My Training As A French Country Doctor

Medical school in France was very cheap and open to anyone who wanted to enroll — at least for the first year. Only those who scored highest on year-end exams were allowed to continue to 2nd year.

Over 600 hopeful students enrolled that first year — but I worked extra hard and placed 38th. Only about a hundred were admitted. I was in!

Soon after I passed the “elimination contest” that was meant to let those of us who had scored best (and were allegedly the smartest) continue with the business of medical school. We had to get down to the business of learning things that we would need to function as doctors.

There was one quick little course to teach us “The business of medicine.” It was only a few lectures. I did not think it would be terribly relevant to me, since I knew from the beginning that I was going back to America for graduate study and practice.

Strange that I remember nearly every word of it now. It is a chilling memorial to what medicine had become Post World War II — of what has been lost from medicine in my lifetime.

He was an older gentleman, a bit formally dressed, with hair dyed with something akin to back shoe polish. His face was taught and craggy. I remember thinking he would have made a tough and distinguished member of the French Army Medical Corps.

He said he had left us a time of peace — to keep it and enjoy it. He said for our hard work in medical school we would (as well as our spouses) occupy a space of respect in our villages. Oh the few specialists among us would go into the exalted academic world. I always thought I had been made for that, whatever country.

Most of us would become “French country doctors.” Our wives would go riding on horseback Sunday afternoon with the wives of the Mayor and the notary. Hard working peasants would take their hats off for us.

Ours would not be the luxury of specialization.

We should be properly known as “omnipracticiens” — everything practitioners.

If someone’s life was in immediate danger, we ought to be equipped to save them on the spot, stabilizing them well enough for expensive transport to a high-tech big-city medical center. We would own a fluoroscope, be capable of reading whatever it showed, and describing it in writing and/or drawing a picture for the medical record. Rarely would technical medical assistance be available. If not, he shrugged his shoulders and said “do your best” in starting intravenous lines and such.

It sounded pretty tough.

It convinced me I was returning to a more technically advanced medicine in America. After all, I had already worked two years “between classes” in my first two undergraduate years of Boston University.

He told us keeping financial records for our practices would not be tough.

Of course, we had to be rigorously honest in all our dealings, and if we could not be, we should not be doctors. Period.

All it took to keep an honest set of books was to use bound composition notebooks, like a schoolboy, one at a time. We ought to enter, only in ink, the date, time, and nature of the service, as well as the amount of cash received. If we made an error (after all, most of us had not majored in math) then it should be crossed-out with but a single line and corrected below.

Rates were those which had been ratified by appropriate authorities at appropriate levels of government.

Simple and easy would be foolproof.

We were cautioned of the importance of the personal physical examination, and to learn the basics well. Our study of diagnostic signs would be irreplaceable, for the decision of who need blood tests and referral would rely on that examination alone.

He suggested that the Germans were becoming too reliant on medical technology, as opposed to physical signs. (He even hinted, as others did, that might have something to do with why they lost the war.)

We must be good French people and never forget to treat the patient and not the disease.

A few repetitions of “Vive la France” ran through the audience as he put down his chalk at the end of the lecture.

How could I not love him and all the French?

Now America seems to have done what he feared. Tests we use every day are imperfect with “false negatives” and “false positives.”

If you are not getting better as you have been led to believe, always question how your diagnosis was made.