Counterfeit funds for medical deserts, teleconsultation booths frustrate patients and doctors

Imagine. You are ill and make an appointment with a doctor via the internet, as yours is not available. Problem: when you arrive at the practice, there is no doctor on the horizon. Instead, electronic terminals equipped with a blood pressure monitor and other connected stethoscopes. Surprised, you sit down and enter your CPR number, which you are asked by the tablet that speaks to you. Then a stopwatch pops up indicating that you only have ten minutes left to wait. Finally, after 25 minutes, a doctor appears on the screen. He explains to you how to examine yourself while receiving data from remotely connected devices. In less than seven minutes you leave with a diagnosis and a prescription.

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Everywhere in the territory, from Paris to Gravigny (Eure) via Carrières-sous-Poissy (Yvelines), fiction has surpassed reality. Amplified by the barriers associated with the health crisis, the proliferation of teleconsultations has exploded. In some municipalities it is even possible to consult a doctor from a pharmacy, town hall or by going to the supermarket. ” Our desire is to alleviate medical deserts and provide access to care for all says Nathaniel Bern, one of the co-founders of market-leading Medadom. A cumbersome but commendable mission that does not appear to be unanimous among health professionals.

Sometimes impaired care

I have recently been crushed Considers Jeanne, a Parisian without a regular doctor. Irritated by sore throat and exhausted from fatigue for a week, the 30-year-old decides to consult a general practitioner as her three Covid-19 tests turn out to be negative. ” I had a lot of preconceptions about the terminal when I saw it … I was right “, She gets annoyed. After five minutes fast “, The verdict falls from the doctor at the other end of the camera: Covid-19. ” I isolated myself a few more days at home and took another test, still negative. “, she says. After which she decides to resume an appointment and make sure the therapist is in this time” face-to-face “, as they say. Result: she leaves with blood tests, which will later confirm infectious mononucleosis.

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Patients who have been misdiagnosed by a colleague in teleconsultation, Jean-Paul Hamon has already received more than one. To this General Practitioner from Clamart (92), ” nothing replaces the physical examination. If you do not put your hand on your stomach for stomach pain, you run a risk “. Jean-Paul Hamon admits that teleconsultation can sometimes provide services, as in the Covid-19 period, and deeply fears the deployment of these teleconsultation booths.” It is a mistake to think that this is a solution to medical desertification, it is above all a deterioration in the quality of patient care “, he thinks.

An observation shared by Dr. Sylvaine Le Liboux in Valençay, Indre. Last October, the doctor did not hesitate to strike for a few days in light of the installation of a teleconsultation terminal in a local town hall. President of the Professional Territorial Health Community (CPTS) in Boischaut Nord, she has worked for 29 years to improve patient care in her department. ” We were neither heard nor warned while organizing the care offer here “, She still complains angrily, even though she ended up winning. Main criticism of this device: it would not only focus on areas in the medical desert.

Full-time teleconsultation

Anne *, a general practitioner in northern France, worked for Medadom for a few months. ” It is an experience with positive sides and less.she qualifies immediately. Sometimes we do a real favor for people who do not have doctors for miles around. “. But after a few weeks, the frustrations pile up.” There is, of course, the fact that one can not touch the patients, but also that one can not carry out medical follow-up and that there is a cruel lack of knowledge about the medico-social substance around the patient. “, she continues.

In addition, a small salary, between 25 and 30 euros per hour, two to three times less than a colleague working in a company. And with good reason: Anne worked as an entrepreneur. Not on behalf of Medadom, but for one of their ” partner companies », Médisanté, which pays doctors in connection with teleconsultation times. Near Marianne, Anne claims to have signed a contract of 20 hours per week, which forms the framework for her practice as a doctor in teleconsultation. ” When I reported my activity to the College of Physicians, they drew my attention to the unregulated nature of my contract “Remembers the young woman.

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Because a doctor’s exclusive use of telemedicine is not allowed. According to recent amendments to the National Convention organizing the relationship between independent doctors and health insurance in relation to telemedicine, ” a doctor can not perform more than 20% of his total activity by appointment by distance (teleconsultations and telecommunications expertise combined) over a year “. But according to the Médadom, which is fighting for an increase in this threshold, this ban would only apply to private doctors, and not employees, as Anne had with her contract.” I preferred to stop because I did not want to alienate the order, but it is difficult for us to place ourselves on these platforms “, she comments. At the main job sites, dozens of positions are offered that are similar to Anne’s.” Recruitment is active due to the teleconsultation boom “, Argues Nathaniel Bern.

counterproductive?

The National Council for the Order of Physicians, for its part, explains by voice of its General Delegate for Health Data and Digital Technology. Marianne pay special attention to the general practitioners who would work full time with teleconsultation. ” It would be dangerous and impermissible to have doctors who do not perform any action », Annoys Stéphane Oustric.

Today, Medadom has installed 2,000 terminals across France and aims for 10,000 in 2023. After winning the tender from the Union des groupements d’achats publics (Ugap) in 2021, to equip town halls in particular, the company has just signed an agreement with PharmaVie the network, which brings together almost 500 pharmacies. But while the company boasts of an increase in the patient base of pharmacies as soon as a terminal is installed, many pharmacists say they are on guard. ” Care must be taken that it does not have the opposite effect, that is, that young doctors will no longer settle there due to competition from a hut. », Comments Pierre-Olivier Variot, President of the Union of Community Pharmacists, who has also already observed this.

Others, like this pharmacist from the Paris suburbs, fear a drift in the question of securing prescriptions. ” When patients come with a prescription on their smartphone, it can not be checked whether the prescription has already been usedshe says. It is problematic when it is euphoric drugs like Xanax, codeine or morphine “. Like many other relatives, she believes that the practice of teleconsultation deserves to be monitored more. As for its role as a bulwark against medical deserts, few believe in it … Too bad for the 27 million Frenchmen be in a medical desert within five years.

* Name has been changed.

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