Ten ideas to give back medical time to doctors

Dr Michaël Rochoy is a general practitioner. Two years ago, he listed for “Le Figaro” ten simple measures capable of relieving doctors from time-consuming tasks, which take up the time they can devote to patients. Today, he maintains them, but notes that very little has been done to debureaucratize medicine and lighten the time of those who treat us.

Getting an appointment with your GP is difficult today. Tomorrow, it will be worse: according to a Drees report from March 2021, the standardized medical density on the aging of the population will worsen before returning to its current level around 2030. To ensure patients have the care they need, we need medical time.

Access to care raises questions, but the answers given are always those of politicians and administrators who wrongly believe they know how health professionals should work. Thus, in a report published in September 2021, two senators recommended increasing the interactions of doctors with local and regional administrations (regional health agencies), without worrying about the fact that this would be to the detriment of time dedicated to care. They recommended continuing what already exists (financial incentives, creation of health centers, etc.) and considering “adopting coercive measures adjusting the principle of freedom of installation”.

In reality, it is not just doctors that we lack: we especially lack medical time. Here are ten ideas to improve this situation.

General practitioners do not have to be “controllers” of Health Insurance, checking that nurses and care assistants do not commit fraud when they declare that they carry out personal hygiene care. These professionals are able to know the care they provide and its relevance. Validation by signature of the general practitioner on each of their acts is an insult to their integrity.

General practitioners also do not have to control ambulance companies on behalf of health insurance. If a patient has to travel from point A to point B for care, this must be considered justified a priori and the health insurance can carry out ex post checks if it wishes to hire staff for this purpose.

In the majority of cases, the certificates of parental absence produced by doctors for the days provided for in the parent's employment contract are only papers ensuring that the parent has reported that the child has been ill to his or her doctor. , without necessarily having needed the latter to treat him. This therefore has no medical benefit.

This would allow the most modest people, often those most exposed to difficult jobs, to be able to stop early while benefiting from daily allowances for which they contribute monthly (and covering 60% of their usual income), rather than stop too late when long and expensive care becomes necessary.

Daily medical hazards (gastroenteritis, isolated fever, dysmenorrhea, acute lower back pain, etc.) can justify a work stoppage of 1 to 3 days, without requiring recourse to a general practitioner. Here again, the latter do not have to be “controllers” on behalf of Health Insurance of the good faith of the insured.

It very often happens that insurers, when compensating a contributor, suddenly become interested in his entire history. These approaches are abusive, time-consuming and offensive to patients.

Patients with disabilities or loss of autonomy must contact their doctor for procedures that relate to social and non-medical care. If it is impossible to quickly train tens of thousands of doctors, we could, however, train professionals dedicated to these essential social issues, to help with home care or institutionalization, or for example to quickly grant a block- braille notes to a visually impaired person, without them having to wait for a medical certificate and 3 to 6 months of delay for the processing of their file.

Nurses (and advanced practice nurses), pharmacists, physiotherapists, speech therapists, podiatrists, must be able to take care of a certain amount of care independently according to their skills: vaccinations recommended according to the schedule in force (by nurses and pharmacists), annual renewal medical bed (by pharmacists or medical equipment specialists), prescription of orthopedic insoles (by podiatrists), renewal of speech therapy sessions, prescription of nicotine substitutes (currently closed to pharmacists, dietitians and even non-tobacco specialists). doctors!)… However, too many of these acts still require “control” prescriptions from doctors today, which are an affront to the skills and integrity of other health professionals.

Psychologists and dietitians have their own skills, but the fact that their consultations are not covered by Health Insurance means that for certain patients who cannot finance them, their role is delegated to general practitioners.

The health system has several branches, several health insurance plans, and countless mutual funds and insurance companies. The system is complex and this complexity has been shown to be costly. During the Covid-19 pandemic, we observed that in an emergency situation, only Health Insurance covered medical care and devices (delivery of masks, reimbursement of PCR tests, teleconsultations, etc.). ), just as it takes care of the care of those with the lowest income (solidarity supplementary health care) or requiring long and expensive care (long-term conditions). Thus, simplification would be a welcome cost-saving measure.

In a depressed medical demographic, it is time to stop using medical time to “check” that nurses, physiotherapists, ambulance drivers, pharmacists, employees and parents are not fraudsters, and to better delegate certain tasks. It is at this price that we will be able to restore medical time and slightly improve access to care in the territory, which will also make it possible to develop teleconsultation for the most deserted places in the country, for lack of anything better. Of course, it is also possible to hold nothing back and offer to undress one desert to dress another. It won't do any good, but at least it will be easy to defend.