Health reforms: what if the solution involved the “re-universitization” of medicine in the City? (Analysis)

2023-10-18 08:44:07

Analysis by Philippe Leduc, doctor and health journalist, initially published on the Les Echos-Le Parisien website.

“Our medicine is sick. Let’s treat the problem at the root! » In this short and impactful book, the former dean of medical faculties – Patrice Diot – proposes with Pascal Maurel, health journalist, a new vision for reforming the health system, by painting a fairly impressive fresco of the system’s difficulties. French health service for 20 years. The key: strengthening the university.

“Medical practice needs to be rethought and the profile of future doctors needs to be redesigned, taking into consideration the expectations of society” immediately attacks the teacher who pleads pro domo so that “ French universities and their health components are all taking their place and becoming the driving force behind the transformation of an exhausted health system”.

It’s necessary “form the Homo medicus of tomorrow: no longer the one we know today but a man or woman of progress, innovative, cultured, caring, engaged in life social and the City. Universities must rise to this challenge.”

The teacher from Tours who chaired the National Observatory of the Demography of Health Professions is not as much the arsonist firefighter that one might fear.

From Napoleon to Macron

In small touches without a classic masterful presentation, we are told all the bad fairies who have focused, especially since 2000 when the golden age still reigned, on the cradle of health in France. Everyone takes it for granted, from Napoleon with his health officers to today’s President of the Republic.

This journey through time and space of the determinants of health is striking because it shows wanderings of all kinds and unfortunate decisions, from the numerus clausus to Mica (Incentive mechanism for the cessation of activity of doctors, created in 1988 and maintained until 2003).

A table without concessions

Dr Philippe Leduc, doctor, health journalist and author of the blog Think Tank Economie santé, Les Echos group.

The grievances are serious: commercialization of medicine or on the contrary nationalization, “consumer” patients, lack of doctors, uncooperative professional networks, multiplication of procedures, numerous evaluation and control obstacles which have not yet allowed for avoiding errors and financial scandals, inability to respond to new challenges, neglected public health, poor control of the increase in health spending, deteriorated governance at the hospital, decline in research, influence of the hospital on training, very stereotypical profile of medical students, etc., etc.

The observation is severe. At the origins of many difficulties: the training of doctors is widely described. The hesitant waltzes make you dizzy. To put “end to waste and distress” good high school graduates failing after the first two years of medicine, a ludicrous system took shape.

A graduated response

The objective, increasingly shared, is to bring “a graduated response to the needs of the population by entrusting non-medical professionals with tasks that are currently only permitted to doctors. It’s about developing shared, coordinated exercises and not simple delegation of tasks”. The authors plead for interprofessionality and to decompartmentalize teaching and bring students from different fields to interact.

“Reuniversitarize” medicine

In conclusion, somewhat hastily, the authors recognize that the health system nevertheless has assets: solidarity and inexpensive studies. They ultimately want the role of each person in the organization of medicine to be determined and to redefine medicine in society. Finally the « re-university students ».

Surely the subject of another book.