Talk to the Snail

by Stephen Clarke

  Even so, the French aren’t satisfied.20

  The best example of this dissatisfaction I ever heard was at a spa hotel in the southwest of France. I had come for a long weekend of relaxing massages and seaweed baths, and was surprised to discover that before they would let me anywhere near the hot tubs, I had to see a doctor, who was going to prescribe my treatments. ‘Don’t worry,’ I was told, ‘la visite est remboursée’ – the consultation would be refunded by the state. I seriously considered asking whether the same applied to the minibar.

  As I sat in the waiting room in my fluffy bathrobe, I listened to two elderly ladies discussing the French health system. It was ‘going to the devil’, they agreed. I thought they were repeating the common complaint about le trou de la sécu – the ‘hole in the social-security system’ or health-budget deficit. Most years, France overspends on health by several billion euros. Not surprising, really, if all the French guests at this spa spent twenty euros or so of the state’s money to see a doctor when all they wanted was a bubble bath.

  But no, this wasn’t what was bothering the two ladies. It was the difficulty one of them had had persuading her doctor to prescribe the spa treatment itself as a medical necessity. She’d been going on cures for twenty years, she said, and it had always been automatic before. This time, the doctor had forced her to identify some specific problem (she’d chosen sciatica) to treat, rather than prescribing her a week of massages and sploshing about in a seawater swimming pool just for her general well-being. Soon, she said, they might be limited to the purely medical spas like Aix les Bains – a former Roman spa in the Alps, famed for its sulphurous waters and casinos.

  I had to admit that the situation was getting drastic.

  My visite médicale was a farce. The doctor weighed me, checked that I still had a spine, asked if I was averse to being stood against a wall and sprayed with a high-power hose of cold water (er, yes), and ticked a few treatments on the spa’s menu.

  I saw that he had ticked two sessions of aquagym, which sounded a bit strenuous.

  ‘Can’t I exchange those for seaweed bubble baths?’ I asked.

  ‘OK, if you prefer,’ he said, and made the change. My highly scientific medical prescription was complete.

  While I was simmering away in my fishy-smelling tub, I tried to calculate what all this was costing. If the spa had, say, a hundred guests a week for fifty weeks of the year, and all of them paid twenty euros to see the doctor, that came to a hundred thousand euros a year. The state refunds only 70 per cent of medical expenses for most adults, but even so that was a hefty sum, just at this one spa. And if only a tenth of the elderly guests got their whole treatment paid for, you could probably double the cost to the state. If you added on the national-insurance cover paid by the state for the spa’s employees ... my mental arithmetic fizzled out as I did a typical French shrug (very easy to perform when you’re lounging in a vast bathtub) and decided it wasn’t my problem. I had no complaints about the French health service at all.

  Big Boobs

  The government has taken some steps to reduce health spending by encouraging the use of generic drugs and cutting the list of refundable medicines. But no government would dare to get too tough on health for fear of losing the next election and/or provoking mass demonstrations.

  So as not to appear totally inactive, the health minister announced a crackdown on medical fraud. Some of the examples of health cheating quoted in the press were very revealing.

  One woman had been going to see various doctors seventy-five times a month, and getting prescriptions for an average of twelve boxes of antidepressants per day. Another woman had tricked a doctor into prescribing a breast enlargement after claiming that her boobs had shrunk after an accident. But these frauds are only cases of people pushing back the boundaries of what is legally, acceptably available on the national health. It is perfectly acceptable for a woman to have a breast enhancement paid for by the state if her boobs are not symmetrical enough to be shown off on a French beach.

  And France is only now, and very slowly, introducing a scheme which will force people to register with a single general practitioner. In the past, people could have several GPs if they wanted, and visit whichever of them could offer an appointment at the most convenient time. Also, because doctors are paid per consultation, they can be tempted to outdo one another in generosity in an attempt to hold on to their fickle patients.

