Report 1

Reporter: Sam Smith

Contact at destination: Prof Franck Bacin: ophthalmologist and clinician in charge of international exchanges.

Year of visit:2007





1) CHU Hôpital Gabriel Montpied, Clermont-Ferrand .

This is the region’s principal hospital. It is large and modern hospital situated on a hill a mile or so from the city centre. From the hospital one may look out over the town centre and local volcanoes which the region is famous for. The wards are split into bays mostly containing 1 or 2 patients.

2) Hôtel-Dieu, Clermont-Ferrand .

This is an elegant old building in the old town centre. Having been extended and added to on several occasions it makes for convoluted navigation but a more intimate, personable feel than the CHU .

Department Médecine interne at the CHU Hôpital Gabriel Montpied for 4 weeks. Chirurgie viscérale at Hôtel-Dieu for 3 weeks.

Work / Study undertaken

I first spent 4 weeks based under the consultant (Chef de Service) Mr Aumaitre’s team. This consisted of 4 juniors (les Internes), 4 registrars (Chefs de Clinique). There were also 5 medical students attached to the ward (les Externes), who were on the ward in the mornings and went home to revise for finals in the afternoons. I spent most of my time with the juniors, who were very friendly and willing to let me present to them.

Mornings. Every morning started from 0830 onwards with coffee, croissants and chat. Some days there were radiology meetings on-ward. Then the ward round started, being split up between the team. I took lunch with the juniors in their ‘Internat’ compound on hospital grounds, followed by more coffee.

Afternoons. There were some afternoon teaching sessions where the juniors presented to everyone, and one evening meeting at a local hotel where all the Médecine Interne doctors discussed cases and presentations. Afternoons were also clinic time for the registrars, which were mostly concerned with auto-immune stuff such as Wegeners and Scleroderma. I was free to follow patients to scans, bronchoscopies etc, and spent time in the respiratory function lab as well. One afternoon I helped one of the seniors with the English version of the paper he was writing. Some afternoons I clocked off early and went out into the hills, which was fine too.

I saw conditions as varied as: Pneumonia; Plural Effusion; COPD; Asthma; Lung cancer; Pulmonary Fibrosis; Pulmonary Embolism; Pulmonary abscess; Bowel cancer (presenting as anaemia); Atrial Fibrillation; Aortic valve stenosis; Heart failure; Acute pancreatitis; Pancreatic cancer; Cholangitis; Pylonephritis; Prostatitis; Disseminated prostate cancer; Haemochromatosis; Essential throbocytosis; Cutaneous lymphoma; Renal lymphoma; Peptic ulcer; Lumbar disk herniation; Erysepelas; Viral meningitis; Lyme’s disease; Crohn’s disease; Giant cell arteritis; Polymyalgia rheumatica; Scleroderma; Wegener’s granulomatosis; Systemic lupus erythematosis; Aquired haemophilia; Scurvey secondary to anorexia nervosa; Heriditary Haemorhagic Telangectasia; Eccinococcosis; Toxoplasma retinitis in an immunosuppressed patient with rheumatoid arthritis.

I then spent 3 weeks doing general surgery under Pr Chipponi’s team. I spent time both in theatre and on the wards, though the notes on the wards were quite insubstantial, usually simply a referral for surgery following the diagnosis of a gastrointestinal cancer. I saw lots of collectomies, a liver resection, oesophageal resection, laparotomies of acute abdomens, appendicitis, stoma reversals and cholecystectomies etc. I got to scrub in but not to suture. I found this second part less interesting, and the team less friendly, but still saw lots of useful stuff.

Description of destination

Clermont-Ferrand , as described to me by Prof Bacin, is part of ‘La France Profonde’: it’s in the middle of the country surrounded by vast rural areas and few tourists go near it. Which is a shame. The city centre is delightful, packed full of small bars, quality boulangeries, restaurants and old architecture. That there were no tourists nor other foreign students around meant that I spoke French the whole time, which was a welcome change from my Erasmus year in Toulouse where the safety net of other foreign students was all too tempting.

Being in the Massif Central , Clermont-Ferrand is an excellent location for anyone who likes hiking, mountain biking, road cycling, rock climbing, and even parapenting (the Puy de Dome, the biggest of the volcanoes, situated several kilometres east of Clermont-Ferrand , is a very popular and convenient launch site!). Not far away is the Massif de Sancy, a more rugged and glacially formed set of mountains.

