NOTE2BIB, illusion démocratique ou nouveau témoignage de démocratie sanitaire ?

hippocrate.jpg Dans sa kyrielle d’idées novatrices, le rapport ATTALI, encore lui, proposait la possibilité pour les patients d’évaluer leurs praticiens, idée qui a été concrétisée par l’apparition du site « Note2bib » (prononcez notetoubib) qui a officiellement pour objet de faire partager l’expérience, vécue par les patients, des professionnels de santé, « en toute sincérité et sans règlement de compte. Chaque professionnel a également un droit de réponse aux commentaires qui lui sont adressés. »

Dans le respect apparent du principe du contradictoire, ce site prend soin de préciser que les commentaires sont modérés et que toutes les remarques portant sur la compétence professionnelle des praticiens seront effacés, autant de garde-fous permettant de se prémunir contre des dérives potentielles. Pour autant, grâce à ce principe d’appel à témoignages et dans un contexte toujours plus consumériste de la médecine, on imagine sans peine la formidable ampleur que peut prendre ce site, qui sauf erreur ou omission relève du droit mauricien, ce qui le protège des déboires judiciaires de son homologue feu « Note2be » portant, lui, sur la notation des professeurs par leurs élèves.

Un ami me faisait remarquer que la révolution numérique était en marche et que les citoyens avaient le choix entre prendre le wagon ou rester à quai. Ce site obligera peut-être à terme les médecins, libéraux au premier chef, à s’interroger sur leur pratique professionnelle davantage qu’ils ne le font actuellement.

C’est justement d’évaluation des pratiques professionnelles (EPP), non plus par des professionnels mais par des profanes, qu’il est question ici lorsque des sites de ce genre apparaissent. Rappelons pour mémoire que le code de la santé publique a inscrit, depuis la loi du 4 mars 2002, la formation médicale continue (FMC) au rang des principes fondamentaux participant, au même titre que le devoir d’information médicale ou le respect du consentement, à la qualité des soins offerts au patient. La FMC constitue désormais « une obligation pour tout médecin » ((article L. 4133-1 alinéa 1 du code de la santé publique)).

La loi du 13 août 2004 relative à l’assurance maladie a introduit de nouveaux dispositifs d’évaluation individuelle ou collective des professionnels exerçant en établissement de santé. En quoi consiste cette EPP ? Il s’agit d’une analyse de la pratique professionnelle en référence à des recommandations et selon une méthode élaborée et validée par la Haute Autorité de Santé (HAS) qui habilite les médecins ou professionnels chargés d’organiser ou de réaliser les actions d’EPP ((art. R. 161-73 du code de la sécurité sociale)).

A compter du 1er juillet 2005, elle s’applique obligatoirement à tous médecins quelque soit leur mode d’exercice. Adaptée à chaque mode d’exercice, l’EPP associe le Conseil national de l’ordre des médecins, l’URML, les commissions médicales d’établissement (pour les établissements publics de santé) et les conférences médicales d’établissement (pour les établissements de santé privés).

Avec des sites tels que « Note2bib », il n’y a rien de tel puisque l’objectif est justement de déposséder les autorités évaluatrices compétentes des professionnels de santé au profit des patients qui, certes, ne disposent a priori pas des compétences professionnelles pour juger du travail de tel ou tel praticien, mais qui peuvent juger selon d’autres critères, à la fois objectifs (accueil, accessibilité, ponctualité, voire même dépassements d’honoraires, etc.) et plus subjectifs (dialogue, explication, implication, écoute, par exemple).

Sous prétexte que le patient n’aurait pas fait d’études de médecine, la faculté de dire et d’écrire ce qu’il pense à propos des médecins, généralistes ou spécialistes, qu’il a côtoyés, d’établir des témoignages, même rendus, si besoin est, anonymes, lui serait interdite. Il me semble que cette conception paternaliste appartient au passé.

Les esprits chagrins pourront toujours objecter, avec raison, que les patients mécontents peuvent saisir la commission des relations avec les usagers et de la qualité de la prise en charge (C.R.U.Q.P.C), instance obligatoirement présente dans tout établissement de santé, public ou privé, pour se plaindre de telle ou telle pratique médicale.

