How will we be cared for in 10 years? The 5 radical ideas of Pr Guy Vallancien

Our health care system is in very bad shape. Everyone agrees on this diagnosis. Not necessarily on how to fix. Without jargon – and in a somewhat provocative way – Professor Guy Vallancien offers a radical treatment, breaking with the current methods of organization and financing.

Ex-Rapporteur and project manager at the Ministry of Health (2002-2012), this renowned surgeon is also the author of numerous books, including Medicine without a doctor? Digital at the service of the patient. He recently offered members of the Côte d’Azur Santé de Nice-Matin his answers to the question selected for this meeting: “Our health system in 10 years: where, how, by whom will we be treated?”

1. AI at the service of patients

For Professor Guy Vallancien, artificial intelligence (AI) will cause a major upheaval in the health system. “We must stop believing that only the doctor can make a diagnosis, it’s obsolete”, he tackles confidently. With the help of AI, a nurse or a pharmacist could also perfectly make a diagnosis, according to the academician. Supporting arguments. “ Remember that in 70% of cases, the diagnosis is based on the interrogation. In 25% of cases, it is the biological data, imaging – and other complementary examinations – that inform the doctor. The clinical examination only represents 5%!”

Similarly, the prescriptions could, according to him, be controlled by very powerful artificial intelligences. “It will be a very useful aid that will allow the transfer of acts. Even if the final decision will, of course, remain human.”

Nowadays, robotic surgery facilitates the gestures of doctors. But the lecturer augurs that she “will become more and more complex and will then justify the creation of new professions.” And especially “operating engineers, trained, like pilots, to carry out certain tasks”.

Another challenge for AI: improving training. “We could train doctors more quickly and in complementarity with other professionals.”

2. Rethink the profession

“General practitioners work very hard and they are poorly recognized. But what are we doing to help them? You have to sit around a table and dare to negotiate a new medical order.”

For Professor Vallancien, the consultation at 35 or 50 euros, the safeguarding of the pre-square of doctors in the face of the rise in power of nurses in advanced practice (IPA) are all outdated battles. To improve our healthcare system, he suggests redefining the role of the doctor. And for that, it is necessary, according to him, to listen to the wishes of the younger generation. “She wants to be paid well, do a good job and on time.”

According to the urologist, contrary to popular belief, there is no need for more beds or more doctors. Or only to fill the gaps related to new modes of exercise. “Doctors are going to work less, 40 hours a week, when we, the older generations, were doing 72! This is a societal evolution on which there is no going back; we must listen to those who will be in the field 2030, not those who are on the way out.”

Faced with this new medical exercise that is taking shape, he is campaigning for “a denser, shorter, more shared training “, and more only “centered on the acquisition of knowledge.

3. Decompartmentalize

To the question “By whom will we be treated?”, Professor Vallancien answers without batting an eyelid: “By all health professionals, in collaboration. The young generation of doctors has understood this, he insists, she wants to work with nurses, physiotherapists, pharmacists…”

In this same logic, the renowned urologist pleads for the abandonment neither more nor less of the distinction between paramedical and medical. But also between public and private hospitals.

To collaborate and work together, it invites health professionals to already get to know each other. “Few doctors went to see the organization of a pharmacy and vice versa, he illustrates. To encourage this, we must imagine a more transversal training. During the first years, a future health professional should do internships in the laboratory, in the pharmacy, in a nursing service…”

4. Evaluate actions

For the guest from the Côte d’Azur Santé, the relevance and quality of the doctor’s acts are not valued enough in France. Or not at all. And to evoke his personal experience: “In my 45-year career in surgery, I have never been checked in France… We work blind and we don’t have the means to improve our services.

He proposes to set up a simple evaluation based on the death rate, the rate of complications after operation, the rate of unplanned intensive care visits…”The idea is not to thank the best of the best but rather to identify the 5 to 6% of doctors who hurt and “cripple” patients. This evaluation could also make it possible to fight against acts deemed irrelevant “which represent 20% of all acts, i.e. an unnecessary expense of 25 to 30 billion euros per year, it’s enormous!

5. Pay better

For Professor Vallancien, fee-for-service is an absurd method of remuneration. “Let’s pay doctors better, by capitation (1), with part of the salary devoted to incompressible administrative time (…) If we go to a preventive doctor, rehabilitation, there will be no more acts!”

1. Capitation consists of allocating a sum to the doctor who, in return, undertakes to take care of a patient for a defined period (usually one year).

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How will we be cared for in 10 years? The 5 radical ideas of Pr Guy Vallancien

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