False remedy for medical deserts, teleconsultation booths frustrate patients and doctors

Imagine. You are sick and make an appointment with a doctor via the Internet, yours is not available. Problem: When you get to the office, no doctor on the horizon. Instead, electronic terminals equipped with blood pressure monitors and other connected stethoscopes. Surprised, you sit down and type in your Social Security number, as suggested by the tablet talking to you. Then a stopwatch appears indicating that you only have ten minutes to wait. Finally, after 25 minutes, a doctor appears on the screen. He tells you how to examine yourself, while he receives data from remotely connected devices. In less than seven minutes, you are gone with a diagnosis and a prescription.

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Throughout the territory, from Paris to Gravigny (Eure) via Carrières-sous-Poissy (Yvelines), fiction has surpassed reality. Driven by confinements linked to the health crisis, the deployment of teleconsultations has exploded. In some municipalities it is also possible to consult a doctor at the pharmacy, in the town hall or by going to the supermarket. ” Our desire is to remedy the medical deserts and provide everyone with access to treatment says Nathaniel Bern, one of the co-founders of Medadom, a market leader. A laborious but commendable mission which does not seem to be unanimous among health workers.

Sometimes degraded care

I got ripped off recently “Consider Jeanne, a Parisian without a regular doctor. Irritated by a sore throat and exhausted from fatigue for a week, the 30-year-old decides to see a GP when her three Covid-19 tests are negative. ” I had a lot of preconceptions about the terminal when I saw it … I was right “, He gets annoyed. After five minutes quick “, The doctor’s verdict falls on the other end of the camera: Covid-19. ” I isolated myself for a few more days at home and took another test, still negative. “, she says. After that, she decides to resume an appointment, making sure this time the practitioner is in.” face to face “, as the saying goes. Result: he leaves with blood tests to do which will later confirm infectious mononucleosis.

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Patients misdiagnosed by a teleconsulting colleague, Jean-Paul Hamon, has already received more than one. For this general practitioner of Clamart (92), ” nothing replaces the physical exam. If you don’t put your hand on your stomach for abdominal pain, you are taking a risk “Admitting that teleconsultation can sometimes provide services, such as during the period of Covid-19, Jean-Paul Hamon 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 believes.

An observation shared by Dr. Sylvaine Le Liboux in Valençay, in Indre. Last October, the doctor did not hesitate to go on strike for a few days in front of the installation of a teleconsultation terminal in a local town hall. President of the Boischaut Nord Regional Healthcare Professional Community (CPTS), he has been working for 29 years to improve patient care in his department. ” We have not been consulted or warned, while we organize the offer of care here “, She still complains angry, even though she ended up winning. Main criticism of this device: It wouldn’t just focus on areas in the medical wasteland.

Full-time teleconsultation

Anne *, a general practitioner in the north of France, worked for a few months in Medadom. ” It is an experience with good and bad sides.qualifies immediately. Sometimes we do people who don’t have doctors miles away a real favor. “. But after a few weeks, the frustrations build up.” There is the fact of not being able to touch patients obviously, but also of not being able to carry out medical follow-up and there is a cruel lack of knowledge of the socio-medical fabric that surrounds the patient. “, continues.

Added to this is a meager wage, between 25 and 30 euros per hour, two or three times less than a colleague who works in the company. And for good reason: Anne worked as a contractor. Not on behalf of Medadom, but for one of them ” partner plants », Médisanté, who pays doctors as part of the teleconsultation hours. Neighbor Marianne, Anne claims to have signed a 20-hour weekly contract, framing her practice as a teleconsulting physician. ” When I reported my activity to the Collegio dei Medici, they warned me of the unregulated nature of my contract “Remembers the young woman.

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Because the exclusive exercise of telemedicine by a doctor is not allowed. According to the recent changes made to the national convention that organizes relations between independent doctors and health insurance with regard to telemedicine, ” a doctor cannot carry out more than 20% of his total volume of remote agreement activities (teleconsultation and tele-competence combined) in the space of one year “. However, according to Médadom, who is campaigning for an increase of this threshold, this ban would only affect private doctors and not paid doctors, as Anne did with her contract.” I preferred to stop because I did not want to alienate the Order, however it is difficult for us to position ourselves on these platforms “, He comments. Dozens of positions similar to Anne’s are offered on major construction sites. ” Recruiting is active due to the boom in teleconsulting “, Says Nathaniel Bern.

Counterproductive?

For its part, the National Council of the College of Physicians, through its general delegate for health data and digital technologies, explains to Marianne pay particular attention to those professionals who will work full time in teleconsulting. ” It would be dangerous and inadmissible to have doctors who do not practice any act », Annoys Stéphane Oustric.

Today Medadom has installed 2,000 terminals throughout France and aims to reach 10,000 by 2023. After winning the tender of the Union des groupements d’achats publics (Ugap) in 2021, for the equipment in particular of the municipalities, the company has just signed an agreement with the PharmaVie network, which brings together nearly 500 pharmacies. But while the company boasts of an increase in the patient base for pharmacies as soon as a terminal is installed, many pharmacists say they are vigilant. ” You have to be careful that it doesn’t have the opposite effect, which is that young doctors would no longer want to settle there due to competition from a booth. », Comments Pierre-Olivier Variot, president of the Union of community pharmacists, who has already observed this.

Others, like this Parisian suburban pharmacist, fear a drift on the issue of prescription safety. ” When patients arrive with a prescription on their smartphone, it is not possible to check whether the prescription has already been usedshe says. It is problematic when it comes to narcotics such as Xanax, codeine or morphine “Like many health professionals, he believes that the practice of teleconsulting deserves to be more controlled. As for its role as a bulwark against medical deserts, few believe it … Too bad for the 27 million French people who are estimated to find themselves in a medical desert within five years.

* The name has been changed.

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