"I bordered on disaster ..." Hervé, 90, is well aware of this: teleconsultation saved him. After a first operation for a subdural hematoma at the end of February, this pianist began to suffer from persistent headaches. "It worried him," blows his wife Joseline. I made an appointment with our family doctor over the Internet. With teleconsultation, she organized the scanner for the next day. "
The diagnosis is immediate: new subdural hematoma, on the other side. We must act quickly. "He was transferred to the Henri-Mondor hospital in Créteil at 3 pm, operated on at 5 pm and returned home three days later," said his wife, who found "the teleconsultation brilliant". "My experience is convincing," confirms Hervé who did not hesitate to go to the hospital in his condition. “The risk was so great of not going there, and then I trust the hospital staff. "
But unlike Hervé, the patients are far too numerous, since confinement, to avoid medical offices, exposing themselves to a possible worsening of their pathology. The number of consultations billed to Health Insurance for people affiliated to the general scheme was halved, with only 2.3 million consultations for the period from mid-March to mid-April, compared with 4.6 on the same period in 2019.
And this, despite the very strong increase in teleconsultations (more than 1 million the week of March 30 in France). The Regional Union of Liberal Health Professionals reports that the number of consultations is collapsing: - 97% for dentists (emergency only), - 44% for general practitioners, - 76% for specialists, - 78% for masseurs physiotherapists…
Emergency professionals as well as city professionals have alerted in recent days about the considerable decrease in the request for appointments for reasons other than the suspicion of coronavirus. The fear of being contaminated even in the waiting rooms leads many patients to delay or postpone the use of care, including when they are suffering from pathologies requiring regular monitoring.
Patients returning to the emergency room in recent days
Health authorities, doctors, firefighters ... All have noted this phenomenon. “We are very worried, people no longer consult their specialist, no longer call the doctor. If you have chest pain, for example, don't wait! "Summarizes Lieutenant-Colonel Gabriel Plus, spokesperson for the Paris fire brigade.
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"It is not possible that there is no longer a heart attack or stroke in France," confirms Lionel Lamhaut, emergency doctor in Necker, who coordinates transfers of patients in intensive care from Ile-de- France. "People who do not call expose themselves to sudden deaths if they wait too long", fears the emergency room doctor, who has seen a heart attack reappear with cardiogenic shock, a sign, he insists, of too long a wait. The covid is not therefore solely responsible for the explosion in the number of deaths at home last month, compared to March 2019, which climbed to + 57% in Seine-Saint-Denis or + 75% in Hauts-de -Seine.
After a sharp decline, hospital emergencies would see an increase in attendance for the past few days. A sentiment confirmed by the French Hospital Federation, which does not yet have figures to back it up. Patients who come to hospital as a last resort, after having delayed too long.
Jean-Luc Fontenoy, general practitioner at Livry-Gargan and president of the Order of physicians of Seine-Saint-Denis, sighs. “We may end up having more deaths caused by chronic pathologies than by Covid! Because other serious conditions can arise, even in this period of confinement: he cites the dramatic case of a young girl, who died a few weeks ago as a result of pyelonephritis (urinary tract infection).
"People are sure they are bothering us, but not at all!"
“We have to fight the misconception that doctors are not available. We have to get the message across: the cabinets work, ”insists Aurélie Combas Richard, director general of the CPAM 93. Who also welcomes the“ extraordinary boom ”in teleconsultation in the department. In mid-April, almost one in five patients in the 93 consulted their doctor by videoconference or telephone (sessions reimbursed 100% by Social Security), compared to less than one in a hundred before the crisis. It is remarkable, but many patients do not have the tools and means to use it.
In Nogent-sur-Marne (Val-de-Marne), Doctor Anne-Marie Bénéteau-Béchara repeats it tirelessly. "People are sure they are bothering us, but not at all! She insists.
To encourage patients to consult again, she created, with all the doctors in the town, a center dedicated to Covid patients. This structure makes it possible to have two distinct streams and to reserve the usual city offices for other pathologies. She was thus able to diagnose breast cancer requiring rapid treatment in two young women, for example.
"Go get your patients!"
The Syndicate of Liberal Physicians, through the voice of its president, Dr. Philippe Vermesch, urges its members to "go and get the patients". “Starting from our appointment book and our active file of patients, we can, each of us, get our patients to help them and continue to do our job. This is exactly what Dr Anne-Marie Bénéteau-Béchara does, who reminds the elderly and the chronically ill one by one.
Same approach with regard to the four municipal health centers (CMS) of Saint-Denis, which usually follow 2,500 patients of all ages. Contrary to the general trend, activity has not decreased in these structures which accommodate the most precarious, without health coverage (1,700 consultations in March, against 1,900 in February).
However, it has reorganized: medical specialists have withdrawn, with the exception of gynecologists. The days were split into two: mornings dedicated to "Covid consultations", afternoons to other patients, "with cleaning of the premises between noon and 2 pm".
"Here too, teleconsultations have gained momentum," notes Simon Bonnaure, director of health for the city of Saint-Denis. It is time to recontact patients whose condition requires follow-up and to plan new consultations. We will also have to think about after May 11. "
It will then be necessary to cope with the influx of patients, especially in a department of Seine-Saint-Denis which has fewer doctors than the rest of Ile-de-France (54 per 100,000 inhabitants, against 71 in the regional scale).