Ils pourront toujours dénoncer tel ou tel comportement déviant devant le conseil départemental de l’ordre compétent dans la spécialité concernée.

Face aux dépassements d’honoraires abusifs de médecins en secteur II dit à honoraires libres, ils pourront même écrire à la caisse primaire d’assurance maladie territorialement compétente.

Les autorités, on le voit, ne manquent pas pour dénoncer et contribuer à assainir les pratiques médicales sujettes à caution.

Dans ces conditions, à quoi bon recourir à l’Internet pour exposer aux yeux du grand public les témoignages portant sur le retard de prise en charge d’un médecin généraliste, sur les remarques désobligeantes d’un gastro-entérologue, sur l’absence de communication d’une dermatologue, sur l’incompétence prétendue ou avérée d’une ophtalmologiste, sur l’abus de prescription d’un chirurgien-dentiste, sur le certificat de complaisance dressé par un kinésithérapeute ou sur le dépassement d’honoraires en consultation pré-anesthésique. On pourrait multiplier les exemples à l’envi.

S’il est correctement encadré, ce genre d’initiatives peut servir de fondement à une démocratie sanitaire, non plus formelle mais réelle.

L’outil n’en est qu’à ses balbutiements mais les médecins doivent comprendre que, à l’instar de la mondialisation des échanges, et notamment de l’information, c’est à un changement d’ère qu’on assiste et que, au lieu de chercher à lutter contre ce mouvement inexorable, il serait sans doute préférable et plus réaliste de l’épouser pour pouvoir l’influencer.

Rien n’interdit d’imaginer qu’un jour les avocats, les experts-comptables, les notaires, etc. puissent être, à leur tour, « évalués », jugés par les quidams, les citadelles – même, et surtout libérales – tombant les unes après les autres, toujours dans le respect du secret professionnel, bien entendu.

Alors, renouveau ou illusion, il est sans doute encore trop tôt pour le dire.

Omar YAHIA

This Post Has 1 603 Comments

  1. beagle dog dit :

    very handful of sites that occur to become in depth beneath, from our point of view are undoubtedly effectively really worth checking out

  2. usually posts some quite interesting stuff like this. If you are new to this site

  3. Google dit :

    Although websites we backlink to below are considerably not related to ours, we really feel they may be really really worth a go by means of, so possess a look.

  4. Really enjoyed this post.Really looking forward to read more. Will read on

  5. one of our guests just lately encouraged the following website

  6. check dit :

    Spot on with this write-up, I really assume this web site needs rather more consideration. I all most likely be once more to read much more, thanks for that info.

  7. Thanks for sharing your thoughts about morgage credit score refinance home loan approved.
    Regards

  8. It’s topper credt card if you fold the credit accountthat was sound business exercises. And the other part about this is that it faresn’t feature an one-year rattling exchangeable really.

  9. Im obliged for the blog.Thanks Again. Really Great.

  10. Julian Wilson dit :

    Do you mind if I quote a few of your articles as long as I provide credit and sources back to your webpage? My blog site is in the very same niche as yours and my users would certainly benefit from some of the information you present here. Please let me know if this okay with you. Thanks!

  11. Kiera dit :

    Hi it’s me, I am also visiting this website regularly, this web site
    is genuinely pleasant and the visitors are genuinely sharing nice thoughts.

  12. Menaje del Hogar es una empresa que trabaja tanto en el ámbito local como provincial de la Comunidad de Autónoma de Madrid, contando con una oficina central de administración y con técnicos distribuidos en todas las zonas en las que prestan sus servicios. Estamos abiertos a nuestros clientes antes, mientras y después de hacer nuestro trabajo, de reparación Frigorificos Liebherr si tiene alguna sugerencia nuestro personal telefónico le atenderá gustosamente porque estamos deseando escucharlas. Servicio técnico Liebherr aseguramos la máxima calidad en las reparacion de Frigorificos Liebherr y los repuestos, así como en otros aspectos también importantes como la amabilidad, información honestidad y transparencia.

  13. Google dit :

    The time to study or take a look at the content material or sites we have linked to beneath.

  14. This article will assist the internet visitors for setting up new webpage
    or even a blog from start to end.

  15. amor tantra dit :

    Im grateful for the article post.Really thank you! Fantastic.

