Ritchie on French health care system

He is remarkably ill informed, isn’t he?

The French model is built around an absence of GPs

Err:

France

In France, the médecin généraliste (commonly called docteur) is responsible for the long term care in a population. This implies prevention, education, care of the diseases and traumas that do not require a specialist, and orientation towards a specialist when necessary. They also follow the severe diseases day-to-day (between the acute crises that require the intervention of a specialist).

They have a role in the survey of epidemics, a legal role (constatation of traumas that can bring compensation, certificates for the practice of a sport, death certificate, certificate for hospitalisation without consent in case of mental incapacity), and a role in the emergency care (they can be called by the samu, the French EMS). They often go to a patient’s home when the patient cannot come to the consulting room (especially in case of children or old people), and have to contribute to a night and week-end duty (although this was contested in a strike in 2002).[citation needed]

The studies consist of six years in the university (common to all medical specialties), and three years as a junior practitioner (interne) :

the first year (PACES, première année commune aux études de santé, often abbreviated to P1 by students) is common with the dentists, pharmacists and midwifery. The rank at the final competitive examination[10] determines in which branch the student can choose to study.
the following two years, called propédeutique, are dedicated to the fundamental sciences: anatomy, human physiology, biochemistry, bacteriology, statistics…
the three following years are called externat and are dedicated to the study of clinical medicine; they end with a classifying examination, the rank determines in which specialty (general medicine is one of them) the student can make his internat;
the internat is three years -or more depending on the specialty- of initial professional experience under the responsibility of a senior; the interne can prescribe, he can replace physicians,[11] and usually works in a hospital.

This ends with a doctorate, a research work which usually consist of a statistical study of cases to propose a care strategy for a specific affliction (in an epidemiological, diagnostic, or therapeutic point of view).

An absence of GPs, yers.

And this is great. When corrected he tells us:

Your arrogance reveals the folly of posting your comments

I’ll remember not to do so again

76 comments on “Ritchie on French health care system

  1. I left this comment which will probably not appear

    Yesterday I went to see my French GP. He was not absent. In fact there are French GPs per capita than there are English GPs. Probably because they are not overpaid as they are in the UK.

  2. There are GPs in France. Is the healthcare model built around them?

    Is this guy wrong?

    As someone with an MA and PhD in Social Policy and Administration, who studied the NHS in some depth, and compared it with other country’s healthcare systems, I confirm that the Tories are NOT moving us towards the French system, but the _American_ one pre-’Obamacare’, when over 40 million US citizens (12.74% of the total population) were without any form of health insurance, and were dependent on Emergency Room treatment for medical care. Health care costs were, and are, the single biggest cause of personal bankruptcy in the US. Yet the USA spends a higher percentage of its GDP (17.2%, $8,608 per capita, or $2.7 trillion in 2012) on healthcare than we do. If the EU agrees to the TTIP, the process of NHS privatisation will be complete, and furthermore, will not be reversible, which is what the Tories must be hoping for, and why the TTIP must be opposed. (That will be spoiled somewhat if we withdraw from the EU, but we will stay in at least until 2017.) – See more at: http://www.taxresearch.org.uk/Blog/2014/08/20/the-nhs-and-private-medical-care-do-not-mix-why-isnt-that-obvious/#comment-area

  3. “Is this guy wrong?”

    Almost certainly: look

    ” someone with an MA and PhD in Social Policy and Administration.

  4. “Is this guy wrong?”

    The basic feature of the US system is that the patient pays through the nose, either indirectly in huge insurance premiums, or directly if they aren’t insured. In the UK there isn’t even the suggestion that patients should pay.

  5. Arnald,

    Of course he’s wrong, and has no brain, he’s a Socialist at the age 57. Anyone that age with half a brain would have learned that Socialism always fails.

  6. Bloat

    Tosser.

    Andrew M

    Direction of travel

    Rob

    Worstall is uneducated in comparison. Yet you’d suck him off

  7. Would I really? Hmm, don’t think so. Maybe some of your sexual frustration coming through there and projecting onto others.

