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Richard Smith: Doctors and the Hollande affair

20 Jan, 14 | by BMJ

Richard SmithIt’s hard not to be fascinated by Francois Hollande’s alleged (why do we keep bothering with this word?) affair with an actress with stories of two Parisian love nests, bags of croissants being delivered by security men for breakfast, and the president travelling by scooter for their assignations. But the bit of the story that fascinates me most is the role of doctors. Are they, I wonder, being used?

Anonymous doctors first entered the story when Hollande’s “official partner”—Valerie Trierweiler, “the First Girlfriend,”—was admitted to hospital with a coup de blues. It seems she admitted herself for tests, but did any doctor have to agree? We are led to think that this was her reaction to being told about her partner’s affair, but it’s hard to believe that she didn’t know about her partner’s escapades discretes, when they seem to have been going on for two years and were talked about all over Paris.

Despite the huge expansion in psychiatric conditions in DSM V, “les blues” or “reaction after being told that your partner is having an affair” have not made it to disease status. Would your local GP request that you be admitted to an NHS hospital with such a diagnosis? I imagine too that Trierweiler is not in a routine psychiatric hospital but something much more pleasant.

Trierweiler is reminding us that hospitals can be places of sanctuary. It may not be true of the hospitals we know best, the total institutions with bed pans clattering and inmates having a 10% chance of being harmed. Rather this is hospital as in the archaic “hospice for travellers or pilgrims.” We might easily add the lovesick and broken hearted. Because we are in France, I think of the Hôpitaux à Beaune, an exquisite 15th century building that each year hosts an auction of Burgundy wines.

Probably the sanctuary that Trierweiler needed most was not from disease, but from the media and nosey colleagues. This is a grand example of what sociologists call the “sick role,” something we all learn unconsciously as children. If I tell my mother I have a stomach ache, then she will sympathise, care for me, and let me off school, whereas if I tell her I simply don’t want to go to school she’ll scold me and send me anyway. Even the most invasive media will not burst into the hospital and ask awkward questions.

Originally Trierweiler, a journalist herself, was expected to be released after a couple of days, but she is still there as I write, more than a week after Hollande’s affair was exposed. She is said to “have had tests” and be suffering from “low blood pressure,” one of those continental diseases that Anglo Saxon doctors don’t recognise. Occam’s razor suggests that the tests are not necessary and that her low blood pressure is not the real problem.

But what caught my attention the most was the assertion that doctors had said that she should not see the president, providing an alternative explanation to the possibilities that the president was heartless or a coward or that she was too furious to see him. Doctors forbidding the President and the First Girlfriend to meet is the old fashioned kind of doctoring, familiar from plays and films, where doctors take charge and take the boldest decisions on behalf of patients: “Put her to bed immediately, give her this sedative, and insist she doesn’t see anybody or get out of bed for a week.” This is a huge distance from the shared decision making that is modern medicine. That the doctors issued such a command is not believable, although I’ve not seen the media question it. That the media still believe that’s the way that doctors operate may reflect the fantasy of ceasing to have to take responsibility.

The doctors are clearly being used. What next? “Doctors insist, it is reported, that the president should marry his new girlfriend, Ms Trierweiler is given a generous pension and officially named as Second Girlfriend, and the French media say nothing.”

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.

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