  16. tech forum dit :

    Here is an excellent Weblog You may Uncover Fascinating that we Encourage You

  17. tech forum dit :

    just beneath, are several entirely not associated web pages to ours, nevertheless, they may be surely worth going over

  18. I was pretty pleased to locate this web-site. I wanted to thanks for your time for this fantastic read!! I definitely enjoying each little bit of it and I have you bookmarked to take a look at new stuff you weblog post.

  19. Google dit :

    Sites of interest we’ve a link to.

  20. sex video dit :

    Very shortly this site will be famous amid all blog people, due to it’s good articles|

  21. It is a fabulous read personally, Ought to disclose you are the most effective bloggers We ever before discovered. Appreciate it with regard to publishing this informative article.

  22. Google dit :

    Although web-sites we backlink to below are considerably not connected to ours, we feel they are in fact worth a go by, so possess a look.

  23. Dorothy Nash dit :

    I like what you guys are usually up too. Such clever work and reporting! Keep up the wonderful works guys I’ve you guys to my blogroll.

  24. Google dit :

    Sites of interest we have a link to.

  25. sex video dit :

    Hey there! I could have sworn I’ve been to this blog before but after browsing through some of the post I realized it’s new to me. Anyhow, I’m definitely glad I found it and I’ll be book-marking and checking back frequently!|

  26. Going Here dit :

    It as not my first time to pay a visit this site,

  27. Looking forward to reading more. Great blog.Thanks Again. Awesome.

  28. Just wanna input that you have a very nice website , I the layout it really stands out.

  29. This very blog is without a doubt awesome and besides factual. I have picked many handy things out of it. I ad love to come back again and again. Thanks!

  30. You could definitely see your expertise in the work you write. The world hopes for more passionate writers like you who aren’t afraid to say how they believe. Always follow your heart.

  31. Lucas Wilkins dit :

    Hello there, I found your blog by means of Google at the same time as looking for a related topic, your web site got here up, it appears to be like great. I’ve bookmarked it in my google bookmarks.

  32. keep up the superb piece of work, I read few articles on this web site and I think that your blog is rattling interesting and has got bands of fantastic information.

  33. Excellent goods from you, man. I have understand your
    stuff previous to and you’re just extremely excellent.
    I actually like what you’ve acquired here, really like
    what you are saying and the way in which you say it. You make it enjoyable and you still take care of to keep it smart.
    I cant wait to read far more from you. This is actually a
    terrific site.

  34. I do consider all the concepts you’ve offered in your post.
    They are very convincing and can definitely work.
    Still, the posts are very brief for beginners.
    May you please extend them a bit from next time? Thank you for
    the post.

  35. newspaper dit :

    Very nice post. I just stumbled upon your weblog and wished to say that I ave really enjoyed browsing your blog posts. After all I will be subscribing to your feed and I hope you write again soon!

  36. although internet websites we backlink to below are considerably not associated to ours, we feel they’re really worth a go by way of, so have a look

  37. Every weekend i used to pay a quick visit this web page, because i wish for enjoyment, for the reason that this this site conations genuinely pleasant funny material too.|

  38. Regardless, I am definitely delighted I discovered it and I all be bookmarking it and

  39. Just wanna admit that this is extremely helpful, Thanks for taking your time to write this.

  40. veja mais dit :

    You appear to know so much about this, and I see you’re a published author. Thanks

  41. pixie clothes dit :

    Wow! This could be one particular of the most useful blogs We ave ever arrive across on this subject. Actually Fantastic. I am also a specialist in this topic so I can understand your effort.

  42. My spouse and I stumbled over here by a different web page and thought I might as well check things out. I like what I see so now i’m following you. Look forward to checking out your web page repeatedly.|

  43. that will be the end of this report. Right here you will uncover some websites that we believe you will value, just click the hyperlinks over

  44. one of our guests recently encouraged the following website

  45. online survey dit :

    This particular blog is no doubt awesome and besides diverting. I have picked many interesting stuff out of it. I ad love to come back again and again. Thanks!

  46. The data talked about in the post are some of the most effective out there

  47. You can definitely see your expertise in the work you write. The sector hopes for even more passionate writers like you who are not afraid to mention how they believe. All the time follow your heart.

