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Do GPs prescribe drugs too easily?

WE ASKED readers about their experiences with French doctors

WE ASKED readers of our newsletter about their experiences with French doctors, following an investigation which found they were too quick and easy to prescribe anti-biotics.

I was astonished on my first visit to a doctor in France some 15 years ago at the amount of medicine I received. There was never a single item, always three or four. Reflecting on this I realised that in the previous two or three years my UK doctor had literally given me nothing. Each visit I happily left with the assurance that "It's nothing and will go away on its own."

Over the years I have, however slowly accepted the French way. Last May I had a slight cold while visiting in UK and on returning, one of my ears remained a little blocked from the aeroplane. After a couple of weeks it was still a little uncomfortable so I went to visit my Doctor. I spent five minutes in his surgery and an hour and a half at the chemist!

One of the first things that struck me in France was the sack of medicines you would leave the pharmacy with after having got a prescription from the doctor. Over half of the medicines would not be used and would generally get thrown away. If the French had to pay something for each prescription drug, where today they are fully reimbursed, I am sure they would demand only the drugs they really needed. It is a huge waste of money.

For many years I've worked for free as a translator English/French in local teaching hospitals (CHU). One of my brothers was a GP in London and that brought me into contact with British medical practice. With over-prescription, there are several factors in play;
1. Incentives by the drug manufacturers to prescribe their drugs
2. Cover-up of ignorance of the precise pathology by prescribing drugs that "overlap" - better be sure than sorry!
3. Some patients judge the medic's competence by the number of molecules on the prescription - it is not easy to judge the competence of a doctor (nor of a garagist!) unless you have knowledge.
4. I'd say the average French GP is more arrogant than his British colleague, but this is changing for the better, and there are traces of humility in face of the ignorance of the causes and development of so many diseases. So often, the doctor just doesn't understand what is happening to his patient. Or he knows, and knows also he can do nothing to cure the pathology. So he prescribes half a dozen drugs to reassure the patient and himself.

To sum up; yes the French medics over-prescribe, antibiotics, anti-depressors, somnifers etc, but they are increasingly under pressure by the sécurité sociale to restrain this tendency which costs the system billions of euros.

One has to start by praising the patient-centred approach of the French health service which, for us, has been absolutely superb especially when contrasted with the target-obsessed NHS. A great deal of money however, could be saved by reducing the quantities of most medicines prescribed. I have had some surgeries over years and have ended up returning bags of painkillers and other medications, still sealed, to our local pharmacist who assured me that at least they will be sent to the appropriate charities. The point though is that this is money being spent unnecessarily and if replicated all over France adds up to enormous sums of money.

I have not personally experienced over-prescribing of antibiotics in France although I have heard it happens. As I suffer from chronic obstructive airways disease (C.O.A.D.) I need to take them every time I have a chest infection anyway.

I do believe it is as much the patient's fault however, as the doctor. A number of people I know go straight to the doctor when they have so-called flu instead of going to bed, increasing their liquid (water not wine) intake to around six litres per day and giving themselves three daily steam inhalations (with or without menthol or derivative).

One doctor, a locum, did give me a type of fluoroquinolone antibiotic after two courses of Augmentin hadn't worked and I ended up with tendonitis in both Achilles tendons, not being able to walk without pain for about six months. Not very sensible, considering this side effect is ED

We were living in France from 1979-1981 with my two young children. My six year old had a problem which turned out to be due to the smallpox injection he was obliged to have to enrol into school. He had a small fit on the journey over to Paris. We were recommended to the children's hospital in Paris who asked us to let them give him a brain scan.

By then, I had made some friends, a couple of them in the medical profession. An American Nurse told me: "If they can't find anything wrong, they will test you until they find something". So I decided not to have such an invasive procedure carried out. My French friend, who was also a nurse, looked at his medical notes and said it was quite surprising that he could be prescribed these antibiotics, six or seven, as usually children of his age don't respond to any of them.
A case of over prescription, I think.
Sometimes, it is better to let mother decide and to let nature take her course.

My own and my husband's experience here in France is that we always seem to get at least three items prescribed, whatever the ailment whenever we've visited the doctor's (and the vets for that matter). At the chemist the people queueing always seem to be being given a shopping bag full of stuff. I've always assumed that the Doctors must be on commissiom from the drug companies.

