Coup de sifflet (end of the game)

Something is happening. In many, if not all, French public hospitals, caregivers (doctors, nurses, auxiliary nurses) are organizing meetings, in order to share their “ras-le-bol” and to propose actions to alert the government and the citizens about the forthcoming death of public hospitals. Among other claims, our representants are asking for massive hiring and salary reevaluation, in order to make public hospitals great again. They are also proposing to stop immediately the medical coding, de facto depriving the hospitals from their main source of money.

I will certainly be accused of pessimism – which, after all, is exactly what you would expect from a disillusioned neurosurgeon – but I do not envision this collective fight against our executive directors (and, by a hierarchical ricochet, against the ministry of health) as a move forward.

First, by using these very same fighting modalities, we put ourselves in the same subordinate relationship as employees struggling against their boss. In other words, we acknowledge that doctors are nothing more than a workforce, managed by the directors of their hospitals. I do not accept this view, as I rather consider that the mission of an hospital director is to provide, by all means at his or her disposal, the optimal environment for caregivers and patients, and that only the medical community has the legitimacy and credibility to determine which equipment and human resources are needed.

In the same line of thought, stopping the medical coding should not be viewed as a means to put pressure on the hospital directors in order to win the case regarding our claims, as strikers of private mining companies did at the end of the 19th century. It is just that after 15 years using it, all doctors are now convinced that this is the most stupid way to give account to the administration of our activities and that we collectively want to change this nonsensical rule of the game.

Second, because there is a strong risk that the victory – if any – would be a “piège à cons”. Indeed, one easy escape for rulers could be: “We have realized that you are experiencing difficult times, that you are feeling underrecognized. So, to prove that we are completely in line with your claims, we have decided to increase your salary.” This likely issue will come with a smear campaign in medias (which has already started), stating that employees of public hospitals are privileged compared to others, in order to make jealous the rest of society. “Diviser pour mieux régner”. A basic. Then you can order: “Now shut up and go back to work !” Reducing the current crisis to a salarial claim would be a huge misinterpretation of the anger expressed in the public hospitals: what is at stake is not our income (not to say that salary should not be reevaluated in public hospitals!), but our collective will to maintain the highest level of care for all of our patients. An ideal that fitted perfectly both French republican values and the Hippocratic oath.

Third, and most importantly, I do not believe that we can reverse the current way our directors are managing our hospitals, and more generally, the current way our governments are managing our country.

When I was in Australia, I was proudly praising about our public healthcare system and one day, as I was naively wondering why France could care for everyone with the same top quality whereas Australia could not, one of my fellow colleague, looking at me with a mocking smile that I will never forget, told me: “Have you ever heard about something called the debt ?”

He was so right! I now understand how much we were raised in an illusion.

Part of the destiny of the AP-HP now belongs to those money investors, scrutinizing the Standards & Poor rating of its debt. And over the past years our hospital directors have progressively denied their convictions – that may have pushed them initially to work in public hospitals – to become chief financial officers, more focused on preserving the AA rating than on providing caregivers and patients the environment for optimizing chances of cure.

“This is the end” sing The Doors on the first images of Apocalypse now.I’m afraid “this is the end”, at least, of the French healthcare system.

So, what’s next ?

As far as care is concerned, inequalities will become the rule. Only richer people will be able to afford the cost of a top level care. Let’s face this inevitable trend. A revolution for the French Republic ! Liberté, Egalité, Fraternité: my ass !!!

For medical research, there will be two options. Either collaborating with private companies. In oncology, most studies are already granted by pharmaceutical companies. Again, this is not without any adverse effects: in such trials, endpoints are not only designed for medical objectives, but also for optimizing the chances to make the investments profitable. I have been recently contacted by a start-up developing a drug for IDH-mutated glioma, and I can testify how much their endpoints were not defined only from a medical perspective …

Or begging money from generous sponsors. Like artists in old times, doctors will be supported by “patrons of the arts”. The neurosurgeon Wilder Penfield has been a precursor, when he created the Montreal Neurological Institute thanks to the generosity of the Rockfeller foundation. At that time, he wrote the following words in a letter to the director of the foundation: “I do not know how to thank a Foundation, but I thank God that it exists and I pledge myself to make their generosity bear the finest type of fruits of which we are capable”.

And now the real question: those people who are governing our country, are they aware that France is no more honoring its ideals and that they are the first to be blamed for not having even attempted to struggle against the purportedly unstoppable extension of profitability to the health domain ? If yes, are they ashamed ? scared ? or do they simply prefer just not to think about it ?

A topic for another post …

Et comme le rappelait l’éternel décalé Vialatte, « Et c'est ainsi qu'Allah est grand »