HASAt the beginning of this century, there was no need for a “general practitioner”: one could easily find a general practitioner called a “family doctor” who made home visits, especially for the elderly – like the physiotherapists in somewhere else. The French healthcare system was considered the best in the world in terms of accessibility. We are now close to twentieth place (The Lancet, 2017).
In the meantime came the thirty-five hours, retirements not compensated by a Malthusian numerus clausus, and the Covid-19 hurricane. This led to an unthinkable situation: medical deserts including in Paris, beds closed for lack of nurses, emergencies in an anarchic situation sometimes forced to close after having fought so many years for an unconditional welcome.
The prospects for improvement are slim, the Ségur plan having proved that upgrading was not everything and that foreign doctors would not be enough. The interim becomes a career. It’s hard not to give in to defeatism; however, if the system will not be able to be entirely upset, suggestions can be made to remedy this situation.
First, emergencies can no longer and should no longer be the gateway to hospitals. This organization represents a significant cost in examinations that are not always useful, except for the logic of “sorting” to which emergency physicians are forced under pressure. There are successful experiences of addressing patients (via opinion submission platforms, dedicated lines, etc.), which are easy to use for both doctors and users.
A source of savings
The spectacle of the deadly stranding of patients on stretchers is not tolerable: it is necessary to open beds of general medicine but also better to “turn the beds”, the objective is not to reduce at all costs the average length of stay in hospital (DMS), which has become an absurd obsession, but to accelerate the transition to less expensive structures.
Entry into medium stay [c’est-à-dire en services de soins de suite et de réadaptation (SSR)] must be faster, especially for patients who do not need technical care – this is a source of savings! It is also necessary to create in each department at least one reception structure for patients whose problems are more social than medical, and who occupy “medicine” beds sometimes for months. And it is urgent to simplify guardianship procedures to resolve certain inextricable situations.
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