    You consider an MA in some Sociology-related bollocks an ‘education’? I suppose if you don’t have one, as you clearly don’t, then anything must sound impressive.

  8. Arnald

    In this case, the chap you cite is a moron. We are not heading towards pre-Obamacare US style healthcare*. The current NHS reforms are stupid, but no one is suggesting that we should go to a system where we rely on private insurance + basic care via ERs at county hospitals + medicare/medicaid. The NHS remains responsible for all and private providers will provide services to the NHS.

    I’m expecting the private providers to attempt to cherry pick contracts that will leave the NHS out of pocket – because the NHS has no true idea of costs. This is what happened under the last Labour government when they tried to introduce “competition” into the system. The latest GP centered purchasing organisations are likely to suffer from similar problems. Markets are good for efficiency when prices are informative, but I expect the new NHS reforms to show that the NHS buyers have no real grasp of costs. (This makes me far more cynical about the reforms than Tim).

    And seriously, social policy and administration? Basically, it means “moron”.

    * No one in their right mind would invent the US system.

  9. Another exchange with Ritchie:

    Me; “I think your claim that we are moving to the French mopdel is absurd” I have often noticed that your spelling goes completely to cock when you are on a foaming rant Mr Murphy.
    RJM: Mostly it’s using an iPad that actually does that
    But feel free to think whatever you will if it nurtures your own prejudices.

    That iPad of his really does seem to have a mind of its own!

  10. Ken,

    I think you are being unkind using the word “Moron”

    “I am 57 years old, I have a BA in English and American Literature from Warwick University, and an MA and PhD in Social Policy and Administration from the Universities of York and Kent respectively. I taught at the latter for a while, but have now had to give up work because of disability – I have Asperger Syndrome, OCD and epilepsy. One of the things that has made me really angry has been the way the present British Government has sought to portray people like me as ‘skivers’ and spongers off the taxpayer, and re-create the Victorian distinction between the ‘deserving’ and the ‘undeserving’ poor.”
    http://anewvisionofsocialism.blogspot.co.uk/

  11. Andrew K

    Anyone who claims that we are moving to the pre-Obamacare US system is a cretin. There are criticisms to be made of the NHS reforms but that isnt one of them. If he wishes to be treated even semi-seriously, as he clearly wishes to be -by proclaiming his academic qualifications, he should not make such absurd claims.

  12. I think it is a little more complicated than either the WGCE or Tim suppose. Yes, there are many GPs in France but the point is that if you are ill you would not automatically go to a GP. If your ears hurt, you go to the oto-rhino person. If your eyes hurt, you go to the ophthalmist. If you have a rash you go to the dermatologist etc etc. As the wiki article suggests, the French GP is there to cover general health issues rather than to act as the gatekeeper for the health service (ie the person who stops you getting proper treatment until it is almost too late)..

  13. When I needed treatment in France, I went to what is supposedly one of the best hospitals in the country. The standard of medical expertise I encountered was second to none; the administration and organisation surrounding it was laughably, symbolically, French.

  14. Ken,

    I don’t think I signalled the sarcasm sufficiently there. It comes across more in my (surprisingly allowed) comment on Ritchie’s blogpost.

  15. diogenes

    It may be different here in the south of France.

    My wife and I use the same “GP” and accept his advice as to which specialist to visit. The “GP” writes a letter of introduction and, if there is a degree of urgency, makes the appointment. Thus, through him, I was able to see three specialists within 5 hours of presenting myself at the surgery with extremely high blood pressure. Without the intervention, as in England, I would have needed to negotiate any appointment through receptionists.

    Incidently, the surgery’s three Doctors have no receptionist and only one accepts appointments. Home visits are available at extra charge, covered by our top up insurance. The system works well.

  16. I too am in the south of France (life is hard) and can agree with Gruntled66 who I am guessing is in the Pyrenees Orientales.

    I would actually call them super GPs.

  17. @ Arnald
    Blaber informs us that Ed Balls is fiscal conservative. He also tells us that he is disabled because he has a personality disorder, so when he tells us that medical bills are the largest source of US bankruptcies I thought I might check: he is wrong on that one too.
    http://www.factcheck.org/2008/12/health-care-bill-bankruptcies/
    There is no evidence that the Conservatives want to abolish the NHS and leave millions with no healthcare or to move to an American system: if they wanted the US system they would encourage PMI by restoring tax-deductibility of premiums.
    So yes, that guy is wrong.

