Cécile Manaouil

La personne de confiance, nouvel outil de la relation médecin patient

THE NOTION OF A PERSON OF TRUST: Introduced by the law dated March 4th 2002, the person of trust is there to accompany the patient in all his/her measures of care; this person is also conceived as an helper in medical decisions or when the patient participates in biomedical research protocols. DESIGNATION MODALITIES: Any adult, unprotected patient can designate a person of trust, whose intervention is not only limited to hospitalisation (the nursing staff are obliged to propose such a person), but can also intervene during care at home or at the doctors. The designation is made in writing and can be revoked at any time. The person of trust can be a relative, a friend or even the treating physician. A SPECIFIC ROLE: The person of trust can be of help in medical measures in routine medicine when the patients needs to be accompanied, and in the case of diagnosis or serious prognosis, and when the patient is incapable of expressing him/herself.

Fighting violence against health workers: a way to improve quality of care?

Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing anti-violence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care.

Intérêt de l’analyse anatomopathologique dans une série de 400 autopsies médicolégales

OBJECTIVES To assess the usefulness of histopathologic examination in forensic autopsies. MATERIAL AND METHODS All consecutive pathological reports and slides from forensic autopsies performed in our department since 2006 have been reviewed. RESULTS Four hundred forensic necropsies were reviewed. In only 150 cases (38%), pathologists had data about manner of death and gross autopsy findings. Major diagnoses, related to death, and unsuspected by forensic pathologists, were discovered in 83 cases (21%): in 48 cases (12%) gross examination of the heart, lungs and liver showed gross diagnoses missed by the forensic pathologists, and in only 35 cases (9%) microscopic examination revealed a major unsuspected diagnosis (in brain, heart, lungs, liver, kidney and pancreas specimens). In 213 cases (53%), histopathologic examination confirmed gross autopsy findings and allowed to date some wounds. In 104 cases (26%), microscopic examination was not contributory. CONCLUSION Microscopic examination revealed major diagnoses in less than 10% of forensic autopsies. Its effectiveness is limited for homicides and suicides. Systematic microscopic examination of numerous organs is often useless and should be limited to cases with no anatomic causes of death. Our study emphasizes the need for a better communication between forensic pathologists and histopathologists, and for a better training of some forensic pathologists for gross examination.

Les autopsies d'adultes au CHU d'Amiens durant la période 1975-2005

Resume Nous avons revu retrospectivement les comptes-rendus des autopsies medico-scientifiques d’adultes realisees au CHU Amiens durant la periode 1975-2005. 1 639 autopsies ont ete realisees chez 1 049 hommes et 590 femmes. Trois periodes se detachaient : 1975-1987 (periode 1) avec un nombre eleve d’autopsies (86/an), 1988-1996 (periode 2) avec une chute importante du nombre d’autopsies (43/an) et 1997-2005 (periode 3) avec tres peu d’autopsies (14/an). Les patients etaient plus jeunes durant la periode 3, 38 % ayant moins de 50 ans contre 26 % et 29 % durant les periodes 1 et 2. Le sex-ratio H/F augmentait durant la periode 3 (2,7 contre 1,7 et 1,9 durant les periodes 1 et 2). La periode 3 etait marquee par une augmentation des decouvertes autopsiques de pathologies majeures (36 % contre 28 % des autopsies des periodes 1 et 2) et par une augmentation des autopsies apres accident medical (20 % contre 12 % et 13 % des autopsies des periodes 1 et 2). La periode 3 etait marquee par une augmentation du delai entre la date du deces et la realisation de l’autopsie et par une diminution du delai d’envoi des comptes-rendus, 2 % des autopsies n’ayant jamais ete repondues par les pathologistes. En conclusion, notre etude confirme le declin majeur des autopsies sur 30 ans. Les sujets autopsies sont actuellement plus souvent des hommes jeunes, l’autopsie etant realisee plus frequemment dans une ambiance medico-legale. Les biais de selection des malades font que les diagnostics majeurs decouverts a l’autopsie sont plus nombreux actuellement qu’il y a 30 ans.

