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General practice in rural France

Year: 2001
Setting: Mauvezin, France
Position: Private general practitioner

I have been living in Singapore for six years, but this year I have spent my summer differently. I received a call from a friend looking for substitute doctor in a small town near Toulouse. July is coming to an end and so is my assignment. It has been a demanding and rewarding experience. On the rewarding side, it is the first time that I work in a single-payer health-care system in a rural setting and I learn a few things about its modus operandi. On the demanding side, I have to deal with some unique professional challenges.

My work is organized as follows: In the morning, I see patients in the office. Most of them have made an appointment, but others just pop up any time and I have to squeeze them into my schedule. This is because French law mandates that a doctor cannot refuse to see a patient under any circumstances. It is disruptive, but I get used to it. Three times a week, I spend the afternoons making house calls in the countryside. The itinerary is organized by the secretary and she tries to create a logical flow from one patient to another. At first, I do not know what to expect but patterns begin to emerge. I deal mainly with renewal of prescriptions for chronic diseases such as hypertension, diabetes, arthritis, cardiac diseases, thyroid hormone replacement, etc., and conditions of people who are not totally autonomous for age-related or medical reasons. I am amazed by the ground I cover and the mileage I accumulate over a one-week period.

However, the most difficult part is finding the patients. I am equipped with a mobile phone but the landscape is hilly and, at the bottom of the valleys, communication is often interrupted. It means going to a hilltop before calling when you are lost! And getting lost is not a rare occurrence. There are no names for small roads and there are no house numbers. Consequently, GPS is no help. So, typically the directions I receive on my agenda go like this: “After a haystack bigger than usual (?), you will see a meadow with cows on the right-hand side. Make a left at the next crossing.” Sure enough, the haystack is gone or the cows have been moved to another meadow, or I am on the wrong road altogether. In those cases, I call the secretary who asks me: “What do you see around you?” I have to describe whatever I think would be landmarks in the vicinity. This can be difficult if you are a city person and do not know botany or agriculture very well! In the end, it all makes for a good laugh, but in the moment a feeling of frustration can build up rapidly. All in all, my stay in Mauvezin proves to be an enriching time personally, professionally and financially.

Lesson for the doctor: The practice of medicine comes in different colors and shades. Finding the one you like the most may be a long process.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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