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Consult a French or an English gynaecologist?
If you want to consult a gynaecologist in the UK, your GP will surely answer back "I can do it". As a French woman used to having a personal relationship with your gynaecologist, you might be quite sceptical. Is it a good idea to consult a GP? Would it be better to see a French gynaecologist in London? Where should you go? Let's try and answer some of the questions you may have with a comparative analysis of both gynaecological health systems.
"An apple a day keeps the doctor away"
The famous British phrase "An apple a day keeps the doctor away" seems to structure the UK's attitude towards medicine: keep fit and healthy and you will not need to go to see a doctor. Contrary to the French, who have a tendency to over-consume diagnostics and drugs, the Brits only go to the doctor's if it is strictly necessary.
GP – Gynaecologist - Surgeon: A very sectored system in the UK
This custom also applies to gynaecology. Why should you see a specialist if the GP can deal with it? Your GP will be responsible for all your basic gynaecological problems such as the pill, a smear test, blood tests and your periods. He is a "gatekeeper" for the other specialists, and will refer you to a gynaecologist only if you have an important health issue that requires more in depth or specialist knowledge (fertility, ovary abnormalities, menopause).
If a surgical intervention is necessary you will be referred again to a gynaecologist surgeon or to a breast surgeon. Contrary to France where gynaecological surgery takes cares of the breasts, the cervix, the uterus and the vulva, the British surgery is very sectored. "It is not the gynaecological surgeon but the general surgeon (specialised in the breast) that will take care of mammary reconstruction. The gynaecological surgeon only takes care of the bottom not the top", explains Christine Frayret, a French breast and gynaecological surgeon.
A complete treatment in France
French women go to the gynaecologist on a regular basis (at least once a year) from a very young age (14-15 years old), without a GP referral.
The French gynaecologist has broader responsibilities than the British one, spanning from simple to complicated issues, but they also have a very close relationship with their patient, who often talks about her sexual problems too.
"French patients are used to seeing a gynaecologist regularly, who undestand know which is his/her role. They also have a personal relationship with their gyneacologist and speak about intimate topics. The British do not expect that treatment nor to receive so much attention, they only come for very precise problems”, explains Dr Nele Dumpert, gynecologist and obstetrician.
Cervical cancer follow-up
In general, cervical cancer prevention is more efficient in France than in the UK. France's mortality rate is 1.8 per 100,000 women compared to 2.4 in the UK. This difference might be due to the regularity with which French women have a smear check.
France
In France, they are meant to go every three years, but usally go every year and if ever they feel the need for another one in the meantime, it is covered by the Social Security system (French to the NHS).
UK
The UK only offers a free smear check every three years and recommends check-ups
every three or five years. By limiting smear checks for women that cannot pay, the UK may miss serious health issues. For example, the recent case of Becky Ryder who died of cervical cancer aged 26. A couple of years earlier, she had been denied a smear test because she was under 25 despite the fact that she had some reasonable reasons to believe that there was a problem. Smear tests used to be advised from the age of 20. This was changed in 2003.
Key figures: Cervical cancer in France and in the UK
|
France |
UK |
Age for a smear check |
25-65 |
25-64 |
Recommended frequency of smear checks |
Every three years |
Every three or five years |
Incidence of Cervical cancer |
7,1 / 100 000 women |
8,4/100 000 women |
Cervical cancer mortality |
1,8/ 100 000 women |
2,4/ 100 000 women |
Pregnancy
Prenatal
As far as pregnancy is concerned, the French have a systematic and general follow-up while the British have a tendency to plan the best scenario. In the UK, most of the medical tests (blood group, rubella, HIV, smear test, ultrasound scan) are proposed but not compulsory, unlike France were they are mandatory and taken covered by the Social Security. Furthermore, in the UK, women tend to be weighed just once at their first prenatal meeting, whereas the French weigh them every time they come for their check ups.
Labour
After labour, French women stay in hospital for four to five days and they once theyleave the hospital they are seen a minimun of ten times by a physiotherapist who will provide massages and give advice in order to avoid organ descents and to rebuild the body as it was before the pregancy.
In the UK, assuming their are no problems, women stay in hospital for two days for their first child and one day for their following children. During their short stay, a physiotherapists within the hospital comes to explain how to exercise and to rebuild their post-pregnancy body.
Breast-feeding & preparation for parenthood
When it comes to breast-feeding the UK has always been seen as a champion in the field, teaching women how to breast-feed and promoting this method. Nevertheless, France has become better in years and now offers breast-feeding classes. They also give labour classes starting from the 6th month which are covered (8 of them) by Social Security. The British also provide antenatal, postnatal and parenting classes (e.g. NCT), to allow women to prepare themselves for the arrival of their new baby and meet future parents in their area, but this preparation must be privately funded.
Therapeutic relationship
Exasperated by the NHS's slow referral process, English women sometimes chose the French or private system. When they do come and see a French gynaecologist, they trust the specialist, unlike most French women: "English women are more introverted, French women will dare to question you, they are very free" says Christine Frayret, French gynaecological and breast surgeon in London.
Key figures
|
France |
UK |
Smear test age |
25-65 |
25-64 |
Smear test frequency |
Every 3 years |
Every 3 or 5 years |
Cervical Cancer Incidence |
7.1 / 100 000 women |
8.4/100 000 women |
Cervical Cancer Mortality |
1.8/ 100 000 women |
2.4/ 100 000 women |
Breast Cancer Incidence |
133.4/ 100 000 women |
120.7/100 000 women |
Breast Cancer Mortality |
17.6/ 100 000 women |
25.3/100 000 women |
Maternal Mortality |
8/100 000 births |
12/100 000 births |
Infantile Mortality |
3.40/1 000 births |
4.56/ 1000 births |
According to these figures, it would apear that France''s systematic approach to gynaecological problems prevents better to some extent health issues but the cost of prevention is very expensive for the State (most tests are covered by Social Security). On the other hand, the British manner of always planning for the best scenario does limit costs, but runs the risk of missing out on very important problems. In addition, British women do not seem to have such an close and open relationship their gynaecologist.
Which gynaecologist should you see?
Dr Frayret Christine – Gynaecological and breast surgeon
Dr Frayret Christine's website in English and in French.
Tel: 07805059868
Address: 81 Harley Street W1G8PP London
Telephone: 020 7034 8421 / 020 7079 4344
Dr Nele Dumpert - Gynaecologist
Address: Richmond Practice, Private Doctors' Service, Roseneath Mount Ararat Road TW10 6PA Richmond Upon-Thames
Telephone: 020 8940 5009
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COMMENTS:
29/04/2013 - rebecca said :
Bonjour,
Merci de votre commentaire. La pilule n'a pas été évoquée dans cet article, car FranceInLondon avait déjà rédigé une note à ce propos. Voici le lien: http://www.franceinlondon.com/en-Article-966-Alert-Should-women-still-be-taking-the-pill-Health--contraception-dianette.html
26/04/2013 - vanlef75 said :
Un portrait idyllique de la France pour les questions soulevées, sans doute vrai, mais l'article n'évoque pas du tout la question de la contraception, qui laisse à désirer en...France! (le tout-pilule a ses défauts, parfois très graves comme l'a révélé le scandale de la fin 2012...)
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