I have a second home in Ceret (Languedoc Rousillon) and visit a doctor here when I need to. I'm impressed by the way she always prescribes homeopathic or herbal medicines first, and apologises when she feels she needs to prescribe a (heavy) pharmaceutical drug. I'm also impressed by the range of herbal and homeopathic remedies widely available in pharmacies here. On the other hand, I watched one customer buy a virtual suitcase full of prescription drugs recently! A corresponding problem in the UK is being prescribed the 'wrong' drug because it's cheaper - with no explanation.
Good health for 2011!

I would raise another similar issue: the way medications are packaged; some in 28s some in 30s others in large or smaller quantities.
If, like my wife and I, you have several types to take over a long period, the medications get out of phase and if I'm not very careful, out of date too.
It's possible to need to flush quite large quantities if our needs change, the cost to the health service must be enormous.
Don't blame the doctors without sorting the pharmaceutical companies too.

When we moved to France, our doctor cut the drugs my wife took by over 9o per cent.
In the UK every time she saw her GP or consultant more drugs were given, but nothing was ever cancelled. On the whole I find that the doctor will offer something to solve a problem, it is up to the individual to decide if they really need what is being offered.
I find the doctor's in France take the time to examine the patients instead of writing a prescription as one walks through the door.

Not only are too many drugs prescribed (I am suffering as a result of that right now), but bad drugs too. I am suffering because my doctor just kept on prescribing anti-inflammatory and pain killing drugs instead of getting an MRI done. By the time it was done (at my insistence) a lot of damage had occurred and when the drugs wore off I was blacking out due to the pain.

I had to be taken to hospital by paramedics as I was unable to move. If my doctor had not masked the pain with his drugs and done an MRI earlier, the problem would have been apparent and I would not be house bound with a damaged knee

Every time we go to the doctor we get a prescription for at least two, usually three tablets.

In general, I believe the doctors are better in England, but the hospitals are better in France

I agree that doctors appear to oversubscribe drugs on occasions, especially antibiotics but I really think patients need to think more seriously about when they need to go to the doctors.

For those who have top up insurance it is all too easy to say to themselves “We’ll pop along to the doctor’s. It is not going to cost us as we have insurance.” I don’t have top up and never go to the doctors unless it is absolutely necessary.
Most of us only have colds, not flu. If you have flu you really know it. When I had it I went to bed took plenty of water and paracetamol. I didn’t go to the doctor. Naturally if symptoms persist and you have underlying health problems it is wise to visit the doctor, but in general it is not necessary.

We need to take more responsibility for our own health. I have a sister who spends fortunes at the chemist when she has the slightest twinge and she doesn’t seem to get better any quicker, just poorer. However, I have another sister who has MS and certainly does need to see a
doctor more regularly. It is not difficult to work it out for ourselves.

Apparently, it is too easy to get drug prescriptions in France, because doctors normally prescribe anything you want to have. Then they add another drug to it all to balance eventual side effects.
Finally, many doctors have no trust in homeopathic medicine, which in many cases could have been just as good and less 'poisonous'.

The medics should be ashamed of themselves. Over-prescription of antibiotics merely results in the development and spread of resistant strains so that when antibiotics are really necessary they don't work because the bacteria are resistant.
This has already happened with most of the penicillin groups throughout the western world and tetracyclins and cephalorins are well down the road. Science is running out of novel antibiotics so unless the use is restrained, we could face in a few generations a world that is almost back to pre-1940s when there weren't any antibiotics. Just tell people "sorry you have a virus and antibiotics don't work on viruses, go home and get to bed, drink lots of water and stay warm". JR

My experience is that doctors in France over-prescribe full stop. Last October I consulted my doctor about pain in my arm. He prescribed three different medications, including six boxes of painkillers, each containing 16 capsules. As I still have the problem, I saw the doctor again this week. He prescribed, amongst other things, further painkillers. As I avoid taking pills if possible, I still have most of the previous prescription, and so I crossed out the painkillers before presenting the prescription to the pharmacist. We always have this option.

The relationship between doctors and chemists is far too cosy and the French government either does not care, or is too lazy to deal with it.

Roll on Boots or Lloyds chemists setting up in France to give competition to these wretched people.

Some years ago Le Figaro published an article about a survey carried out by the CNAM on the French health service. Amongst other things it found that the French used several times more medications than any other European country. An example given was of over prescribing sleeping pills to elderly people some of whom were sufficiently groggy on a morning as to fall over and break a hip.

I have been prescribed on occasion with either unnecessary extra items, or too large a quantity. In which case I tell the pharmacist which items on the prescription I wish to buy.

Doctors are drug pushers, end of story. Why? Because it's what they are trained and brainwashed to be from their first day at medical school. I never visit a doctor, which is no doubt why I am so healthy. I am proactive with my health, eat well, exercise and take natural medicine as both a preventative and curative means of looking after my health.

