Virtual surgeries in France

An answer to GP shortage or an online step too far?

1 May 2019
By Connexion journalist

Around 700 online medical consultations take place every week in France, with patients using telemedicine booths to talk to doctors via digital link.

Use of telemedicine started in September and 7,939 consultations have since been reimbursed. It followed an agreement with doctors’ unions in June 2018.

The booths are said to be a particular boost in so-called medical deserts – areas suffering from a lack of doctors.

Doctors retiring in rural areas are rarely replaced. There are 102,000 GPs in France, against 70,140 in the UK for around the same populations.

Pharmacies in Roanne and Perpignan have agreed to set up booths where patients can chat with a GP or specialist.

Booths are fitted with stethoscopes and blood pressure monitors. Doctors provide instructions to use them and prescriptions are directly printed by the machine.

We ask two experts if the booths are a real solution for the lack of doctors.

FOR

François Lescure, former chemist and co-founder of MédecinDirect

When you need to see a doctor but you are unable to, you are happy to find any doctor available, even if it is remotely.

You do not have to travel and it is a good way to avoid the emergency service or going to hospital too often.

Telemedicine is great for people in medical desert areas. They can see a doctor online and get an answer to a question very quickly.

Sometimes the doctor will tell the patient to go and see a doctor physically or go to the hospital if they cannot help. But he or she can also prescribe drugs when cases are not so serious.

Getting to see specialist doctors such as dermatologists or ophthalmologists can be complicated. You need to wait at least six months in some areas, so telemedicine helps people to get appointments and answers quicker.

Telemedicine is something magical today because there are not enough GPs and they are all very busy. It is quick and easy, and it allows people to get the serious opinion of a real doctor.

Before, we used to Google our symptoms but when we read what was written on the internet we felt we were about to die in the next few minutes.

The role of telemedicine is to reassure people. You can ask a question and have an answer in 30 minutes by text. Sometimes, people just want advice or a second opinion, so not every consultation ends with a prescription.

Then, doctors do not want to work from 8h00 to 20h00 any more, like their parents used to do, and with this tool they can easily manage their timetables. Retired doctors or women doctors on maternity leave can also work this way.

Telemedicine can help prevention around young people, too. Many are scared to speak about certain topics, such as sex, with their GP so this allows them to contact another doctor online.

All doctors have access to the history of the patient so there is no mystery. And with the arrival of booths, different tools allow doctors to go even further in the diagnosis.

Telemedicine is a way to guide patients. It does not replace the doctor but it helps. It is a different medical exercise, but it is still a medical exercise. We have to accept new practices.

AGAINST

Jean-Paul Hamon, president of the Fédération des Médecins de France

It is good to want to help patients living in medical deserts or in retirement homes, but there are obstacles to the expansion of telemedicine.

For example, I had an 18-year-old man come to me after he was given a wrong prescription. The doctor did not know he was allergic to penicillin and the result could have been catastrophic.

Commercial platforms which put you in contact with doctors are working for the money and they do not help. They make the service for the patients worse.

Now they want to set up booths in pharmacies, but I do not see how this helps the interests of the patient.

You can look into an ear, a throat, and you can do an electrocardiogram remotely, but it requires a nurse or at least someone who knows how to use the equipment.

An examination with a stethoscope is not even the same. The noise is stronger and you really need to be used to it. You cannot touch the person, you cannot palpate a belly, for example, and the patient does not even know the doctor.

The doctor does not know you either and he does not know about your reactions so, once more, the conditions of care for the patient are being made worse.

Telemedicine is a tool but it will not replace a real doctor and it cannot be a commercial tool to the detriment of patients’ care.

A machine makes the consultation less human, although you can see the doctor through a video call. Being face-to-face and in a booth is totally different.

And doctors do not manage their time better. First, there is the time of the consultation, which takes even longer with a doctor who does not already know you, and then another doctor has to look at the prescription or the results of an examination. Nobody saves time and we keep on reducing the quality of the service.

We are currently disorganising the care system in France, with MPs planning to let everyone prescribe drugs.

The healthcare system is not able to check everything when it comes to the reimbursements of online consultations.

It is important to change what was signed a few months ago (ie. the agreement on telemedicine). Specialists are underpaid, the patient’s care is being ignored, and we are making healthcare conditions worse.

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