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FRENCH HEALTH SERVICE

DOCTORS

Patients in France being sent for ‘pointless’ tests

France's health service is renowned world wide, but a new report has criticized its doctors for being inefficient and costly, by sending their patients for far too many pointless and expensive medical exams.

Patients in France being sent for 'pointless' tests
File photo: hang_in_there/Flickr

Doctors and other medical professionals in France need to be more “sober” in sending patients for medical examinations and scans, according to a report from France’s Academie nationale de medicine (National Academy of Medicine), published this week.

Dr. Jean Dubousset, a Paris-based orthopaedic surgeon and one of the report’s authors, told The Local that despite France’s reputation as having an excellent health service, young doctors were being taught “push-button” medicine.

“They are not taking the time to conduct a physical examination of their patients, or to ask in-depth questions. And they rely too much on the use of computers – I hear from many patients that their doctor actually looks more at the computer screen, than at the patient himself,” said Dubousset.

To make matters worse, the tests patients are being sent for are extremely costly to France's health service.

According to figures quoted in French daily Le Parisien on Friday, blood and urine tests cost a staggering €2.5 billion in 2011, and MRIs and other scans cost €917 million in 2010.

Ultrasounds for pregnant women cost a total of €127 million in 2010, and in 2011, screening for colon cancer cost €97 million in France.

The report comes after two doctors released a controversial book last year that claimed half of the medicines available in France were useless.

When it comes to early detection of cancers and other diseases, Dubousset believes that while for certain groups (individuals with a family history of cancer, for example), screening is very important, for others the results can be vague and lead to unnecessary anxiety among patients.

“Take for example breast cancer. Authorities in France recommend regular mammograms for women between the ages of 50 and 74, but for women younger than 50, mammograms are not particularly useful. This is because at a younger age, there can be many small, benign presences which can cause needless concern,” said Dubousset.

“We’re making patients think they have these illnesses, because of uncertain screening. Then all you’re doing is putting a new disease in the mind of the patient,” he concluded.

The academy’s report, entitled “Improving the relevance of medical strategies” also notes that easy access to regular check-ups, through free national health insurance, does not help doctors to be more efficient or streamlined in their work.

Around 600,000 French women and men undergo a voluntary check-up every year, involving systematic blood and urine tests.

“Nobody gets a prescription unless it’s from a doctor or a dentist, so that underlines the responsibility of the medical profession in these excesses,” said the report.

The report also states that intrusive surgery is being carried out on elderly patients unnecessarily.

"Fitting a pacemaker for someone suffering from Alzheimer's disease is both a moral and financial aberration," it states.

Doctors, however were critical of the report.

"Perhaps there are some unnecessary exams, but it's complicated. They have to remember that for us the most important thing is the patient," Dr. Christophe Thiollet told The Local.

Jean-Michel Mathieu, a general practioner in the town of Tours told Le Parisien: "These doctors need to get out into the field. We don't work in easy conditions. They don't know why we propose a prescription or an exam to someone. We are thinking only about the interests of the patient."

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DOCTORS

Germany’s GPs begin vaccinating patients against Covid-19

For the first time in Germany's vaccination programme, family doctors are allowed to administer jabs.

Germany's GPs begin vaccinating patients against Covid-19
A doctor in Pforzheim, Baden-Württemberg, talking to a patient about the Covid-19 vaccine on March 30th. Photo: DPA

After the painfully slow start to the inoculation campaign in Germany, a new stage is beginning this week: 35,000 GPs nationwide are planning to give residents vaccinations against coronavirus.

Some practices were due to start on Tuesday April 6th, while others are still waiting for vaccine doses and want to follow in the next few days.

Since the start of the rollout at the end of December, injections have so far been administered mainly in the 430 vaccination centres nationwide.

READ ALSO: Germany to make vaccines available at GP practices: What you need to know

Initially, only a small supply of doses is available to family doctors. In the first week, all practices together will receive 940,000 vaccine doses a week.

In purely mathematical terms, that is about 26 doses per practice per week. In the week of April 26th, however, there will be a significant boost to resources – and at that point GPs can expect a total of more than three million doses each week.

READ ALSO: GPs in Germany call for vaccines to be given according to health not age

How will vaccinating work at GPs?

GP practices have to follow the fixed priority order of who can be vaccinated first in Germany.

READ ALSO: When will I be in line for a Covid-19 vaccination?

There is no central invitation programme for vaccinating patients, according to the federal Health Ministry. The practices can regulate how they allocate vaccination appointments themselves – for example by phone or with online bookings.

Some family doctors have been vaccinating for some time as part of pilot projects – and in Bavaria jabs by GPs started last week in 1,635 practices.

Calls to speed up vaccine campaign

This weeks marks the second quarter the vaccination campaign when more Covid vaccines are expected after scarce supplies in the first quarter of the year.

The Association of Private Health Insurers (Verband der Privaten Krankenversicherung, PKV) is calling on the federal government to quickly push ahead with vaccines.

“The start of the vaccination campaign, also through GP practices, is the right step, but it is not enough to get the coronavirus vaccine to as many people as possible as quickly as at all possible,” association director Florian Reuther told DPA.

“Already at this stage politicians must prepare the next step and make vaccination possible in companies and with all other groups of doctors and dentists as soon as vaccine supplies increase as expected in the next few weeks.”

Health Minister Jens Spahn (CDU) had said at the end of March that company doctors should only join the vaccination campaign after GPs.

READ ALSO: Germany’s Health Minister promises more freedom to those fully vaccinated

“There is still too little,” Spahn said of the available doses. He said he found it difficult to vaccinate younger employees of companies as long as the older ones were not yet protected.

But Reuther said the infrastructure of company doctors was particularly suitable. “We already have numerous requests from health insurance companies whose company doctors are immediately available to vaccinate their work forces – but unfortunately are not allowed to order vaccine at the moment,” he said.

Many companies had also offered to vaccinate employees’ family members as well. In Reuther’s view, this would also make sense. He called on the federal government to solve the necessary organisational issues now – “and not only when the vaccines are piling up in the yard”.

READ ALSO: Vaccination centres in some German states ‘to close over Easter

Vocabulary

GPs/general practitioners – (die) Hausärzte (or der Hausarzt as singular)

Surgeries/practices- (die) Praxen (or die Praxis as singular)

Vaccination centres – (die) Impfzentren

Vaccination appointment (der) Impftermin

Company doctor/in-house doctor – (der) Betriebsarzt

We’re aiming to help our readers improve their German by translating vocabulary from some of our news stories. Did you find this article useful? Let us know.

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