Newsletter November 2022

The National Council of the Order of Physicians (Cnom) held a press conference on the subject of the care pathway on Thursday November 24, 2022.

Dr François Arnault, president of the Cnom, Claire Siret, president of the public health section and René-Pierre Labarrière, president of the professional exercise section, reaffirmed the institution’s position on this question before the journalists.

“The presence of the doctor from the start of the care pathway, during the diagnosis, is essential”, reminded Dr. Labarrière. The Order fully supports the delegation of certain tasks, within care teams coordinated by the doctor. However, “this delegation of tasks must make it possible to free up medical time, not to circumvent or replace the doctor, insisted the president. Even in the event of difficulties of access to doctors, the examination by the doctor in the entry into the disease is essential, only he can make a diagnosis. The Order has refused, refuses and will refuse any derogation from this principle, in the primary interest of patients. »

The president also recalled that the institution was in favor of the 4th year of general medicine, professionalizing and supervised with an internship supervisor, but opposed any form of coercion and the distribution of 4th year students into under-dense areas. , which would have the main effect of discouraging young colleagues. “We must better consider medical students and interns, who bear witness to major professional suffering,” assured the president, who recently received student representatives.

In France and around the world, strong supply tensions for antibiotics based on amoxicillin alone or in combination with clavulanic acid are being felt. At issue: excessive consumption of antibiotics and a slowdown in production since the Covid-19 epidemic. The forms most affected by this shortage are drinkable suspensions in bottles, generally prescribed in town for children.
The National Agency for the Safety of Medicines and Health Products (ANSM) recommends not prescribing antibiotics if it is not necessary, i.e. in the event of viral infections (bronchiolitis, Covid-19, superficial skin infections, etc.).

HAS has developed a new identification aid tool domestic violence, intended for general practitioners. The objective: to screen all patients, to find out if they have experienced or are experiencing domestic violence, even in the absence of warning signs. The HAS recommends questioning patients during the anamnesis, in the same way as for the medical history or the consumption of tobacco. In the event of violence, the doctor completes the medical file, can offer a second appointment to his patient or direct her to appropriate support: medical or psychological, social or legal. In case of questions, the doctor can turn to 3919: a line is dedicated to healthcare professionals.

Among the diseases screened at birth, sickle cell disease is the most common genetic disease in France. Until now, its screening was carried out in a targeted manner, in newborns whose parents had origins at risk. Now the HAS recommends that it be extended to all newborns. Firstly, because it is the only disease screened at birth whose incidence is increasing regularly: 557 cases screened in 2020, compared to 412 in 2010. Secondly, because screening is not uniform at national level. Finally, because the infant mortality rate remains very high. For the HAS, these reasons make early detection essential in order to begin appropriate treatment as soon as possible.

The decree relating to the occupational health medical file (DSMT), posted Wednesday 16 November in the Official Journal, changes the rules concerning this tool. It specifies the new methods of constitution of the file, its duration of conservation, as well as its contents. The latter consists of the patient’s identity data necessary for his care – including his national health identity – as well as the data of his attending physician. Correspondence exchanged between health professionals “for the purposes of coordination and care” is also included. The file is placed under the responsibility of the prevention and health at work service, but the employee may oppose the access of the said service to the content of his file. It is kept for 40 years from the date of the last visit, and within the limit of 10 years from the date of the death of the person holding the file.