Lhe new emergency crisis, which forced a number of services to close their doors this summer, is the symptom of a distress in our health system that it would be wrong to attribute solely to demographic questions. It is also the consequence of a profound upheaval in medical practices over the past thirty years. To be convinced of this, it suffices to remember that Dr. Braun’s recent “flash mission” follows a series of alerts already describing the same findings – the Steg report in 1993 or the Grall report in 2015 -, while the medical demography was not so low, even flourishing.
In thirty years, emergencies have become the focal points of the entire healthcare system, supposed to respond to all requests. The population that goes to these services can be divided into three groups: people with life-threatening emergencies, those in general or social medicine, and those who require gerontological care.
Two consequences
Over the decades, the emergency room has become the main geriatric department of the hospital, and its activity has changed in nature. Geriatrics is a slow medicine that requires a lot of observation time and contact with families and downstream medico-social structures, often far from the hospital, and this, in the end, for relatively few technical acts.
This development has two consequences. On the one hand, the efficiency of the emergency services is compromised, because the human and technical capacities are quickly saturated by this long-term medicine. On the other hand, nursing staff, who have chosen emergencies for other practices, no longer find the satisfaction of their initial vocation.
One of the foundations of classical gerontology is based on the so-called Jean-Pierre Bouchon curve, theorized in 1984 (1 + 3 or how to try to be effective in geriatrics. Rev Prat Med Gen 1984; 34:888): from a certain age, aging – highly variable from one individual to another – reduces the ability to cope with what can be called habitual physical or intellectual effort, according to an inevitable downward curve. Intercurrent illnesses or events (such as temporary dehydration) either lower the threshold or increase the slope of this curve, and it is the marvel of medicine to mitigate their consequences to find a previous or near aging curve. But if not every event should be related to aging alone, it nevertheless remains unavoidable.
You have 57.08% of this article left to read. The following is for subscribers only.