Access to care: the diagnosis must be made by a doctor… with some exceptions

Access to care: the diagnosis must be made by a doctor... with some exceptions

To free up medical time and improve access to patient care, the Rist law has made it possible since 2023 to delegate certain tasks to paramedical professionals. But the Academy of Medicine points out that this should not call into question the importance of medical diagnosis.

To facilitate access to care and improve care in medical deserts, the Rist Law made it possible to consult a physiotherapist or speech therapist without a prescription, to carry out vaccinations or tests in pharmacies, to see each other prescribe examinations by an advanced practice nurse… But these developments must not eclipse a reality that is always necessary: ​​skipping medical diagnosis must not become the norm, but must remain an exception. The Academy of Medicine warns of a possible deviation.

Diagnosis, a profoundly medical approach

As the Academy of Medicine points out, medical diagnosis is not a step that can be conveniently replaced by an opinion from our pharmacist or another professional, even if we have confidence in it.

“The medical prescription is not an administrative formality. It is the result of an approach carried out by the doctor, which is based on listening to the patient, and the in-depth individualized analysis of his symptoms and his situation (age, history, family, professional, socio-economic context). The physical examination and analysis of the results of any additional examinations then allow the doctor to establish a medical diagnosis. (…) It is therefore the culmination of an intellectual process whose conduct takes advantage of the fact that the doctor, after at least nine years of study, has significant theoretical and practical knowledge and has, over time, growing experience and constantly updated knowledge.

It also reminds us that the time spent in an unsuitable therapeutic approach can be equivalent to a delay in starting an effective treatment.

For Dr Kierzek, “Everyone must do their job in good cooperation”

Consulted on the subject, Dr. Gérald Kierzek, medical director of TipsForWomens, confirms this need to recall this essential: “It should even be enshrined in law. A diagnosis must be made by a doctor.”

“That there is collaboration and delegation of tasks, via assistants under the responsibility of doctors, advanced practice nurses, physiotherapists, pharmacists… is not a problem. But the diagnostic part is a medical part which is up to the doctor. Being a doctor is a long training course, it’s 10 years of study, and the learning of particular reasoning, which cannot be replaced by reflex sheets or algorithms. he assures.

But the situation of medicine at several speeds depending on the area undermines this medical logic.

“We can clearly see what is happening: as there are not enough doctors, we accept this de facto situation, and we are gradually replacing them with “sub-doctors”. In the end, this is not good for anyone, neither for patients nor for health professions who find themselves in competition, where they would benefit from being in collaboration. Medicine is not interchangeable. For the good of the patient, everyone must do their job in good cooperation.”

With another side effect: “By dint of stripping the profession, this can only demotivate people from doing general medicine” worries our expert.

A prescription without diagnosis only under conditions

Faced with the extension of access to examinations and therapies without a doctor’s prescription, the National Academy of Medicine:

  • Recalls that the medical prescription is based on the medical diagnosis, which is the essential component of the therapeutic approach;
  • Emphasizes that the initiation of treatment with a curative aim, in particular of a medicinal nature, without a prescription from a doctor and therefore without prior medical diagnosis, can only be conceived when the following conditions are met: verification of the unavailability of a doctor ; minimal risks of side effects from the therapy concerned; and medical evaluation, after a determined and repeated period, of all procedures thus initiated;
  • Recalls that the absence of doctors capable of making a diagnosis is not conceivable in the context of a health establishment, in which a patient, whether entering through the emergency department or through the medical consultation department, cannot be considered deprived of a capacity for medical diagnosis, and therefore medical prescription;
  • Emphasizes that, regardless of the type of exercise, a diagnosis of illness is not sufficient to indicate a need for rehabilitation, or any treatment whatsoever;
  • Considers that the obligation of prior prescription by a doctor is not an obstacle to the revaluation of certain health professions or to the streamlining of the patient’s care pathway, but an element of securing the practice of these professions and of security health for the patient.