France’s generous heath care system is undergoing a serious shake-up that has set doctors on edge for the last few months.
In the waiting room of Paris’s oldest hospital, however, the daily rounds of a casualty ward go undisturbed. A pregnant woman flips through a glossy magazine while a homeless person mumbles that the hospital is too “working class”. The Hôtel-Dieu casualty ward welcomes everybody: French citizens, tourists, and even inmates held by the Paris police.
French Health Minister Roselyne Bachelot is pushing through a reform to balance the books in French hospitals and boost the powers of the hospital directors, a move that worries French doctors who want to be part of the decision-making process. At the Hotel-Dieu, as in several hospitals around France, staff have joined symbolic strikes to protest a draft that will be examined by the French Senate on May 12.
The balance of power
Emergency physician Stéphane Boizat says French hospitals do need reforming. For example, he says, some units are obsolete but, he adds, “the Bachelot reform is not quite what we expected.”
“All hospital physicians agree on one thing," Boizat explains. "We don’t want merely a money-making management for our hospitals." According to the Hôtel-Dieu doctors, the health care reform will grant the directors overarching powers even though they have no medical training.
Faced with the uproar, on May 7 the Senate’s review committee reworked the proposal so as to reduce the powers of hospital directors in the new plan, before the Senate examines the draft next week.
Dr. Gerald Kierzek, head of the hospital’s mobile emergency unit, was symbolically on strike on April 28. He wants to improve the hospital’s effectiveness without neglecting its main mission of caring for everybody without exception. According to Dr. Kierzek, a unit’s budget under the proposal would be calculated according to its medical workload without taking into account other activities such as teaching, research, and social care.
“I don’t find it shocking that some private hospitals select their patients in the [wealthy] 16th district of Paris,” says Dr. Kierzek, “but public hospitals can’t choose their patients and they care for everyone: homeless people, patients with several illnesses, aged people, etc.” These patients need a lot of care, but the rate fixed for such work isn’t high enough, he explains.
In the tranquil waiting room, Beatrice, a carer for older people, sits patiently. Her daughter was rushed to the emergency services when she fainted in a metro station. “I completely disagree with the Bachelot reform,” she said. “The director is not a doctor, he can’t take all the decisions!”
Caroline, a brunette who used to work in a lawyer’s office, believes a compromise can be met over hospital governance, with managers and doctors at the helm. “We need doctors who know their job and administrators who are good with numbers and managing hospitals.”
During a panic-attack, Caroline instinctively went to the casualty ward of the Hôtel-Dieu. “People here are very understanding, they guided me,” she says. Caroline was diagnosed with depression and says she suffered harassment at her workplace.
“I very much like this hospital’s traditions. Everybody gets treated here, homeless people, prisoners,” explains the young woman. “It’s reassuring, there are no inequalities of treatment.”
"The flaw of the casualty ward is that you have to wait a long time," she adds. According to Dr. Kierzek, 90 percent of all casualty patients are treated in less than four hours.
A telling look into society
"The casualty ward is a place where [France’s] social problems come into focus,” says emergency physician Boizat. “When there is a housing crisis, people sleep here, when temperatures drop, people find refuge here,” says Dr. Boizat.
The casualty ward also bears witness to social change, say Hôtel-Dieu staff. According to Maryline Ardon, a nurse who has woked in the casualty ward for 31 years, their unit sees fewer drug addicts because heroine is out of fashion. Violence, however, is still a worry, even if patients rarely attack doctors, she says.
Physicians are proud to be the only ones to make decisions at the casualty ward. “We are all alone here,” exclaims Boizat, forgetting for a second the pending Bachelot bill, “at least, we were, until now.”