Eight hours.
That's how long we had to wait for a doctor to come and note the death of Albert*, an octogenarian who died suddenly in the early morning in his house, on a Sunday in January.
A very difficult half-day for his family, who took refuge in the next room.
“We installed him as best we could on the living room sofa and waited in the kitchen until 3
p.m. for the doctor to arrive
,” says Simone*, a member of his family.
It was a very hard moment.”
This long wait is a rarely mentioned consequence of medical deserts: in Côtes-d'Armor, there was only one doctor available to come to your home to make the death certificate, whose certificate is required to proceed with the procedure. removal of the body.
A single doctor on call for an entire department, around ten deaths to be noted in one day... and as many grieving families, traumatized by this endless wait.
A situation which, for several months, has also been repeated in nursing homes.
A few kilometers from Albert's house, a resident who died in the middle of the night
“could not be seen by a doctor until 6
p.m. the next day.
It was last summer, it was very hot in the room.
The referring doctor was on vacation
,” says Céline*, a nursing assistant in the establishment.
“No regulatory deadline”
The problem exists across the country.
The reason: the lack of general practitioners.
“There is no regulatory deadline for establishing a certificate after a death
,” recalls Dr. Nicolas Liechtmaneger-Lepitre, president of the Council of the Order of Physicians of Côtes-d'Armor.
But it’s tricky to let families stay in front of a body for several hours.”
This is all the more problematic when he is on the public highway, and must remain there until the death certificate has been issued.
The Pas-de-Calais police were also confronted with the situation in mid-January: they had to wait several hours with the body of a deceased man, hidden under a white sheet in the street.
No general practitioner or Samu doctor was available that day.
GPs are overwhelmed and cannot leave their patients at the practice to go and draw up a death certificate, because it takes time and they don't have any.
Dr Francis Meurin, president of the Council of the Order of Physicians of Pas-de-Calais.
During the day, the rule is that it is the attending physician who notices the death of his patient.
But very often, he can only come to your home after his consultations.
“General practitioners are overwhelmed and cannot abandon their patients at the office to go and draw up a death certificate, because it takes time and they do not have any
,” explains Dr. Francis Meurin, president of the Council of the Order of Physicians. of Pas-de-Calais.
This is a big problem for doctors and patients.”
At night and on weekends, the responsibility falls to the doctors on call or sometimes to the Samu, via 15.
“Most of the time, we have two doctors on call for the whole department, but it is large, and we give the priority to the living who need care
,” adds Nicolas Liechtmaneger-Lepitre.
Call the nurses...
One solution, proposed by the Ministry of Health in 2023, relies on independent nurses: those who volunteer will be able to issue a death certificate in certain cases.
An experiment has just been launched in six regions (Hauts-de-France, Île-de-France, Réunion, Auvergne-Rhône-Alpes, Centre-Val-de-Loire and Occitanie) for a duration of one year.
Nurses must have been qualified for at least three years, and undergo training lasting one and a half days.
In Île-de-France, where a first training course has already brought together 18 volunteers in December 2023, 93 state-certified nurses (IDE) employed in 11 home hospitalization services will be trained this year.
116 nursing homes said they were interested in ensuring that their nursing staff were also interested by the summer.
Then will come the turn of the liberal nurses.
The ARS of Île-de-France estimates that 400 liberal IDEs could thus be able to issue death certificates by the end of the year.
Remuneration of €42 during the day and €54 for nights, weekends and public holidays is provided for each act.
If the results of the experiment are conclusive, the system could be extended to all of France.
Waiting for hours for a doctor when you have just lost someone is adding pain to the pain.
Nurses are in contact with patients and their families, sometimes following them for years.
Being able to issue a death certificate helps families with their grief.
Thierry Amouroux, spokesperson for the National Union of Nursing Professionals (SNPI).
A measure that makes sense, according to Thierry Amouroux, spokesperson for the National Union of Nursing Professionals (SNPI).
“This is not a request from the profession, but from patients.
Waiting for hours for a doctor when you have just lost someone is adding pain to the pain.
Nurses are in contact with patients and their families, sometimes following them for years.
Being able to issue a death certificate helps families in their grief.”
...and retired doctors
In Pas-de-Calais, the Council of the Order of Physicians has found an alternative, while waiting for the IDEs to be trained and operational: it will rely on retired doctors who have volunteered to ensure the establishment death certificates, when their active colleagues are not available.
“This has only been possible for a few weeks and the publication of a
decree
which allows retired doctors who issue death certificates to be reimbursed.
Before that, they would not have touched anything
,” underlines Dr Meurin, who says he is relieved but remains a little disconcerted by the situation.
“Twenty years ago, it was inconceivable to recall a retired doctor, but today, we have no choice
,” sighs the president of the council of the Order of Physicians of Pas-de-Calais .
A solution that the Côtes-d’Armor department could also use.
“It’s an avenue, it could help in the summer
,” says Dr. Nicolas Liechtmaneger-Lepitre.
The more doctors there are, the less people will wait.”
An observation shared by his Pas-de-Calais counterpart, Francis Meurin.
“Even if the sectors to be covered are increasingly larger, we need a doctor per territory to be able to meet the demand.
It's part of the job.
We support patients in their lives, we must also support them in death.”
* First names have been changed.