  A friend of mine, who had just qualified as a doctor, went to do a holiday replacement for a GP in a large Breton town. On her first day, a man came and told her he was having recurring headaches and needed a CAT scan to make sure he didn’t have a brain tumour. My friend said that it might be better to examine him, discuss possible causes and maybe do some other tests first.

  ‘Docteur X’ (the woman my friend was replacing) ‘prescribed one for me last month,’ the man said.

  ‘You had a CAT scan last month? Do you have the results with you?’ my friend asked.

  The man lost his temper, and said he was going to visit Docteur Y, who had a reputation for knowing how to look after his patients properly. He stormed off to get his prescription for a repeat brain scan elsewhere.

  This is an extreme example, but my friend said that lots of the patients she saw came with a shopping list of (frequently very expensive) drugs that the regular doctor always gave them without putting up any resistance. The doctor’s surgery was just a stop on the way to the pharmacy.

  Getting the Green Light

  This national drug habit explains why France looks so brightly lit when seen from outer space. Its towns are decorated with green neon crosses indicating the presence of a pharmacy. I live in the centre of Paris, and there are three large pharmacies within two hundred yards of my house. They are not English- or American-style drug stores, boosting their income by selling food, toys and cheap shampoo. These are fully medicalized pharmacies, surviving (very comfortably) by filling prescriptions and selling over-the-counter medicine, as well as certain pharmacy-only brands of beauty treatment and health supplements.

  The pharmacies have a total monopoly on the sale of anything at all medical. I recently had a chronic toothache while away for a weekend in Normandy. It kept me awake all Saturday night, all the more so because of my annoyance when I found that I’d forgotten to bring any aspirin with me. On the Sunday morning, I went to the local pharmacy, but it was closed. I tried all the shops in the town, but none of them could sell me aspirin, paracetamol or any painkiller other than alcohol. Only the pharmacy was allowed to sell them. The address of the pharmacie de garde (duty pharmacy) would be written on the door, the café barman told me.

  There was no address, just a phone number to call to find out where the nearest duty pharmacy was. It was 18, the emergency services number.

  I phoned, apologized profusely for bothering them with my trivial problem, and was told that the nearest open pharmacy was twenty kilometres away. As I didn’t have a car, it was going to cost me a return taxi ride just to buy a box of aspirin. I was tempted to ask for an ambulance. It might well have worked.

  All this because the pharmacists’ lobby is so strong in France that even the lowest grade of non-prescription medicine can only be bought in a pharmacy. So if you live outside a big town, you just have to wait till Monday.

  In the end, I decided to conduct a door-to-door search at the hotel, and the first person who answered had a toilet bag stuffed with the full hypochondriac’s selection of cures for everything from headaches to cholera, and gave me enough painkillers to tide me over till the Monday.

  And on the Monday, I went to see my wonderful, fully refundable, state-system dentist, whose surgery is straight out of a sci-fi movie. There are some things it’s hard to complain about.

  Special Treatment

  Despite new restrictions as to which specialists the French can go and see without a referral from their family doctor, it is still very quick and easy to get an appointment with people who would be kept h
idden behind walls of bureaucracy in Britain.

  Women go directly to a gynaecologist for the Pill or a check-up, and children can have specialist paediatricians as their regular doctors. Outside a hospital like the Hôtel Dieu in Paris, the specialists are listed on a noticeboard, with the telephone number of their surgery. If a GP prescribes a visit to any of the specialists at a hospital, the appointment will often be given within days.

  This does have a downside. I once had a sinus problem, and a friend recommended a ‘merveilleux’ ear, nose and throat man. I went along to his surgery, a posh apartment in the west of Paris, and walked into a modern art gallery. A car salesman in a flash suit arrived, took me into his designer-catalogue office, tapped around on my face with his gold-laden fingers, and asked me whether I was free for the operation at his clinic two days later.

  He misinterpreted my shocked silence. ‘It’s all refundable,’ he said.

