In the first issue of Das Magazin, Dr. Francis Pierre Serra answered our questions. The 65 year-old doctor in the small French town of Bergues is able to look back on a diversified and exciting professional life.
Name: Dr. Francis Pierre Serra
Age: 65 years
Family status: married
Place of residence: Bergues, France
Education: General practitioner (GP), university degree in medicine, specialist areas: geriatrics, dementia and palliative care
Duration of self-employment as an office-based physician: 38 years
Average age of patients: 55 years
Dr. Serra: I have been fortunate to be able to work in a highly diversified job. As an office-based doctor, I am the person to contact in the small town of Bergues in northern France for both major and minor illnesses of my patients. Furthermore, I worked for some time as a gynaecologist and obstetrician as well as twelve years in a nursing home. In this position, I was able to experience at close quarters which illnesses in particular the residents of the nursing home increasingly suffered in the last months and years of their lives. This moved me to dedicate more of my time intensively on the subject of palliative medicine. I hold a university degree in this specialist subject and I started a project with the palliative ward of a local hospital. In the meantime, this work takes up the main part of all my activities. Although I enjoy my work, the position as an office-based doctor is not always easy. We doctors are regularly confronted with new statutory changes or further administrative difficulties. Then it is not always easy to stay happy and motivated in ones work. In my 38 years as a doctor I have experienced so much that I can now retire at 65 with a good conscience, and I have now decided to leave everything else up to my younger colleagues.
Dr. Serra: The problems of patients for which they consult a general practitioner, like I am, are all very different. They range from simple angina to cancer, which – as a disease – is almost always hopeless. It is my job to make an exact examination of the patient and to make a correct diagnosis as well as select a method of treatment which is conducive to therapy. In this respect, we office-based doctors bare an enormous responsibility as we have to decide when one should really start getting worried about apparent banal symptoms.
Dr. Serra: In short, everything! Trust is particularly important in my work to develop a trustworthy relationship with the patient. Without this, good treatment is not possible in my opinion.
Dr. Serra: These include being on-call during the night and at the weekend. As the French government has introduced the principle of voluntariness for on-call services, it is becoming more difficult to find colleagues who voluntarily take on this task. Naturally, one could pass this time differently, but I maintain the position that good medical care also has to be ensured at weekends and during the night.
Dr. Serra: A typical week for me begins on Monday at 8:00 a.m. with a 2-hour office surgery. Other appointments in the week take place by appointment only in the mornings, afternoons and in the evenings. The rest of the day is reserved for home visits, visits to the nursing home as well as for preparing expert opinions for the court. This does not include time for administrative tasks (such as bookkeeping, settlement with the health insurance companies and writing protocols). Sometimes I do these activities on a Sunday morning.
Dr. Serra: I use all the Vliwasorb absorbent dressings for my patients, which I am very satisfied with. Marie Janas, my contact person at L&R, introduced me to the product and I was convinced immediately – thanks to its high absorbency and its excellent ability to absorb exuding wounds. I am absolutely enthusiastic about this wound dressing and always use it if the case in hand justifies it.
Dr. Serra: The central subject for me as a general practitioner is the prevention of all infectious diseases and cardiovascular diseases and, of course, cancer. We have made enormous progress; in the 80’s, prevention was still not very well structured. Since the French health authorities HAS have issued guidelines and procedures, all doctors can use uniform therapeutic methods. Big differences in the type and the quality of treatment between physicians should now actually be a thing of the past. Unfortunately, this is not the case and for this reason I always say: Give me 30 doctors, and you will find 30 different opinions and methods of treatment.
Dr. Serra: Above all, solutions for those areas where almost no one has been active before. Here I am particularly thinking about behavioural disorders in older people. In these cases, one often works with medicinal solutions instead of with cognitive or behaviour-orientate methods. Unfortunately, no individual treatment plan is created very often for reasons of time and behaviour disorders in older persons are often only treated with medicinal products. Although medications can help in some cases, a combination of cognitive and medicinal solutions would make more sense as the preferred form of treatment. I have also come to this result in my two investigations, which I carried out in a Parisian nursing home about behavioural disorders in demented persons, for which I received the award “Médecin généraliste d‘or” (special distinction awarded to French GPs).
Dr. Serra: As far as the future is concerned, I would really like to see more prospective doctors making the decision to become office-based general practitioners. This is not necessarily the usual choice currently in France. In addition, I hope that high-quality health care will also be ensured for patients in the future. In this respect, closer cooperation between doctors and medical nursing care should be created. As comprehensive medical care ultimately benefits the patient, he/she should be the centre of attention.