Premier "coup d'épée dans l'eau"

This is not a scoop that French public university hospitals have entered in a troubled period. And it is trendy to believe that these institutions, created just after the end of the second world war, have had their days. That times have changed, and that this old-fashioned system cannot anymore take up the challenge of offering a top level of care to our fellow citizens.

However, facts plead for preserving the French system.

First and above all, because it has produced, and still produces, a high level of care and innovations. In the field of neurosurgery, among others, the names of Jean Talairach, Bernard Pertuiset, Alim-Louis Benabid, Bernard George, Marc Sindoux, Christian Sainte-Rose, Jean Régis, Hugues Duffau, Stéphane Palfi, Sébastien Froelich come to my mind. All of them grew up thanks to the environment provided by academic hospitals. And all of them trained and inspired generations of young neurosurgeons fellows all around the world.

Secondly, I categorically refuse to view sick people as a business opportunity. I do not want patients to be considered by doctors as marketing targets that should be conquered, as consumers are by companies selling cars or smartphones. And I have good reasons for that.

In 2009, I did a 6-months fellowship at the Prince of Wales private hospital in Sydney, Australia. I certainly learned some advanced technics of neurosurgery. And I learned even more about a proactive style of caring patients, of supporting them vigourously whatever their physical condition. Such qualities were echoed through medias voices. But I was also stunned about the very likely link between some surgical decisions and the number of zeros that would appear at the bottom line of the play slip of the surgeon at the end of each fortnight. At that time, I thought that I was simply lost into the cultural differences, that I was just unable to adapt my value system – inherited from the centuries of the history of Old Europe – to the new mentalities of such a nascent country as Australia. But 10 years later, here is what could be read last month in the Sydney Morning Herald , and I quote the journalist, quoting himself an anonymous neurosurgeon : “"You've got to decide what's in the best interest of the patient," he said. "His problem is that he will operate on anything when there is money involved."”

In other words, as soon as profitability is included in the delicate equation of surgery decision making, your judgment is biased. And the human brain is wired in such a way that there is nothing you can do to counterbalance this bias, induced by our greed for money.

The obsession of profitability has insidiously permeated the mind of the managers at every level of our medical institutions, whatever their position on the rich palette of profitability nuances, from the public non-profit (if not to say money-loosing) institutions to high-profit making private clinics. From the minister of healthcare down to the administrative manager of a care unit, profitability is the first and only criterion for defining annuals targets. And profitability needs quantification. Up to the point that surgeons have been asked, at the end of their surgery, to scan the code bar printed on the ID sticker of their patients, in order to update on-line the bill that will be edited at the end of their hospital stay.

Who would be stupid enough to believe that what makes a good surgeon can be reduced to an excel sheet of codes quantifying his monthly activity ?

How to quantify the energy transmitted by the caring team to the patients, helping them to cope with their disease ? how to quantify the daily kindness of nurses and auxiliary nurses who selflessly comfort the patients in their loneliness of sick people ? how to quantify the innumerable hours spent by a neurosurgeon trainee to acquire experience and skills, day after day, night after night, course after course, surgery after surgery ? how to quantify the level of expertise finally reached after so many years ?

Partisans of private system will argue that you cannot survive in the private if you are not good, and that the competition is the most efficient way to keep only the best ones in the race. A natural Darwinian selection.

Unfortunately, it is not that simple. I have seen so many surgeons with an overrated good reputation, be they in the private or in the public. “Et les mythes ont la vie dure”. This is because reputation is commonly built on subjective criteria, like the personality of the surgeon, or its communication skills and objective results are not always in line with such abilities. Not to mention that private institutions are very good at advertising. They are able to produce this kind of videos ads which would make you want to be sick, as life in such clinics looks like a fairy tale !

Our leaders have decided to give up with the excellence of the French public academic healthcare system. "Quel gâchis !"

I can say with a high level of confidence that a large majority of French people would be very upset about what is going on, should they be informed !

And now the real question: where does come from the unstoppable wave that has striked, one after one, all the different branches of public services, ending a long period of French history in which serving the State and its citizens was an honour ? What should do people like me, who still believe “envers et contre tout” that money is not an end in itself : resign and follow the trend ? or engage in this lost cause ?

A topic for a future post …

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