Mustard, bus drivers, childminders, doctors… French society is witnessing a surprising return to food shortages. Regarding medicine, certain administrative standards annihilate any hope of a return to normal. Demoralizing!
We are facing shortages of all kinds in France, which have not been seen for many years. The big little subject of the summer will have been the disappearance of mustard, an inexpensive product of daily use in all classes of society. When you find a jar on a shelf, you immediately buy it, smiling at the bargain, but that’s very rare. Another chronic scarcity, that of the Parisian buses: officially they still exist but you have to wait 25 minutes, 40 minutes, 50 minutes even, in the middle of the week, however, at times of great urban activity. We are told that it is because there is no longer anyone to lead them. There is also a lack of qualified personnel to take care of small children in crèches. There is a lack of paper to publish books, of cars, of building materials, of labor to pick the fruits and harvest the grapes in the vineyards, of water to water the crops. Every day we discover more or less serious shortages.
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But what is also emerging is the shortage of doctors. Specialists as generalists, city as countryside; even Paris has become a medical desert. You have to wait, wait, months and months, then end up going to the emergency room (only to wait there for many hours). Doctors are disappearing from our environment: the old ones end up retiring, the young ones postpone their installation, wait while making replacements. The system does not encourage them to settle; they have to deal with standards: this summer young doctors who wanted to settle in small towns or in the countryside were opposed as a prerequisite by the ARS to bring the premises up to standard in terms of accessibility and safety. These upgrades are very expensive and young practitioners have given up settling, preferring to continue an itinerant and less empowering exercise. The endangerment of populations by the absence of physicians or implanted caregivers is much more penalizing and dangerous than the absence of standards; these are theoretical criteria not always in line with real conditions; to be useful, they are not essential in a situation of reduced access to care. In Western hospitals, permanent upgrading absorbs a predominant share of budgets at the expense of technical investment and the replacement of obsolete equipment.
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The scarcity of doctors is becoming such that the HAS (high health authority) is asking learned societies to validate decision-making algorithms allowing, in the face of a symptom, to dispense with doctors, general practitioners and specialists alike. Thus SFORL was asked about an algorithm intended for community pharmacists concerning sore throats. The purpose is to allow pharmacists to prescribe antiseptics, analgesics or antibiotics directly, without physical examination or medical prescription. It is a crude process, a mode of degraded care, which risks letting infections or tumors pass in the absence of competent direct examination. A learned society cannot accept such a probabilistic and non-performing mode of treatment. But the reality of the medical desert is present everywhere in France. It is to be hoped that pharmacists accepting this responsibility would have the intelligence to direct their dispensary customers as well as possible and that overworked doctors would have the discernment to examine patients with significant symptoms.
The problem is that the process and decision trees (in other words, artificial intelligence and robots) do not replace clinical intelligence or years of medical studies. As we cannot shoot cereals that do not grow for lack of water, to make them grow, we cannot bring in doctors who have not been trained. In the meantime, it is necessary to be a facilitator and realistic for qualified and competent doctors who want to settle down; we must put an end to a health policy and inefficient management by standards.
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