  I said I’d think about it, and he gave me an insurance man’s business card and told me to call him as soon as I’d made my mind up. In the end, I took the English way out, bought a nasal spray, and saved the French state thousands of euros. They really ought to offer me a seawater spa weekend to thank me.

  Vive la Différence

  The differences between what you can expect from the British and French national-health services in the case of various common ailments:

  A COLD

  FRANCE: Call your doctor, get an appointment for the next day, or maybe even the same day. Go to a small private-looking apartment, and wait in what looks like a living room with an abnormally large number of magazines on the coffee table. Look at the fashion pages of a recent Elle or news magazine. Be welcomed personally by the doctor, who comes to fetch you, probably just a few minutes late if he or she is not an especially popular or inefficient practician. Explain your problem, have your throat examined, your ganglions felt, your temperature taken with a thermometer pressed on the forehead or in the ear (the days of the rectal probe are gone, much to the chagrin of some). Listen while your doctor tells you the Greek names for sore throat and runny nose (which all the French know). Watch him or her write out a prescription for aspirin, throat pastilles, nasal spray, chest rub, tablets for a steam inhalant, antibiotics in case things get worse, and (probably only on request these days) suppositories. Ask for, and receive, a three-day sick note. Pay the doctor by cheque, and leave the surgery, shaking the doctor’s hand, promising to return if the cold doesn’t clear up in the next few days.

  Go to a pharmacy, get a rucksack full of medicine, watch the pharmacist swipe your social-security card21 so that your refund is credited automatically. Go home, have an aspirin and a hot drink and wait for the cold virus to go away naturally. In the case of recurring snuffles, request a stay at Aix les Bains health spa.

  BRITAIN: Call the doctor’s surgery, be told that there are no appointments free for the next week and to call back in forty-eight hours if you’re not cured or dead. Go to the supermarket, buy a medicated drink, go to work and sneeze all over workmates. In the case of recurring snuffles, try acupuncture.

  BACKACHE

  FRANCE: Two choices. One: go to an osteopathic doctor, who will give one very costly session of treatment that will be refunded by the state because it counts as a diagnosis. In some cases this will cure the problem. Two: go to the doctor and request a course of physiotherapy. Get a prescription for twenty sessions. Find a physiotherapist, go to his or her apartment once or twice a week for massage and exercises, pay (an admittedly large sum) at the end of the twenty sessions and wait for the refund to be paid into your bank account. If the problem is more serious and requires an operation, it will be performed within a month, either at a state hospital or a private clinic. In both cases, most of the cost will be refunded by the state.

  BRITAIN: Two choices. One: after finally getting an appointment with the doctor, listen to him or her prescribe rest and painkillers and, if the problem persists, make a return visit to arrange a one-off session with a physiotherapist at the local hospital who might be free in six months. Two: find your own physiotherapist, osteopath or acupuncturist, who may or may not be qualified. Spend a fortune and hope for the best.

  OLD AGE

  FRANCE: Visit several doctors (all of them refundable), have a nice chat, get prescriptions for hormone-replacement pills, the latest anti-rheumatism and anti-arthritis drugs, sleeping tablets, food supplements and two weeks at a spa (all of them refundable). Go to the electricity, gas and water companies to confirm with them that it is illegal to switch off your supply even if you never pay the bill. Inform your landlord that it is illegal to evict you or increase your rent, even if your lease is up and the market value of the property means that it would not be excessive to double your rent.

  BRITAIN: Put on all your woollies and have a nice cup of tea. Or move to France.

  20 Because they never are.

  21 This is known as the carte vitale, or lifesaving card, showing how central the health service is in the national psyche.

  JACQUES: ‘Voulez-vous coucher avec moi ce soir?’

  LIZ: ‘One is not amused.’

  Monsieur Chirac’s refusal to speak English earns him a right royal brush-off.