  18. Andrew K: thanks for the entertaining link to Richard Blaber.

    A BA in English and American Literature from Warwick University, and an MA and PhD in Social Policy and Administration from the Universities of York and Kent may or may not be prestigious qualifications depending on your point of view.

    For my part, I think they’re rubbish but at his age, the chances are that the taxpayer paid for all this and via his local authority also paid a maintenance grant for his subsistence.

    Asperger (sic) Syndrome, OCD and epilepsy have meant that he was only able to work “for a while” so when he complains about being thought a skiver and a sponger he obviously overlooks the fact that his entire adult life seems to have been enjoyed at the taxpayer’s expense either doing nothing useful or doing nothing at all.

  19. I don’t want to make fun of this Blaber chap too much, as he’s got a triple whammy of conditions there, but sometimes you have to just recognize a crank as a crank.

    “In an authentically democratic socialist society, there would be no unemployment, and anyone who genuinely couldn’t work, whether through illness, disability or simple old age, would be adequately provided for without needing to cap in hand to some charity or the State. However, we can envisage several possible transitional stages before the ideal is achieved, and we must not lose hope of succeeding in obtaining it, just because each attempt falls short of the ideal.”

    The man’s a utopian. Such people aren’t much bothered with reality at the best of times.

  20. Gruntled66

    Thanks for your very informative post. I would just, however, like to check that if you were so inclined you could take it upon yourself to visit a specialist without need of referral from your “GP”. It is certainly what I have done in the past when laid low by ear infections. In any case, the idea of getting a “same day” appointment with a specialist is unthinkable in the UK.

  21. diogenes
    August 21, 2014 at 4:01 pm
    ..
    , the idea of getting a “same day” appointment with a specialist is unthinkable in the UK.

    Not quiote your target but I went to my GP at 11am on a Friday having had blood in my urine after a run and by COB on Monday I had had a whole batter of tests and examinations, including a cystoscopy. The follow on checks were all through and timely.

    I also went once at 11:30 am with a knee problem and by 2:30pm I had had it x-rayed and diagnosed as arthritis.

  22. Arnald,

    I’d apply for your money back; that course on repartee was obviously a rip-off.

  23. “In any case, the idea of getting a “same day” appointment with a specialist is unthinkable in the UK.”

    Not at all. If you present at the GP with something urgent, you will be immediately referred to a hospital to see a specialist as an emergency appointment.

  24. I love the way Arsenald quotes some unqualified welfare-sponging head-case in support of Murphy’s contention that there are no GPs in France and then various Blokes pop up and say, “err, actually, I live in France and here’s how it works [you utter, utter cock].” This is a repeated pattern. Whether he’s dribbling on about tax policy or economics or science, someone here will point out where he is laughably wrong.

    I’ve said it before: Murphy’s ignorance is amazing to behold not just because of its depth but in the ecumenism of its reach. He really is omni-incompetent.

  25. BiCR

    I thought their my be a snappy antonym for omniscient, but sadly there isn’t so we’ll just have to live with using stupid and unknowing.

  26. Further re Blaber
    He claims in his profile to have taught at University of Kent. On another site favoured by academics, where someone who knows the truth might read it, his claim is that he was a *teaching assistant* from 1993-96 while a Ph D student.
    So it would seem that he hasn’t worked since mid-1996 when he was 39. His disability commenced when he graduated … So “retired academic” means “student given part-time job as a teaching assistant who didn’t get another job after graduating”. Nine years at three universities, 18 years on the dole.

  27. “The standard of medical expertise I encountered was second to none”. Impahssable – only in the US can on get a standard second to none: for evidence see many, many US bloggers on health cur.

  28. BwaB

    Well there is ‘omninescient’ which is not exactly snappy but it does mean ‘ignorant of everything’.

