SURVEY – Activity-based pricing, the only method of financing hospitals, has changed the relationship between the administration and medical personnel. Under ever greater pressure, many are at their wit’s end. Whether they are patients, interns, doctors or nurses, the reproaches are fired.
As it treats everyone, the public hospital is a precious asset to every French person. When a health concern arises, many still have the “Emergency” reflex. But because of this so-called “hospital-centered” model, the services are very often saturated and the staff tired. “The mammoth,” as its detractors call it, appears to be on the verge of implosion. Even those who love him no longer hesitate to criticize him blithely. It is enough to meet any patient, nurse, intern, or even, head of department to notice it.
“In the provinces, it is better not to have a heart attack on weekends”
Aged 65, René Mazars is chronically ill. Suffering from polyarthritis, the man is used to going to the public hospital. Even in his instances. For 6 years, he has been a member of Supervisory Board of Rodez hospital (Aveyron). In it, he often hears about budget plans. “Structural elements on which the 3 users who sit have difficulty making themselves heard,” he admits. Even more annoying, the savings on the patient’s back. “Because of the lack of financial margin, the patient is used more and more often as an adjustment variable”, he denounces. This involves increasing certain packaging, “the famous patient packages”, which now exclude people from the scope of the hospital.
René Mazars : ” We even go so far as to make packages in which we give you a pseudo toilet bag. All this to charge 35-100 € more… “
“Complementary health for all concerns only employees,” he recalls. For patients who do not have one, therefore remain at their expense 20% of the stay, plus the additional daily service. “For an elderly person, after 4-5 days of hospitalization, we quickly reach 8,000 euros”. It has been understood that the patient item in the budget is often the easy source for creating new revenue. “We hit on the one who cannot defend himself,” said René Mazars. Finally, inequalities sometimes play out to the nearest day. “With us, as in many territories, it is better not to be sick or have a heart attack on weekends. There is a greater risk of remaining hemiplegic, or even worse, ”he assures us. During these two days, the Emergencies are often understaffed …
“Internal friends have fallen into burnout, anorexia”
Baptiste Beaulieu, former intern at Auch Hospital (Gers). In his blog So this is it (become the book The 1,001 life of Emergencies), the former medical intern recounted this reality. That of a young man immersed in the hectic life of the Emergency Department of the small public hospital in Auch (Gers). “I loved the teamwork, even if it was sometimes hard. Because of the working conditions, some friends fell into depression, burnout or anorexia. They felt that they could not answer everything that was asked of them ”.
Some of these future doctors even frequently crossed the red line, with cases of medical abuse: “We find ourselves making an 80-year-old patient wait for 5, 6, or even 7 hours on a stretcher”. But the man has also witnessed cases of mistreatment from the administration: “With televisions taken from patients at the end of their life because their families had not paid for the subscription. I have seen it very, very often, ”he assures us. Images that he will not forget, like those of families meditating on the body of their deceased in the corridors, for lack of a room. For all these reasons, Baptiste Beaulieu has chosen to go to work in the city, “where the relationship and communication with patients are more human”.
Baptiste Beaulieu : ” I chose city medicine because, unlike the hospital, not ten of us go into a room without showing up… “
But in practice, the general practitioner now suffers from the loneliness of isolated exercise. This is why he sometimes considers going back to the ER. “I miss the acute side of the pathologies that we endure thanks to the saving laughter as a team”. The proof is undoubtedly that the flame is not quite extinguished …
“Even for a small decision everything is difficult and long”
Michaël Peyromaure, head of the urology department at Cochin Hospital. But these future overworked doctors are not the only ones. At the top of the hospital medical hierarchy, the same feeling predominates. While he was involved in the public hospital service, fifteen years ago, for its attractiveness, Professor Michaël Peyromaure today points to many dysfunctions: “As a whole, the hospital stands on its foundations, but I believes that the quality of care has declined in recent years ”.
For him, the hospital is quite simply a reflection of what is happening in the country, “managed in a too centralized and bureaucratic way”. “There is a lack of adaptation to the concrete needs of caregivers and patients,” he laments. “For the slightest small decision everything becomes difficult and long,” he adds. And the list of reproaches against the administration goes on and on. Despite everything, Professor Peyromaure thinks of staying at the AP-HP, hoping that he will become pleasant to work there again, “because what we do is useful”, he thinks.
“Before, I did better in terms of safety of care”
Olivier Youinou, nurse anesthetist at Henri-Mondor Hospital (Créteil). Finally, the first witnesses to medical suffering are undoubtedly the caregivers, and some have decided not to stay in the shadows. To make himself heard, this trade unionist at Sud Santé decided to join the “Nuit Debout” movement. For more than a week, he set up the health commission of the organization nicknamed “Hôpital Debout”. According to regulars at Place de la République (Paris), she is making her voice heard more and more. Led by around thirty hospital staff, the last GA would have brought together up to 300 listeners. With each time, the same leitmotif: to denounce the working conditions of nursing staff in the public hospital.
“Twenty years ago, when I started in the operating theater, we were an anesthetist and a nurse anesthetist in each operating room. Today, we have a doctor for two, three, even four rooms ”. As a result, once the anesthetic machine is started, the nurse is the only one in charge of the patient. From the start of the operation until you wake up. “While I’m more experienced now, I feel like I did better at the start of my career in terms of safety and quality of care. It’s demobilizing, ”he blurted out.
Olivier Youinou : ” As in private clinics, we come to talk about patients who will occupy beds for too long. We have trouble placing them… “
Finally, he plague against the 35 hours, not respected in the hospital. “To pay us what they owe us, they invented the time savings account (CET). For all non-medical workers alone, there would be 1.2 million days placed on it. Martin Hirsch (Director General of Public Assistance-Paris Hospitals) should close the Pitié-Salpêtrière Hospital (Paris) for a year to pay us all, the 35 hours we would like to know them ”. According to him, the management of the public hospital has become “madness”. ” Let them all go [les dirigeants] He urges.
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