Inspiration: Summer clerkship program in Clermont Ferrand, France

01/07/2013 - 26/07/2013

It’s never easy to explain how unbelievable destiny is. I spent 47 days staying in France this summer, 2013. During these days, I stayed 4 weeks at Centre Hospitalier Universitaire de Clermont-Ferrand for clerkship in neurosurgery department.

What’s about the rest of the days? I took this great chance to learn what a French life is. The best part of different culture is to really get involved in it!!

I was touched and sometimes, for sure, astonished by genuine components in French daily lives. During the short staying in France, I made some sincere friends, and I could not thank more for CouchSurfing. I gave out some but gained more back, and gradually, they were integrated into part of me.
C’est la vie, voila. (It’s life, that’s it. ) It’s incredible!

CHU de Clermont-Ferrand, France

This clerkship exchange program in France is under the program of IFMSA, (International Federation of Medical Students' Associations) and I was assigned to the city Clermont Ferrand.

It’s located in the mid-south of France, and it’s the capital of province Auvergne. It’s also called Puy-de-Dôme department (Puy: volcanic hill) because volcanic hills consist most of the terrain here. Good for hikers and who loves outdoor activities.

A well-developed and outstanding medical services consist of many parts, and a well-organized medical system plays an essential role in it. It’s also interesting to compare the pros and cons of medical system between different countries, for we could see how the system well customized to serve the public and the public issues it gives rise to. At the same time, we consult and learn from different system, hoping to bring back their successful experiences.

Take for instance how patients look for a doctor, which is basically different. In Taiwan, patients could choose between clinic, community hospital, or even hospital center on their own. However, in France, also among most of the countries, patients often seek their general practitioner first, except for the emergent problems. If their general practitioners could not solve their problems, they would refer the patients to a hospital. In my view, it’s much more efficient that with general practitioners as the first line to serve patients because it cuts down the probabilities that patients seek the wrong speciality and makes the more high cost resources in hospitals used by who really needs.

Asides from some differences, I would say the medical systems between Taiwan and France are quite the same, for we both have well-developed public health insurance, which covers at least 80% of the citizens. Both health care systems largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization even found that France provided the "close to best overall health care" in the world (from wiki).

In France, the taxes paid to government already include health insurance, and you will get a green card to give to hospital and there’s no more charge when you see a doctor. It’s the basic idea, and it even works for instance an international student who takes a part-time job and pays taxes to the government. There are some inevitable problems, like the deficit of public health insurance, wastes of resources, and the problem of the homeless who are unable to pay the taxes, etc.

Nevertheless, when talking these problems happening in Taiwan with French medical students, we all agree that even we could not solve the upcoming problems, what we can do is to provide the best we could, for actually no perfect system exists.

(Patients need to check their insurance first when they go to hospital; there’s no charging desk in French hospitals.)

I have applied for neurosurgery in CHU de Clermont ferrand, and the schedule is basically as follows:

8:00 the intern who was on duty last night reports the incoming patients

8:30 nurses report the patients in wards

9:00-12:00 the attending doctors and intern take us for ward visit
& externs take history and physical exam for new patients

12:00-14:00 lunch break !! two hours for it !!

14:00-17:00 externs take history and physical exam for new patients

Who are externs? In France, they are medical students who are between their third to sixth year, and they spent most of their time getting involved in clinical works. They will finish their courses in most of the departmenst in hospitals and taking license exam to officially become an intern.

I spent most of my time working with externs and interns in hospital, and they are willing to translate for me when they are discussing cases. Because I went to France the time just when I was about to start clinical works, they also taught me from the basic X-ray reading, data analyzing, and some procedures for patients. I was also welcomed to visit operations when it’s the topic I am interested in.

The following are things impressive to me when I took my clerkship in France for one month.

1. Lumbar puncture, removing CSF to reliving pressure for a hydrocephalus patient

French medical students, externs, are much more involved in clinical work than us do. Apart from history taking, physical exam, they are allowed to perform some invasive procedures when supervised by their interns. (if an international student are willing to hands-on clnical work, insurance for mal-practice are suggested) In Taiwan, lumbar puncture is often performed by intern in most of the hospitals.

(The needle is entered around the horizontal level of iliac crest,
proximally L4 vertebra level.)

2. Blood gas sampling

(radial artery are most common site for blood gas sampling)

3. Physical exam and History taking

It’s hard for a short-period French learner to talk with patients, but thanks again for the translation by externs that I could understand things going on. When I saw some doctors holding their patients’ hands, listening to their needs, or stood asides in the operation room seeing doctors firmly holding their scalpels in any situation. It’s self-evident that I could tell what a caring and genuine doctor is, and they won respects.

(This was the ward that always made me look upon the photos on the wall. They are family, friends, and the beloved grandchildren of a patient suffering from dementia.)

4. Visit to neurosurgery operations and orthopedics operations

(1).Laminectomy decompression

The L4, L5 vertebral bodies was compressed to cause the narrowing of vertebral canal, which compress the nerves passing through. They cut the lamina of vertebrae and put on screw to stabilize the structure.

(2) hernia discale cervicale (hernia, cervical level)

patient suffered from one of the cervical IV disc herniation, and he came to hospital without voice.