A French hospital sentenced for unreasonable obstinacy

On 2 June 2009, the Nimes administrative court condemned the Hospital of Orange (France) for unreasonable obstinacy after neonatal resuscitation. On 14 December 2002, an apparently stillborn child was resuscitated after approximately 30 minutes of foetal distress. Cardiac activity was recovered, but the child has since suffered from severe disabilities. The court did not find any fault committed by the hospital regarding maternal care. However, the hospital was sentenced to compensate for the injuries caused by unreasonable obstinacy. According to the court, the medical team should have taken into account the harmful neurological consequences of prolonged foetal distress. The court did not condemn the act of resuscitation itself, but its excessive length. This court ruling serves as a basis for reflection regarding the limits by which unreasonable obstinacy should be set.

La réforme du statut des experts judiciaires

Resume La loi du 11 fevrier 2004, completee par le decret du 23 decembre 2004 relatif aux experts judiciaires, est venue reformer celle du 29 juin 1971. La loi nouvelle organise une inscription initiale sur les listes des cours d’appel, d’une duree de deux ans, au terme desquels l’experience de l’interesse et l’acquisition des connaissances juridiques necessaires sont evaluees dans la perspective d’une reinscription eventuelle sur presentation d’une nouvelle candidature. Tous les cinq ans, l’expert devra faire une demande de reinscription, pour laquelle une commission, comportant des magistrats mais aussi des experts, emettra un avis motive.

Ethical issues arising from the requirement to provide written information in palliative care

French Healthcare Networks aim to help healthcare workers take care of patients by improving co-operation, co-ordination and the continuity of care. When applied to palliative care in the home, they facilitate overall care, including medical, social and psychological aspects. French legislation in 2002 required that an information document explaining the functioning of the Network should be given to patients when they enter a Healthcare Network. Ethical problems arise from this legislation with regard to providing terminal patients with explicit information upon their entry into the palliative phase of the disease, and requiring them to sign the document. It highlights the limitations of this practice, and the gap between the legislation and the nature of the physician-patient relationship in palliative care.

Les soins sans consentement en psychiatrie : rédaction du certificat initial

Any doctor may be required to take care of patients with psychiatric disorders and be confronted with the necessity of imposing hospitalization in a psychiatric facility. In view of the increase in hands raised by the Judge of Freedoms and Detention, it is important to adopt a rigorous approach in the drafting of certificates for psychiatric care without consent. We will remember: the importance of conscientious fulfilment of the first certificates; the reassessment of the patient within 24hours, by a psychiatrist; a review by the judge of freedoms and detention; the information given to the patient.

Permis de conduire et aptitude médicale

The Highway Code requires that any vehicle driver is constantly in a state and in position of performing easily and without delay all the maneuvers required of them. What about a vehicle driver suffering from a medical condition that does not allow it to meet the requirements of the Highway Code? While it may seem obvious that some diseases irrefutably presumed inability to drive, the regulatory authority had to answer a number of questions. What people should be subject to medical control of driving ability? What constitutes control? Who may be responsible for this control? The government, through a decree dated 17 July 2012 relating to medical control of driving ability, came to ask a new legal framework in this area meets all of these issues. In addition, a decree of 31 July 2012 came to specify the implementation rules for monitoring medical fitness to drive.

Violences subies par les médecins généralistes exerçant en libéral : sous-déclaration des agressions ou des atteintes aux biens

INTRODUCTION The main objective of this study was to estimate prevalence on the liberal general practitioners. The secondary objectives are to identify the possible brakes with the declaration in the monitoring observatory for security of the doctors as well as to determine if the feminization of the profession was associated with the situations violence. METHODS A questionnaire in 5 parts was submitted by telephone to 146 drawn lots liberal general practitioners. It approached the undergone physical and verbal attacks, the infringements on the properties arisen during their career, and the proven feeling of insecurity. RESULTS The rate of participation was 63% (93/146). In all 171 incidents were reported among which 96 physical and verbal attacks (56%), and 75 infringements on the properties (44%) without difference according to the sex. The main motive for the attacks was the refusal of prescription (44%). Practically, no concerned doctor made declaration for the monitoring observatory for the security of the doctors, for lack of interest for 5 of them or the ignorance of its existence for 10 on 32 practitioners having undergone an aggression after the creation of the monitoring observatory. CONCLUSION We observed an under-reporting of the attacks or of the infringements on the properties by the doctors victims. Our study did not highlight difference between men and women.