  48. ssd vps dit :

    I loved your blog post.Really thank you! Really Great.

  49. I don’t know whether it’s just me or if everybody else encountering issues with your site. It appears as if some of the written text within your posts are running off the screen. Can somebody else please provide feedback and let me know if this is happening to them too? This might be a problem with my browser because I’ve had this happen before. Thanks|

  50. Hi there! I just wish to offer you a huge thumbs up for
    your excellent info you have got right here on this post.

    I’ll be returning to your website for more soon.

  51. Jane Scott dit :

    Simply want to say your article is as surprising. The clearness in your post is just cool and i could assume you’re an expert on this subject. Well with your permission allow me to grab your RSS feed to keep updated with forthcoming post. Thanks a million and please carry on the rewarding work.Feel free to surf to my blog post :: free xbox live codes (Margarette)

  52. It is perfect time to make a few plans for the longer term and it is time to
    be happy. I have learn this post and if I may I wish
    to suggest you some attention-grabbing things or advice.
    Maybe you can write next articles relating to this article.
    I want to learn even more things about it!

  53. please stop by the web-sites we comply with, which includes this a single, because it represents our picks from the web

  54. Im thankful for the blog article.Much thanks again.

  55. Hi there, I discovered your web site by way of Google even as
    looking for a similar matter, your site came up, it appears to be like good.
    I’ve bookmarked it in my google bookmarks.

    Hi there, just become alert to your weblog via Google, and found that it is
    truly informative. I am going to be careful for brussels.
    I will appreciate in the event you proceed this in future.

    Lots of other people shall be benefited from your writing.
    Cheers!

  56. This web site truly has all the info I needed about this subject and didn at know who to ask.

  57. Here is a superb Weblog You may Uncover Intriguing that we Encourage You

  58. Jovita dit :

    After I initially left a comment I appear to have clicked the
    -Notify me when new comments are added- checkbox and now whenever a
    comment is added I get 4 emails with the exact same comment.
    There has to be a way you are able to remove me from that service?

    Kudos!

  59. As a Newbie, I am constantly exploring online for articles that can help me. Thank you

  60. here are some hyperlinks to web pages that we link to due to the fact we assume they’re worth visiting

  61. Velva dit :

    Hi there, i read your blog from time to time and i own a similar
    one and i was just wondering if you get a lot of spam comments?
    If so how do you stop it, any plugin or anything you can suggest?
    I get so much lately it’s driving me insane so any help is very much appreciated.

  62. we like to honor a lot of other web web pages around the net, even though they arent linked to us, by linking to them. Under are some webpages worth checking out

  63. Sites of interest we have a link to

  64. Heya fantastic website! Does running a blog such as this take a great deal of work? I have no understanding of computer programming however I had been hoping to start my own blog in the near future. Anyhow, if you have any suggestions or tips for new blog owners please share. I know this is off subject however I simply needed to ask. Thanks a lot!

  65. below you will uncover the link to some sites that we consider you’ll want to visit

  66. You have made some good points there. I checked on the net to find out more about the issue and found most individuals will go along with your views on this web site.

  67. Vicky Vette dit :

    here are some links to websites that we link to simply because we think they may be worth visiting

  68. sex toys dit :

    one of our guests lately suggested the following website

  69. Wonderful beat ! I wish to apprentice while you amend your
    web site, how could i subscribe for a blog site?
    The account aided me a acceptable deal. I had been a little bit acquainted of this your broadcast provided bright clear
    idea

  70. Google dit :

    We like to honor quite a few other net internet sites around the internet, even when they arent linked to us, by linking to them. Underneath are some webpages worth checking out.

  71. Zoe Stewart dit :

    Definitely, what a fantastic website and informative posts, I definitely will bookmark your blog.All the Best!

  72. Google dit :

    We prefer to honor many other web web pages on the web, even when they arent linked to us, by linking to them. Underneath are some webpages worth checking out.

  73. Jan Jones dit :

    Very good post. I certainly love this website. Thanks!

  74. pregnant dit :

    A round of applause for your blog post.Thanks Again. Great.

  75. Google dit :

    Sites of interest we’ve a link to.

  76. A round of applause for your blog article.Really thank you! Fantastic.

Leave A Reply