Hard shoulder

When younger there was a time when I found it difficult to differentiate between shoulder and soldier.  This could make it difficult when I was looking for something to dip into the yolk of my boiled egg. (British English joke there, bits of toast for dunking into egg yolk are called soldiers.)  Last year there was a time when I had a problem with my left arm such that I could not lift it above a certain height and was losing the use of it.  JTO reminded me of the Tommy Cooper joke:

Patient – Doctor, when I raise my arm above my shoulder it hurts.

Doctor – Don’t do it then. (4:15 in below but its worth watching it all)

However it was making washing my self difficult and was getting in the way of work.  So I visited the Doctor and some painkillers and anti-inflammatories later it was sorted.  At the end of last month I started getting pain in my shoulder putting my coat on which was getting worse, little by little.  When in Sarajevo it got so bad I couldn’t put my coat on at all by myself and by the end of the visit I couldn’t put my socks on either.  So on return back I went to the doctors.  Again painkillers and anti-inflamitories  and the problem went.  However, getting a similar problem twice suggests there is something of a more serious problem so I got referred by the doctor to a specialist.  First I had to get an X-ray and an Echograph.  Here you do not have to go to hospital for these.  There is a place, close to the next tram-stop on the ride into the city, where you buzz in to what looks like an ordinary residence, take the lift to the first floor and there is a waiting room.(Building with x-ray on the left, I wonder if there is any special shielding to protect the people above from the x-rays etc, the technician stands behind what looks like a lead shield whilst operating the machine.)  Both procedures were done and I took my results away with me, after I had paid of course.  Then this week, I visited the specialist on the first floor of another residential building just across the road from the x-ray doctors.  He looked at the x-ray, read the letter from the doctor and manipulated my shoulder and asked me to perform various tasks and decided there was a problem with a tendon for which I got a cortisone injection.  It is generally fine now apart from the odd twinge.

Two things come out of this tale regarding the difference between the French and British health systems.  The first is how much more of a role I play in the system.  I chose which Doctor to go to.  He prescribed drugs and an x-ray just as the equivalent probably would have d0ne in the UK, I went to the chemists and got the medicine and paid for it, again as in the UK.  However, for the X-ray I had to find which places perform x-rays, decide which to go to and then find a specialist and go to them.  After the Cortisone injection, rather than pay then for the drugs I got a prescription and had to go to the chemists to collect and pay for it before delivering it to the specialist to replace the one he had used on me.  Similarly when given an appointment to go to a dermatologist before, I was given a prescription for a visit to a dermatologist and it was up to me to find one and go to them.  For blood tests I have to find a laboratory and go to it for the test.  They then send the results to the doctor who prescribed it but also to me.  I have copies of every blood test and every x-ray I have had.   I know more about what is happening to me, about the state of my health and I play more of a role in taking decisions about who I see and they involve me more in decisions about my treatment.  It is so different from the UK system where the Doctor tells you what is wrong and makes an appointment with the appropriate specialist, the x-ray department of the local hospital send you an appointment telling you when it is suitable for them that you turn up, they send the x-ray to the specialist who writes to tell you when it is convenient for you to see him.  I feel I have played more of a part in my health and been treated more like an adult than in the UK where you are treated more like a child.

The second difference is paying.  Paying to see the doctor, for the prescription, to see the specialist, for the x-ray etc, in hard cash before leaving.  People with low incomes or on benefits get a card which means they do not have to pay.  I have an insurance which reimburses me most of the cost but I have to pay first and get the money later.  It’s hell for the cashflow when you get a bill for more than €300 in a month that was not budgeted for.  I much prefer being part of the decision making about my healthcare.  It seems appropriate the day after the final votes to introduce President Obama’s healthcare reforms to be thinking about different healthcare systems.

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