    It’s actually so close to ‘omniscient’ that I might deploy it over there and see how it goes down…

  29. Well I suppose the fact that most of my family is fucking French means nothing then. The assertion worstall makes is wrong.

    Even the wiki entry he’s quoted proves him wrong.

    As usual. Worstall is an incompetent blow-hard who you follow without question. You are laughable.

  30. and this is nonsense

    ““In any case, the idea of getting a “same day” appointment with a specialist is unthinkable in the UK.””

    why say it? oh yeah, tossers, that’s why.

  31. @Arnald (are you having trouble spelling your own name again? Try your shirt collar. Clue: It’s not St Michael)

    “getting a “same day” appointment with a specialist is unthinkable in the UK.” is, no doubt an exaggeration. It likely happens. But regularly.
    But take my own recent experience, here. Getting a GP appointment was three days. Test results took 10. I got fed up with the faffing about & got sorted during a 2 day trip to Lille. Like Spain, specialists make themselves available to the convenience of the customer.
    Note that word customer
    Patients not patience is the priority.

  32. Arnald – I live in France. I go to a GP when I am ill or have a problem. Almost everyone goes to a GP first, just like in the UK. If you disagree with this please explain why.

  33. I think that the LHTD really means – “in France, the GP is not the fund holder”. He didnt really mean “the French system has no GPs”. However, the way it is written is that “the French have no GPs”.

    LHTD = moron
    TW = pendant

  34. ken
    he said the system is set up in the absence of GPs. That is a correct statement.

    Frederick

    It’s a different system. So worstall is wrong. GPs are different to docteurs. Their role is more than medical.

  35. A friend of mine is a GP, in France. I’m at her house as I write. I showed her this and she did that Gallic shrug and laughed.

    Murphy is very stupid, and I’m sorry but this Blaber character is virtually the dictionary definition of an old time village idiot. They give people like that MAs now? Our country really has had it.

    I’m mystified as to why ‘Armald’ would be calling in evidence most of his “fucking French” family to support his hero when it shows him to be either untruthful, or stupid, or both.

    Oh. Hang on.

  36. Arnald: Well I suppose the fact that most of my family is fucking French means nothing then.

    You’d have to admit it’s not very elegantly expressed and semantically rather adrift but if I understand you correctly I’m very sorry for what happened.

    I tried it once myself. Was OK. Didn’t need to see a doctor afterwards so my experience better than your family’s.

  37. By the way, French GPs take my payment (via my carte vitale and debit card) at the end of any visit so you can also state that they do more than “medical”.

  38. @ Armald
    What he *actually* said (I am pasting from his blog) was:
    “The French model is built around an absence of GPs”
    Your statement is false, as was his.

  39. Interested in France, I was referring to some knob saying others had more experience because they live there. I have lived there and have extensive connections. What did you show your ‘friend’? If you have any. I’d probably laugh too.

    Meissen. So by changing every word in a sentence you come up with another. That’s hardly good wordplay. Try harder.

    http://www.rcgp.org.uk/campaign-home/~/media/Files/Policy/A-Z-policy/The-2022-GP-A-Vision-for-General-Practice-in-the-Future-NHS.ashx

  40. john77

    French docteurs are not trained as UK GPs are. They are different titles with different responsibilities. Jesus wept, this site is full of pointless pedants, why not now? You’re idiots.

  41. The dickhead formerly known as Arnald:

    Nobody cares if you and your poxy family were hereditary glass collectors at the fucking Moulin Rouge–the French have GPs –be told you socialist fuckwit.

  42. Murphy has now added “The elimination is of the need to see a GP before a specialist.
    UK health care is 2% of GDP cheaper because we require that
    That was what I meant”
    After denouncing my “arrogance” for stating that.

  43. And now we’ve got the Indie publishing this: http://www.independent.co.uk/news/uk/uks-healthcare-ranked-the-best-out-of-11-western-countries-with-us-coming-last-9542833.html

    Which was produced by these nice American chaps: http://en.wikipedia.org/wiki/Commonwealth_Fund

    What’s the bets that they’re a bunch of leftie doctors trying to push the US towards the NHS model??? (as the rest of Europe runs screaming)

    And having first-hand experience of UK, NL and CH systems, the UK is by far the worst.