Were the locals friendly? Very. I made good friendships with several of the doctors and their friends. I managed to find people to go fell running and rock climbing with, as well as flatmates.

Did you feel safe and if not why not? Absolutely.

What did you do in your spare time? During the six weekends I was there, I went rock climbing, fell running, was visited by my parents, went to the Le Mans 24hr race, visited old friends in Toulouse and hiked in the Pyrenees with them. In the evenings I tended to have a beer and cook for or be cooked for by my flatmates, visit friends, go climbing or mountain biking, or just kick back to the radio or TV.

Is there anything that you would particularly recommend others to do? If ‘La Fete de la Musique’ happens whilst you’re there, go out into the streets and join the party – it’s the only night of the year that the police cannot intervene for playing music at any loudness anywhere in the city throughout the night, so you may have no choice!

Go to the top of the Puy de Dome for sunset.

Check out ‘Resaurant La Cave’ and see how many helpings of the local culinary specialty, aligot, you can manage.

Marvel at how much nicer ‘un pain’ is than ‘une baguette’ at the best boulangerie in Town, ‘le Fournil Saint Esprit’.

What time of year were you there? What was the climate like? I was there for 7 weeks in June and July. It was hot. For the first week there were sudden torrential showers at about 4pm most days. After that it got less muggier and drier. Definitely pack shorts, T-shirts and sandals.

What was your accommodation like? Fantastic. I ended up sharing a charismatic city centre flat with two junior doctors.

Was it provided?No.

If not who arranged it? Knowing how self-contained, characterless and lonely places summertime student accommodation can be, I decided to go out without booking anything offered to me by Prof Bacin, and look for a flat independently. I stayed in a campsite out of town for the first week whilst I looked. It proved more difficult than I had hoped, and what’s more practically all the cheap student accommodation has been booked up. I was very fortunate in being offered accommodation by two junior doctors I met on placement. This technique should probably only be tried if you’re prepared to stay in a tent for the whole placement if nothing else works out!

How much did it cost? My hosts very graciously insisted that I pay them nothing. Hence I tried to ply them with my cooking as much as possible, which to my delight surpassed their (admittedly very low) expectations of British cuisine. The still don’t like marmite, however….

Did you enjoy your visit? Hugely.

Did you find it useful medically? Yes, especially the médecine interne department, which is a type of ward that seems to have no direct analogue in the UK , being a mix of general medical intake and specialist auto-immune/rheumatological admissions, providing lots of diagnostic problems to tackle.

Has it improved your French? Definitely. Being able to converse competently in everyday French lets you focus in on the medical French, which has a surprising amount of totally different terminology, though having said that Franglicising the more Latin sounding English medical terms will work more often than not. Rather irritatingly the French nearly always use trade names for drugs, which of course are all totally different, so I’m ashamed to admit that I quickly gave up looking many of them all up – it was just too demoralising. On top of the medical stuff, what I gained was an increase in fluency, a tendency to translate less literally (and thus be understood more often), and a need to ask people to repeat things much less often.

How has it increased your knowledge of French culture? I now know all about La Fete de la Musique, have been educated in French popular music by my flatmates (Serge Gainsbourg, La Tordue, Les Ogres de Barback), know lots more about the French medical system, have been converted to sourdough bread, came back with a touch of Auvergnat slang to my name, as well as leaving some dear friends back in France.

If you went back would you do anything differently? I would have taken less smart clothes and more casual ones – in France I almost got laughed at when I turned up to placement in what is standard attire here in the UK . All that is important is that you wear a clean lab coat and don’t wear anything too risqué underneath. Casual trousers and a shirt or polo shirt would be fine (this is what many of the doctors wear), and certainly more comfortable in the heat. Don’t bother taking a tie!

How did you get there?I took a car over on the Ferry from Dover .

What was the approximate total cost? The ferry cost about £140, I did quite a lot of miles so probably spent £220 on fuel. I spent more than normal on food, probably about £300, and perhaps £120 on going out and other miscellaneous stuff. Rough total: £800.

Is there any other information that you think may be useful? You’ll be able to access the library in the adjacent medical school. They can also arrange internet access for you.