in meters, however, we went back into the exam room where he measured me and took my weight. Back at his desk, he gathered more information and then told me he was prescribing four medications: an antibiotic, a nasal spray, acetaminophen, and a four-day, low-dose course of prednisone. He explained the reasoning behind each drug and went over the usage instructions. He then handed me a bill for 50 euros. That’s the equivalent of $58.67.

I pulled out a VISA. Désolé Madame, il faut payer en espèces. He only took cash! This makes perfect sense because he rarely has to deal with payments, so why go to the trouble and expense of setting up credit card support. The problem was that I didn’t have 50 euros on me. He wasn’t a bit concerned. He said he’d be there the following day, starting at 8 a.m. I could come at any time and he would have the added benefit of seeing how I was doing. If I didn’t feel well enough, I could come on Monday. He had no concerns whatsoever about me stiffing him.

He walked me to the door as I thanked him for his services. We were the only two left in the office and I wondered who the woman had been when I’d called earlier. Perhaps Mme Lemire? I imagined the two of them sharing an apartment on the other side of the landing and small flat somewhere along the Riviera where they escaped to on a regular basis.

Don’t get me started on the relaxed pace and convenience of French life. Have you heard the expression ville du quart d’heure, or 15-minute city? The idea is that all of your basic needs should be met within a 15-minute walk of your home. Saint-Mandé, where I was staying, is a shining example of this objective. But to tell you the truth, so is every other city in France that I’ve visited. And thus, the pharmacy was located one door down from the doctor’s building entrance.

When I walked in, there was one woman ahead of me and I had to wait a few minutes for her transaction to finish. I then stepped up to the counter, greeted the pharmacist (never forget that first bonjour), and handed him my prescription list. He disappeared into a back room, was back in less than three minutes with all of the drugs. None of them were labeled with my name. But everything was pre-packaged with usage instructions and warnings. There had been no counting out of pills. In some cases, I would probably use all of the meds. In others, I’d have some left over. He rang me up. Only 28 euros! And I left the pharmacy five minutes after I walked in.

Total cost of exam and medications: $92

So go the horrors of socialized medicine.

Endnote

Two and a half days later, I abandoned my self-imposed quarantine, met my daughter for breakfast and then headed to La Monnaie de Paris, the oldest continuously running mint in France, which was hosting a spectacular exhibition on how money, wealth, and capitalism are portrayed across two centuries of bandes dessinées. And in case you were wondering, my ankle swelling days were behind me, despite more than a week of inactivity.