I'm studying in France for a year - my French is pretty good and I can communicate well enough although sometimes I have to ask for specific words to be explained. I have had to go to the doctor a couple of times since I've been here, and it's been quite a daunting experience. One doctor made the effort to speak some English to me (actually I find it easier to speak to French people in French because I can understand their French more easily than I can understand their English but I really appreciated the effort she made.) I hope I don't end up in an emergency care situation though - because before I see the doctor I look up key words in the dictionary! Speaking to French people in general can be a bit scary though - just because I'm not that confident with my accent. So I can completely understand the temptation to remain insular within a community that speaks your language. I'm lucky because I have a lot of friends who don't speak English or who find French easier, and because I can have a fairly coherent conversation in French, but I can imagine if I was a complete novice I'd just hang out with all the other English people.