  THE

  5TH

  COMMANDMENT

  Tu Parleras Français

  THOU SHALT SPEAK FRENCH

  THOU SHALT SPEAK FRENCH

  PRESIDENT JACQUES CHIRAC RECENTLY MADE A POINT OF disrupting a European Union summit because the proceedings were being held in English rather than French. What annoyed him was that the man making the speech was French – Ernest-Antoine Seillière, the leader of the European business lobby UNICE. When Chirac interrupted to ask why he wasn’t speaking in French, Seillière replied, ‘Because the language of business is English.’ This was one truth too far, and the president 22 and three of his ministers stormed out.

  Yes, French bitterness about the way some of their inventions are ignored is very similar to the feeling they have that the planet has been robbed of its rightful world language – French. France still thinks that the world would be a much more diplomatic place if debates at the EU and the UN were held in French. They forget that ambassadors would spend all their time nitpicking about subjunctive verb forms, and countries would get invaded because no one could agree on the 23 adjectival endings in the peace accord.

  And this is not the only reason why having French as a world language would be totally unbearable. The other is a political gaffe that the French can’t help committing. How can they expect other countries to use French as a national language when they mercilessly take the pee out of anyone that tries? The French make jokes about the accents of French-speaking Belgians, Swiss, Canadians, Tahitians, New Caledonians, Caribbean Islanders and Africans. French TV often subtitles anyone with a non-standard accent, as if their way of speaking is so yokelish that no civilized viewer will understand.

  All this goes to explain a certain ambiguity that some French people feel when a foreigner tries to speak the language. They are happy that someone has been (temporarily, at least) converted to the belief that French must be spoken. And they are glad that they can be superior to you, because they know when you make a mistake.

  However, they do feel genuine pleasure when you get French right. I started to get invited on to French radio and TV a lot as soon as producers found out that I could speak good French. Their reasoning was obvious. It doesn’t make good listening if a guest is jabbering incomprehensibly (except on certain reality TV shows, of course). But I only started getting invited back on to the same shows when they realized that I could actually make jokes without getting the grammar wrong. That was très raffiné.

  Which reminds me – there’s a French joke that is funny only because the grammar in the punchline is correct. Just so you get it, let me explain in advance that the penultimate word, ‘fût’, is the imperfect subjunctive of the verb ‘to be’ (the imperfect subjunctive being a rarely used and rather pompous tense
).

  Here’s the joke, in English first for those who don’t speak good enough French to enjoy the full impact of an imperfect subjunctive:

  A Frenchman is talking to a Scot.

  ‘Have you ever tried haggis?’ the Scot asks.

  ‘Yes,’ the Frenchman replies.

  ‘What did you think?’ the Scot asks.

  ‘At first I thought it was shit. Then I regretted that it wasn’t.’

  The punchline in French goes like this:

  ‘D’abord j’ai cru que c’était de la merde. Ensuite, j’ai regretté que ça n’en fût pas.’

  Hilarious, right?

  Yes, hilariously right.

  Parlez-vous Right?

  Worse than the fact that few nations in the world can be bothered to argue about sanctions and wars in French is the deep-seated fear that their language is being killed off by English. This idea is, of course, totally ridiculous. Even French teenagers who listen to radio ads exhorting them to go ‘on line et chat avec tes friends’ are incapable of stringing an English sentence together. And when they go on line, they use a uniquely French chat-speak in which ‘qu’est-ce que tu fais’ becomes ‘kes tu fé’.

  What the French-language protectionists are scared of is exactly what is annoying grammarians and historians of every language in the world – the language is alive and changing, and there’s nothing the grammar control freaks can do about it.

  But the French, more than most other people, still love centralized control of every aspect of life. Which is why the protectionists are so adamant that the French language must not change unless they say so. Each new word admitted into the language does not officially exist until it has been vetted and okayed by the Académie Française and its team of forty modestly named immortels. And whereas English-dictionary compilers happily list any foreign word they pick up, from coulis to karaoke via fromage frais, the immortels usually try to veto foreign expressions and impose French words in their place.