Perhaps I should have come to France long ago . . .
As Val says, I am inclined to be a ‘small-print person’. My charitable interpretation of this centres on my ability to unpick something complex, and pull out all of the important points that so often get hidden away in the footnotes and cross-references. Others might less generously focus on the pedantic downsides of my nature, but I can live with that.
In my last job, I had to spend chunks of time spotting the problems that are concealed in complex details, and finding solutions that turned the complexity to our advantage. You might have thought that this would all be over, now that we live in rural isolation, concerned only with our animals and ourselves. But that would miss the point that the French invented bureaucracy and, not surprisingly, they are working hard to maintain their world champion status in the field. In this arena, there are plenty of tasks for my alter ego – for now Plumber Man is not needed . . . step forward Small Print Man!
I think the key to handling French bureaucracy may be to recognise that nearly all the professionals who work in the system actually think that the rules are meant to be bent, twisted and otherwise made to do what is sensible. If you can become involved in a joint enterprise with them to get the ‘right’ outcome, then you are on to a winner.
I’ve now seen three doctors about my tick-induced illness. The first, who is the regular stand-in for when our registered doctor is away, cheerily congratulated me on the accurate diagnosis of Lyme Disease and sent me away with a prescription for a shed-load of antibiotics and a blood test.
Unfortunately, he failed to fill in the necessary forms for the registered doctor to claim the fees. When Dr Rochelet returned from holiday, he had to ring me and ask that I came in to sign the forms. This happened last time I saw the ‘remplacement‘ so we are getting used to the procedure. I think it shows that the jovial locum doesn’t give a toss about the petty paper demands of the system, but he was happy to give me what was needed to ensure I got better. He also, despite all the system’s rules to the contrary, wrote ATMP* on the prescriptions for medicine and blood tests, thus ensuring I could get them without payment.
*Accident de travail / Maladie Professionelle = Work accident / Professional Illness. These are the two categories for which the health system pays 100% of the costs, with nothing up front from the patient. The rules are very clear: only the mutual insurer can designate ATMP, and they have time to investigate and consider before doing so. Now clearly, the first doctor agreed with me that this is daft – how can you have a system which allows you to pay nothing up front, but only when the bureaucracy has taken up to the allowed 90 days to decide, by which time all the paying will have been done?
Dr Rochelet is less brave (or carefree) than his stand-in. He was not at all sure that the MSA would accept that this was a professional illness. The blood test had come back negative. If it weren’t accepted as a maladie professionelle I had to promise to come back to pay the necessary fees. He was not convinced by my assurance that it would all be OK. As Small Print Man, I had discovered that up to 80% of cases would have negative blood tests at this stage, and that the only necessary diagnostic criterion was the distinctive rash. Poor Dr Rochelet is a bit cowed by the system, I fear. But even I, with all my research, was a bit worried when the summons came for me to attend a ‘controle medicale‘. I had to present myself at the head office at 9.00 am, with all the relevant papers, prescriptions, test results, etc.
Those who knew me at work can probably imagine my reaction. I collected together all the research papers, highlighted and annotated. I had photos, documents, evidence all in order in my file. And off I went to do battle with the bureaucracy.
Dr Carpentier, the MSA doctor, greeted me with a warm handshake, and invited me to sit. Then he asked me how far I had travelled for the appointment. “40 kilometres”, I said. “Why do you ask?” He laughed: “Well to pay your costs, of course! After all, if we demand that you come to see us, it’s only right that you’re not out of pocket!”
We were off to a good start. And it got better. For each apologetic question, I was able to pull out the evidence he wanted. “You have a photo? Excellent! And I can keep it? Wonderful!” “Yes, it’s not surprising that the blood test is negative – it so often is in the phase primaire of the illness.” “No doubt at all, this is the correct diagnosis.” “Sorry to keep you longer, but most of this is just for the statistics.”
Having filled in many forms, and annotated all the papers I gave him, Dr Carpentier had finished the tasks demanded by the bureaucracy. “Now that’s all taken care of, tell me about your llamas. Would it be OK if I called in to see them next time I am in your area?”
Don’t get me wrong. I think bureaucracy is a good thing. I like having the rules clear and spelt out in all the necessary detail. But I also love it when people are confident enough to use them sensibly and don’t get too overawed by the ‘system’. Two of the three doctors were really good at this. I think I need to work a bit more on Dr Rochelet . . . . .