  44. “That was what I meant”

    I don’t understand why he can’t just say what he means in the first place, like any other ordinary person who wants to reorganise society in his image would do.

    Heaven forfend he ever get near drafting of legislation……

  45. @ Armald
    “The studies consist of six years in the university (common to all medical specialties), and three years as a junior practitioner (interne)”
    Looks remarkably like the training to become a GP in the UK!
    Medecin generale sounds like a translation of General doctor and the list of responsibilities looks remarkably like those of an English GP

  46. Arnald: So by changing every word in a sentence you come up with another. That’s hardly good wordplay. Try harder.

    I didn’t change anything but I did assume when you wrote – Well I suppose the fact that most of my family is fucking French – that you had left out a word by mistake. Something like “children” or “carriers”.

    The latter seems altogether more likely since, sadly, you show some signs of having reached the tertiary phase.

  47. Arnie – The description from Wikipedia is very similar to that of a UK GP. Basically they all go in, the smart ones work in hospitals and become consultant specialists, some become specialists and the rest become generalists.

    What is the difference. ?

    Oh I know, the UK GP can’t be arsed to do home visits any more since they conned Blair into paying them more for doing less. Now I see.

  48. Arnold

    Then we have something in common. My brother is currently in a relationship with a French. “Fucking French” is far too crude a phrase for me to use though.

  49. “What I meant was” followed by an explanation so far removed from the plain meaning of the original words that one wonders how he could possibly have meant that.
    He didn’t mean it! He reinvents meaning of words and sentences when even he realises what a bell – end he’s making of himself.
    So going straight to a specialist eats up 2% of GDP does it? Yeah, you go and show the authority for that statement.

  50. You still haven’t got it.

    The system is built around the GP in the UK. It is not in France.

    Freddy, no. That’s wrong. GP is specialist and central.

    johnny. No. You’re wrong.

    Ronny, I’m a dual passport holder.

    Meissy, it’s still not very clever. Par for the wannabe course. Piss yourself. You will. I pity your partner.

  51. @Ironman you know his position on actual studies…

    He just knows. Just like he knows that most patents and trademarks exist exclusively for tax avoidance.

  52. Arnald – My GP is not a specialist and is not central. He is in my village. He may have some particular expertise but he sees anyone and everyone.

    I think you are being a pedant in order to avoid admitting Murphy is an idiot. Also Murphy was wrong. You are trying to move to goalposts to a different question and even that is not working.

  53. GP is specialist
    Also black is white, the sky is lime green with polka dots, and air is heavier than water

  54. Arnald: “I’m a dual passport holder.”

    Schizophrenia ? Maybe he is Murphy too.

    Sorry. Could not resist.

  55. Isn’t General Medicine treated as a specialism in its own right? Don’t all become GPs, hospitals have specialist Generalists too. I once got treated by a consultant whose specialism was General Medicine … I think, though I was unwell at the time, so may not have picked up all the details correctly!

  56. So let me get this straight. In the UK all medical services are accessed via a GP initially, whereas in France you can (if you so wish) access any specialist you wish directly, or via a GP first if you require a bit more advice? It seems to me that the French system gives me (the patient) more control over my healthcare than the UK system, which allows the GP to erect barriers to my accessing what healthcare I need.

    NOW I under stand why RM doesn’t like the French system…….authoritarian little shits always prefer a system that allows the masses to be ordered about by their ‘superiors’.

  57. Arnald: Meissy, it’s still not very clever. Par for the wannabe course. Piss yourself. You will. I pity your partner.

    Meissy, eh? Gosh you’re a fast worker when it comes to chat-up lines.

    T’es un pauvre mec, Arnie

  58. “Andrew M
    August 21, 2014 at 11:36 am
    The basic feature of the US system is that the patient pays through the nose, either indirectly in huge insurance premiums, or directly if they aren’t insured. In the UK there isn’t even the suggestion that patients should pay.”

    Jumping in to this a day late as usual – but, if the patient isn’t paying, then who is? Because *that’s* the guy who gets to call the shots on treatment.

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