American Medicine vs. French Medicine – Part 2

August 19, 2013

Once “melanoma” was diagnosed,  I was directed by the dermatologist to the big public Hopital Saint Louis of the assistance publique system that is stigmatized as  “socialized” medicine and dreaded by the Americans – an irrational fear, rather like fearing the devil, and constantly fed fuel by politicians who are obedient  to their masters in the health insurance industry. Since I knew Saint Louis was part of this system and I knew relatively little about it, I asked the doctor if I could be referred instead to the American Hospital in Paris, a private hospital known for providing excellent care. If you like, she said, si vous voulez, but the Saint Louis is the center in France for research into dermatological cancers. That sounded reasonable to me, so setting aside any misgivings I had about “socialized medicine”  – I had none theoretically, what about the care? –  I was off to Hopital Saint Louis, located in a working class neighborhood of the 10th arrondisment.

Time from first phone call to an appointment with the dermatologist,   1 week; time from that first consultation to diagnosis, 4 days; time from diagnosis to an appointment for surgery 1 week. Pretty efficient,  it seemed to me, and comforting, especially since a melanoma, like rust, never sleeps.

The Saint Louis is a sprawling urban campus anchored by the original hospital, which was built in 1607. Originally intended for the treatment of infectious diseases, it was sited outside the city walls; but now it is imbedded in the urban fabric of central Paris. The old building is stately, perfectly proportioned, and on the list of historic monuments. It is still in use. The New Saint Louis, across an interior roadway, is architecturally insignificant, though one senses that its designers were trying to be “original.” But inside New Saint Louis, the main lobby is spacious and light, roofed by skylights, but I  had the impression that all the corridors and offices seemed not quite “awake:” they were lit by the new low consumption bulbs, the ones with twists. The light, thus, was muted;  it  made an impression for in America everything would have been lit to the level of a supermarket. The most notable impression was that the air was not refrigerated. The day was warm and humid. The interior space was somewhat humid but just comfortable enough. The French clearly have different norms in respect to electricity consumption and thermostats. This is a choice. France, I hope I need not remind the reader, is a completely modern country, as technologically advanced as the United States.

I had had an “intake’ appointment with a general dermatologist the day before so my file was in order. I spent, perhaps, 10 minutes on a school-room-style wooden seat, comfortable but spartan,  in the muted light, (but perfectly adequate for reading, which I did: the Roman philosopher, Epictetus, thinking that if I needed to think about dying, I would need some help, and these old Romans, who could be executed at the whim of the emperor (and often were,) have a lot to say about such things. Since my melanoma has probably been caught in time, this reading was more preventative than a cure for an immediate emergency. Presently, I was called.

The surgeon was a diminutive young woman in her thirties, with tan complexion that in France usually indicates North African ancestry, either Tunisian or Moroccan. She was pretty, a comfort. if I must be carved on, especially on my face, I’d rather it would be by a woman, thinking that a woman perhaps has a greater appreciation for the aesthetics of the scar and that women have more delicate fingers. Dressed in surgical greens head to feet, she handled the procedure entirely on her own, without the help of a nurse, though I could hear one nearby attending to other chores. I noted that the doctor had covered her feet without removing her shoes; her heels, concealed in the green booties, tapped on the linoleum floor. This too comforted me. It meant that, like wonder woman, she could transform back into her attractive woman-self when this messy business of cutting, dabbing blood, cauterizing etc, was over. With a local anesthesia, I was aware of everything. The tache, the stain, on my face was about the size of a quarter, so it took some cutting. Being near my ear, I could hear, and have decided that flesh being cut sounds like very fine silk being torn slowly and carefully. The scar will be two inches long.

While she cut, we chatted. My French is just enough. People with my “northern” coloring are more likely to have a melanoma, she said, than people of her ethnicity, who are genetically more sun-tolerant. I asked if she did a lot of these surgeries. “This is my third today,” she said. It was 10:30 in the morning. Chit chat while the scalpel, then the needle and scissors, did their work. I asked when I should return for the removal of stitches. Not necessary. I would go to my neighborhood pharmacy and tell them I needed to see the “public nurse” who would come to my home to remove the stitches. What a system! Makes sense on every level. In America, the second visit to remove the stitches is another opportunity to waste hours in a waiting room and an opportunity to bill the insurance company. The insurance company, managing all this “care” from behind the scenes in Washington, is fine with such an inefficient arrangement. They’ve worked it out so everyone is making money.

In France, health care is not a hugely profitable activity and the services are not a “commodity.” This value choice, I believe, underlies is the difference between the two systems. According to the World Health Organization statistics, the French system produces better health outcomes than does the US system at a fraction of the cost.

She finished up. I changed back into street clothes.  A little blood dripped out from under the bandage. C’est normal. She gave me a package of gauze to compress against the wound and shook my hand. Plaisir, Madame, I said. Moi aussi, Monsieur. A handshake, and I am off to the cashier’s window to pay the bill. When I get it I am so shocked that I return to the surgical suite. “There been an error,” I say, in my clumsy French. “No, that is correct.” For two visits, the intake consultation and the surgery, 70 euros. About $100 dollars.

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