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

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