LE DAILY: Six million French people do not have a doctor and more than one in two French people have already given up on treatment. Whose fault is it ?

GÉRARD RAYMOND: The entire system is responsible for this medical shortage, aggravated by an economic vision of health management. This is what has caused a loss of meaning and of the values ​​underlying the commitment of health professionals, which are solidarity and humanism.

But today, the crisis is too serious to point the finger at any corporation. One could accuse the doctors of not having been able to evolve, and of having clung to conventional negotiations which were not up to the challenge of transforming the health system. But it's too easy! We are in a complicated situation, not just for patients but also for all health professionals and particularly liberal doctors. What interests me is knowing how to roll up one's sleeves to find solutions. But some will have to make greater efforts than others.

Precisely, in your presidential platform, you want to impose regulation on installation. In what form ?

This regulation must go through an intelligent and pragmatic reflection on the situation. Yes, we are not going to continue to contract liberal doctors who wish to settle in areas where there are already enough practitioners. But we are not going to send young people to the depths of Lozère either, without thinking about the existing care offer, without helping them to develop a medical project according to the needs of the population and to work with the other professionals of health, elected officials and hospital structures.

It is under these conditions that doctors can find an interest in settling in under-resourced areas. We believe that it is feasible if everyone makes an effort to have a solid medical project, to work with modern means such as digital health and the sharing of skills, in particular with nurses in advanced practice. This way of doing things is much smarter than giving 20,000 euros to buy a computer. In any case, solitary medicine is over, now it's “solidarity” medicine, group medicine.

Precisely, solo medical practice is being reduced to the benefit of collective organization methods (nursing homes, health centers, CPTS). Should we go even further?

Absolutely ! Young doctors are attracted by team organization methods, regardless of their status, liberal or salaried. These models have certainly had some difficulty in developing because of the initial reluctance of certain unions and previously well-established practitioners. But today, the desire to develop these care groups is much greater.

For our part, we have signed a manifesto in favor of nursing homes because we know that tomorrow, it will be a powerful tool to respond to the medical shortage. In this context, patients have a role to play in what should be the offer of care in their territory. Their place is obviously alongside elected officials and health professionals to build real medical projects. But this is not currently the case because the legislators have forgotten to involve us in the MSPs and the CPTSs!

Fee-for-service payment is one of the pillars of liberal medicine. Would you like to delete it?

I do not wish to abolish fee-for-service because, in the context of unscheduled consultations, the procedure is very important. On the other hand, in the context of the monitoring of chronic pathologies, the flat rate is more relevant. It is therefore necessary to work on a mixed remuneration. But I have no idea of ​​the fair proportion of the packages. Today, any GP has at least 20% of patients with type 2 diabetes or with cardiovascular problems. These patients, integrated into a support course, should be taken care of within the framework of packages or global envelopes that could be reassessed as and when.

Are you in favor of an end to excess fees?

Yes, we want the removal of overruns. Is the consultation of a liberal specialist worth three more than that of a traditional general practitioner in sector I? If it's just to tell me that my blood sugar is fine, I'll pay three times as much to a diabetologist, what does that mean? Let's find organizations that allow these second-line specialists to fully exercise their expertise, with a level of remuneration corresponding to the medical service rendered.

This requires reviewing the mode of remuneration of the profession, even if it means improving the amount of the consultation. Tomorrow, we should be able to graduate this remuneration according to skills and service rendered. In this respect, I find that consultations at 25 euros mean nothing at all. Some are worth much more than 25 euros and others less.

How do you view the explosion of digital uses? Do you see a form of dehumanization of the exercise?

For me, the dehumanization of medicine is the lack of doctors! It is too easy to kick into touch. That said, if the digital tool can be the best thing, it should not be the worst. Telemedicine can be used to create a link between the citizen and the health professional, and to relieve the organization of care, but teleconsultation will never replace the singular conference. The diagnosis must be made face-to-face, we are not going to announce a serious illness, cancer, through a screen.

I want to insist on the interest of telemedicine in the context of programmed pathways for the chronically ill. Why waste half a day to see my doctor when I can send him my blood sugar level remotely using digital tools? It doesn't hold up.

After the failure of the DMP and the launch of “Mon Espace Santé”, are we on the right track? How not to leave out patients far from digital?

The DMP was an above-ground tool, we missed each other for 15 years, we left a lot of money there and it was useless. With "My Health Space", you should not miss it. Now, there is a real digital safe strategy that belongs to all of us.

But indeed, there is always the risk of putting some patients aside, which is why we are putting pressure on Health Insurance and the delegation of digital health to grant financial and human resources and allow the 66 million French to seize these tools. It will also be necessary to support doctors effectively, because this space will be a revolution in their practice: enter everything in the business software, use secure messaging... This revolution must take place in the best possible conditions.

For years, you have wanted the rise of “expert patients”. Is their role recognized?

We have been saying for years that peer support, in the context of therapeutic education, is a plus compared to medical discourse alone. Obviously, some members of the medical profession opposed it, telling us that it was impossible.

The Kouchner law of March 2002 regulated the representation of users in the health system but not that of expert patients. 20 years later, everyone is aware that the patient's experience in their chronic disease is important. Some intervene in the initial training of doctors, to give them a taste of the patients they will meet later. The French Federation of Diabetics deploys around 200 expert patients, a few hundred also for the League against Cancer. We believe it is essential to regulate their status in order to clarify what these expert patients can contribute to the quality of care.

At the dawn of the 20th anniversary of the Kouchner law, what assessment do you draw from the rights of patients? Was it a revolution or dressing?

Yes, it was a real revolution… 20 years ago. Except that the crisis has shown us that texts are not enough. In the midst of a pandemic, no one listened to patients! Hospitals made decisions — such as closing medical visits — without consulting users' commissions. The regional conferences on health and autonomy have been put on hold, the directors of ARS have taken decisions in their corner. Today, the authorities of democracy in health and the legislative texts that govern them are obviously not sufficient. We will have to regain our independence in order to create a new impetus for healthy democracy.