“We need a revolution in the world of medicine”: former minister Jean-Francois Mattei returns to the crisis in the health system

Liberal doctors, leading generals, will close their offices at the end of the week to demand more funds. Joining the medical testing labs mobilized within weeks, these strikers arrive to swell the ranks of breathless health workers, already-strong emergency physicians, pediatricians and even pharmacists. It is with this observation that Jean-Francois Mattei returns from his home in Var in a bad state. Between historical challenges and prospective solutions.

Since Covid, the health system is cracking everywhere: urgent crisis, overworked pediatrics, laboratories on strike, pharmacies in need of weapons and medicine… How do you analyze this?

First, I think that when you are not in good working conditions, you always find reasons to add to the list of mistakes. Today we really have a shortage of caregivers. The first is because we have had a “stop-go” policy since the post-war period. That is, we exercised a lot when there was no caregiver, then stopped when we guessed the needs were less. Unexpected rationalization cannot lead to improvement.

We have neither the fundamental thought nor the means of our ambitions. So we tighten the screw.

And then we ignored the evolution of the mindset of doctors who want a better quality of life and no longer want to be alone. Today we must move towards a revolution in the world of medicine.

You yourself were at work in the creation of a paid service, he shouted today: do you take responsibility for the current difficulties of the public hospital?

Not only do I assume this, but I am reminded that as far as the fee for service is concerned, it is still in place and the current Minister for Health, Francois Brown, will maintain it.

The problem is that I was not helped by my successors who did not evolve it.

What I wanted was for the hospital’s performance to contribute to funding innovation, but it had to be tailored specifically to deal with redundancies.

Like the bronchiolitis epidemic pressing on pediatrics, every crisis seems like a sign of failure. But these situations only lead to extraordinary measures – especially in terms of rewards – they have no substance …

Because care is an urgent measure! Moreover, despite the difficulties, the caretakers faced outbreaks admirably. In France, we have a good care system, but we do not have a good health system. Wait, preventive measures, we don’t buy them, because we always sniff the grindstone. I’ll give an example of the heat wave: The heat wave Plan that was introduced after 2003 when I was the Minister of Health contained good measures, but they went back to a certain regime and we did not lead. . As a result, the heat wave of 2022 caused thousands of deaths again!

A Senate report from March 2022 recommends establishing a patient/caregiver ratio to put care at the heart of the health care system. What do you think?

I think we should talk about medical time dedicated to patients, actually, in terms of the caregiver-to-patient ratio. It is important to preserve medical humanism. Of course, there is the unknown of changing situations and times when the need is less. That’s why, when the number of patients is low, caregivers should be able to move on to other tasks, and especially to continuing education. This is also one of the reasons why I have long thought that a hospital should have a medical director who organizes care in addition to an administrative and financial director. It is in very well organized military hospitals.

We are not coming there. We are wrong.

Interspecialty tensions, intern strike, pharmacist shortage, should we rebuild medical schools and is it too late to do so?

Yes, the health care system, including its training system, needs to be reviewed. My book was published in 1997 From medicine to health, for the reform of medical sciences and the establishment of universities of health. My point was that we have health economists as well as the secondary medical professions… In short, all the health professions to build a true medical body where everyone speaks the same language. But it takes twenty years for an innovative idea to be discussed…

The problem of healing deserts is becoming more and more urgent and no longer covers only rural areas. What solutions do you see?

Rural and urban medical deserts should not be confused. The difficulty for the former comes from the reluctance of young doctors to settle in villages anymore, except for a certain profession. For quality of life issues, but also because they don’t want to be isolated. I’m afraid we can’t convince them to settle in the countryside anymore.

I am also completely against the creation of a fourth year of general medicine, sending students to medical deserts to replace the incumbent doctors!

On the other hand, I’m sure nurses have advanced practice (those with more advanced missions and skills have been left to doctors until now, Editor’s note) may be the answer. Just like telemedicine.

When it comes to urban medical deserts, the problem is a lack of training and therefore a shortage of doctors.

Do you believe that the creation of regional health professional communities (CPTS), which aim to bring together specialists from a region to facilitate patient care, can solve at least some of the challenges of liberal medicine? ?

I much prefer CPTS and I’m sure he should work in groups now: as I said, the youngest doesn’t want to work alone anymore. These communities enable coordination, sharing of tasks and transfer of skills. The general of the 21st century is the coordinator.

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