Make the presence of a health professional compulsory during teleconsultations, what for?

Consult a doctor by interposed screen, everyone does not necessarily have recourse to it. But since the start of the Covid-19 pandemic, it’s a fact, teleconsultation has become widely democratized. Too much maybe? A group of LR deputies intends to strengthen its supervision and have passed an amendment which it hopes to see included in the framework of the Social Security financing bill (PLFSS), which must be voted on in Parliament by the end. of the month.

“Teleconsultation acts must be carried out and accompanied by a health professional in order to allow better supervision of this practice to avoid abuse and to meet patient expectations”, provides the text. Clearly, it is a question of making the presence of a pharmacist or a nurse at the side of the patient compulsory during his teleconsultation with a doctor. But how would this framework translate into practice? Would it be useful? And how do doctors welcome this proposal?

What would be the point of a teleconsultation with a health professional on each side of the screen?

For Isabelle Valentin, LR deputy for Haute-Loire behind the amendment, if teleconsultation “helps promote access to care for all”, it needs to be “prohibited”, to “take place in pharmacies, multidisciplinary health centers or nursing homes, ”she explained in an interview with the JDD. In other words, no more teleconsultation at home, yet deemed practical by many patients who cannot travel.

“I am against a two-speed medicine, between those who can have real appointments with the doctor and the others who have to be satisfied with a doctor via a screen”, defends Isabelle Valentin. The measure is therefore intended to “respond to patient expectations and reassure them”, but “also to correct abuses” and to avoid unnecessary additional costs for Social Security, assured the MP. “If the patient goes to a pharmacy to request a teleconsultation for a cold, the pharmacist will advise him and tell him that the teleconsultation is not essential. It will cost society less.”

Additional advantage: “there will be a lot less sick leave, guaranteed to Checknews Josiane Corneloup, LR deputy for Saône-et-Loire and former pharmacist, who co-filed the amendment. This will slow down the drifts that take hold. ” For the parliamentarian, it is useful to rely on the ” 22,000 pharmacies [de l’Hexagone] “, especially “as the vast majority of French people live less than 10 minutes from one of them”, however defending themselves from any “corporatism”.

How is the amendment received by doctors?

For the elected official, “the theme of teleconsultations has not been brought to the end of the debate in the commission”, while this text also raises the issue of the installation of “consultation gondolas in places easily accessible to the public, like supermarkets, for example,” she commented during a press briefing. So many reasons to ask for the text, according to her, has little chance of finding a place in the PLFSS. “If the patient and insurance procedure is used by the government, this amendment does not remain”, considering also that it was unlikely to be taken up if the government does not use it. health, any more than it helps to fight against

An opinion shared by his colleagues. “During Covid-19 in 2020, when no one had masks, patients who consulted from home should have had a health professional next to them? Don’t meddle with medicine,” tackled on Twitter Dr Jérôme Marty, general practitioner and president of the French Union for Free Medicine (UFML). “You don’t know what city medicine is. You would have done better to limit teleconsultations to treating doctors only, that would have sorted it out”, one more one sister on the same social network.

The only interest in placing a health professional on each side of the screen, “is in the context of telecare, specifies Dr. Hamon. For example, an elderly person who needs a consultation but who cannot move, can teleconsult with the assistance of the nurse who provides home visits and liaises with the attending physician. This avoids hospitalizations. Or in the context of tele-expertise: the attending physician is with the patient and liaises with a specialist: dermatologist, cardiologist or even radiologist. But what is proposed in the context of this amendment has no interest! This does not reduce health expenditure, nor does it help to combat medical desertification”.

And “this amendment raises the question of the conflict of interest posed for community pharmacies which recover this gigantic market”, worry the signatories of a forum published in Release, among the applicants Françoise Barré-Sinoussi, Nobel Prize in Physiology and Medicine 2008 and president of Sidaction, Mathilde Viot, former social affairs adviser to the Assembly, or Antoine Chassagnoux, president of Act Up-Paris. Signatories who consider it “essential that this amendment be withdrawn” and who call for a stop “to infantilize patients and users”.

Is this amendment likely to be incorporated into the PLFSS?

Although the amendment was adopted in the Social Affairs Committee by deputies from all sides, its inclusion in the final text of the PLFSS 2023 has not yet been won. This amendment could “rigidify” the procedure, while we “can have teleconsultation correctly even when we are not accompanied”, said amendment declared during the debates Stéphanie Rist, Renaissance deputy and general rapporteur of the PLFSS at the Assembly .

For the elected official, “the theme of teleconsultations has not been brought to the end of the debate in the commission”, while this text also raises the issue of the installation of “consultation gondolas in places easily accessible to the public, like supermarkets, for example,” she commented during a press briefing. So many reasons to ask for the text, according to her, has little chance of finding a place in the PLFSS. “If the procedure of Article 49.3 is used by the government, this amendment does not remain”, considering also that it had little chance of being taken up if the government does not use it.

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