Proud to keep your New Year’s resolution, you frolic during your weekly jog. A little too ambient by your playlist, you don’t watch where you put your feet and bam… you twist your ankle. And if, instead of making an appointment with your doctor, going for an x-ray, going back to see the doctor, having rehabilitation sessions prescribed, could you go directly to your physiotherapist? This is the idea of the Rist bill, adopted at first reading in mid-January in the Assembly and examined this Tuesday in the Senate.
The text, which aims in particular to fight against medical deserts, authorizes patients to have direct access to several paramedical professionals – nurses in advanced practice (IPA), physiotherapists and speech therapists -, provided that they practice in coordinated care structures. This therefore exclusively concerns those working in professional territorial health communities (CPTS), health homes and centers, as well as health and medico-social establishments and primary care teams.
Specialists who would be less trained in diagnosis
“It would be dangerous to leave nurses in total autonomy”, protests Jean-Christophe Nogrette, deputy general secretary of the generalist union MG France, who fears that his profession will lose its pivotal role in the care pathway. The doctor considers that the level of training in diagnosis is very unequal between the different professions. As a reminder, a doctor carries out more than ten years of study, against five for IPAs, speech therapists and physiotherapists and three for nurses.
A seemingly banal symptom such as a sore throat, which may correspond to diphtheria or the onset of acute leukemia, could therefore pass, according to him, through the radars of nurses. “If you give me someone who has a bad shoulder to rehabilitate, I have absolutely no idea how to go about it,” summarizes Jean-Christophe Nogrette. But the physiotherapist, for example, will not know that this shoulder pain can be linked to a gallbladder that tickles him. »
Professionals who would redirect to a doctor if necessary
But this diagnostic argument does not hold, say the unions of physiotherapists and speech therapists interviewed. “Direct access is just a form of exercise. It is not another profession, recalls Guillaume Rall, president of the National Union of Masseur-Physiotherapists (SNMKR). The objective is not to make a medical diagnosis. ” And Raphaël Dachicourt, secretary general of the union of young general practitioners ReAGJIR, to confirm that “physiotherapists and IPA know very well where their skills stop. »
Currently, at the start of the consultation, the physiotherapist identifies the signs of seriousness which make him say that the care is not his responsibility. “If a patient comes for pain in the left arm, I will ask him questions about a possible cardiac pathology, specifies Guillaume Rall. But it’s not me who will make the diagnosis. »
For their part, speech therapists, often trained by doctors, learn “to which professional to refer a patient in each situation”, explains Sarah Degiovani, president of the National Federation of Speech Therapists. In addition, patients with a neurodegenerative disease such as Alzheimer’s or Parkinson’s, or those who have had a stroke, have already received a diagnosis from their doctor. The argument therefore no longer holds, according to Sarah Degiovani.
Saving time and unclogging cabinets
Another argument against the Rist proposal is put forward by Raphaël Dachicourt: the fact that many physiotherapists can no longer take on more patients. “I work in a territory where there is a three-week wait to consult one. According to him, allowing direct access to these professionals would only make the situation worse. An explanation that sweeps aside the president of the SNMKR, who believes that it would, on the contrary, save real time.
“A person with back pain will go to their doctor, who will give them X-rays, MRIs, even scanners, sometimes prescribe anti-inflammatories and sick leave and, possibly, physiotherapy. When the patient arrives in a session several days or even several weeks after the onset of his pain, the latter has, according to him, had time to develop into chronic pain. “The patient will be afraid to move and rehabilitation will therefore be more complicated. Conversely, if people with low back pain consult their physiotherapist directly, they will, he says, need fewer rehabilitation sessions. In the long term, physiotherapy practices could then gradually unclog.
An opinion shared by Sarah Degiovani, of the National Federation of Speech Therapists. “Currently, when a patient has a doctor’s prescription, we are obliged to perform a speech therapist assessment. The professional would like her colleagues to be able to get rid of this system by sorting themselves upstream. A speech therapy regulation platform, currently being tested in three regions, also allows professional speech therapy regulators to judge the relevance of a report. By filtering patients, waiting lists would then automatically decrease.
Professionals who would be alone
Final argument of the doctors against the Rist bill: “In certain areas, nurses and other professionals could have difficulty in having recourse to the doctor in the event of a question or need, regrets the deputy secretary general of MG France. I am angry because we would put these professions in difficult situations. These questions are all the more important since the goal is to develop direct access in areas that are under-endowed with doctors.
Still, this operation with direct access could work at the level of Houses and health centers, according to Raphaël Dachicourt. Because physiotherapists, nurses, radiologists and other caregivers meet there, know each other and communicate. But for the time being, the bill concerns exclusively health establishments, in which speech therapists and physiotherapists are relatively infrequent. “To benefit from direct access, these paramedical professionals will themselves have to convince their colleagues present in the same structure to switch to this operation”, explains Sarah Degiovani. A fight that is all the more difficult as there are more doctors on site. A lot of noise for not much, summarizes the speech therapist.