Doctors have no training in nutrition even, and are mainly ignorant of treating illness other than prescribing dangerous and most of the time, useless medications.

I have two friends here in Marseille, both (rather stupidly I thought) went to see their doctors for help giving up smoking. Even though one of them only smokes five cigarettes per day, both my friends were prescribed Prozac. I believe the manufacturers of Prozac offer extremely generous incentives to doctors, hardly surprising really is it.

I am absolutely astounded at how busy pharmacies are in France. If I were to recommend a vocation to a young person today in France it would be pharmacist. I am Canadian and I thought that pharmaceuticals prescriptions were abused there, however France is probably worse.
In the years that I have been here as a tourist or resident I believe that younger people are looking and acting more responsibly and a healthier population is apparent.

I don't necessarily think it is the doctors who are the problem but the patients. You can often hear the patient telling the pharmacist what they believe is wrong with them and quite often they only have a minor cold. Never ask a French person how they feel, as you will probably hear their whole medical history.

That said, my father who is 90 years old and lived with me in France had better treatment and medical attention here, but since he returned to the UK for what he calls his final years, he can't even get decent help or treatment.

We never found that doctors in France automatically prescribed antibiotics as a matter of course but maybe they feel under pressure from the patient to give them something. I do think many of the patients abuse a very good health system here which is a shame. I for one would choose both doctors and medical treatment here at any time.

I have nine items on regular prescription. The question should be not what is prescribed, but what is collected from the pharmacy.

Being renewable monthly, some drugs are over-prescribed where there are too many pills in a packet for 30-31 days, while others barely last because they are packaged in four-week blocks.

On the other hand, my doctor prescribes a few items I don't find helpful. In the end he stops when I tell him repeatedly, but in the meantime I simply stop asking for them at the pharmacy.

Overall, I have been impressed to find that the routine tests I have here (x-rays, blood tests) are far more wide-ranging and comprehensive than in the UK, and the routine prescription of such items as proton inhibitors and statins leaves me free to lead an active and normal life without more serious demands on the excellent French health service.

Do doctors prescribe too many drugs? You bet they do. After I have been unfortunate enough to seek the advice of the doctor, I have come away from the pharmacy with a carrier bag full to bursting with two boxes of each drug on the prescription, when in fact I only need part of the contents of half of the boxes.

It is a total waste of precious resources and I do not understand why the doctors overprescribe in this way, especially when the otherwise excellent health system is in financial crisis.

French doctors certainly do overprescribe, whether it is antibiotics or other medicines. When my cholesterol level was slightly high, my GP immediately offered drugs. I persuaded him to let me try to reduce it with diet and exercise.

As it happens, in my case it's hereditary and I couldn't do much to reduce it, so I am now on statins. In many cases, however, the régime I put myself on would have done the trick. But he didn't even consider that.

There are several reasons why overprescription is rife:

French people expect to come away from the doctor's with a prescription and are disappointed if they don't. In the face of that pressure and culture, it's difficult for doctors to do anything else. People emerge from our local pharmacie with bags laden with medicines. The system provides a perverse incentive. Every time you see the doctor, he/she charges 22 euros. They have a financial interest in ensuring that you go back as often as possible, which is more likely to make them prescribe unnecessary drugs for conditions that could be controlled in other ways.

It also provides a perverse incentive as far as the patient is concerned. You don't pay for your prescription drugs upfront; they are paid for directly by your sécu/mutuelle. Nowadays, they dock 50 cents for each medicine from your reimbursement for consultations, but if people had to pay the prescription charge upfront, they might be less keen on taking so many medicines.

Don't get me wrong; overall, I think the French health system is very good and we have benefited enormously when we have needed it. However, there is no doubt that France is way behind other countries when it comes to cutting prescribing costs and the system does nothing to improve things.

We only can talk about our doctor we visit who is very nice. He does not like to give us any tablets if not needed, he says that if one can do without it is much better for your health. He only prescribe antibiotics when neccesary.

The French are knocking back more prescribed medication than Elvis in the 1970s! Every time my daughter gets a cold, her (French) mother marches her off to the GP who dutifully hands out an array of potions, sprays and inhalers which would bankrupt the NHS overnight. The problem is that not all of these products are refunded via the health insurance system and the percentage of these refunds seems to be constantly declining.

Add to that the recent headlines of certain drugs remaining on the market for years despite proven health risks makes you wonder if money isn't more important to certain people in the French health care system than patient welfare.

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