RESUMEN

COMPENSATION SYSTEM FOR PESTICIDE EXPOSURE. The French Pesticide Victims Compensation Fund (FIVP) was created on January 1, 2020 to compensate people exposed to pesticides during their professional activity, or children who were exposed in utero due to their parents' professional activity. Occupational diseases related to pesticide exposure are under-reported. The primary role of any physician is to consider the link between pathologies observed and exposure to pesticides, to provide information to patients, and then to accompany them by writing the initial medical certificate on the Cerfa document specific to work accidents and occupational diseases (AT-MP) for adults, or a certificate on plain paper attesting to the pathology for children, and by providing them with copies of all the medical reports that they deem appropriate to attach to the request. The FIVP allows for the centralized processing by the Mutualité sociale agricole (MSA) of Mayenne-Orne-Sarthe of all occupational disease claims for which the patient, advised by the doctor who wrote the initial medical certificate (CMI), has indicated that the pathology is related to exposure to pesticides. The forms have been modified by the Health Insurance since May 7, 2022.

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DISPOSITIF D'INDEMNISATION DE L'EXPOSITION AUX PESTICIDES. Le Fonds d'indemnisation des victimes de pesticides (FIVP) a été créé le 1er janvier 2020 pour indemniser les personnes exposées à des pesticides au cours de leur activité professionnelle, ou les enfants y ayant été exposés in utero du fait de l'activité professionnelle de leurs parents. Les maladies professionnelles en lien avec l'exposition aux pesticides sont sous-déclarées. Le rôle premier de tout médecin est de penser au lien entre pathologies constatées et exposition aux pesti cides, de dif fuser l'information aux patients, puis de les accompagner en rédigeant le certificat mé dical initial sur le document Cerfa spécifique aux accidents de travail et maladies professionnelles (AT-MP) pour les personnes majeures, ou un certificat sur papier libre attestant de la pathologie pour les enfants, et en leur remettant des copies de l'en semble des comptes-rendus médi caux qu'ils jugent adaptés de joindre à la demande. Le FIVP permet un traitement centralisé par la Mutualité sociale agricole (MSA) de la Mayenne-Orne-Sarthe de l'ensemble des dossiers de demande de maladie professionnelle pour lequel le patient, conseillé par le médecin rédacteur du certificat médical initial (CMI), a indiqué que la pathologie était en lien avec l'ex position aux pesticides. Les formulaires ont été modifiés par l'Assurance maladie depuis le 7 mai 2022.

Asunto(s)

Enfermedades Profesionales , Exposición Profesional , Plaguicidas , Adulto , Niño , Humanos , Seguro de Salud , Exposición Profesional/análisis

RESUMEN

END-OF-CAREER AND END-OF-EXPOSURE VISITS Many legislative changes have been introduced in recent months concerning the activity of occupational physicians. Particular emphasis has been placed on the traceability of exposure and the resulting medical follow-up with the creation of end-of-career and end-of-exposure visits. These new features imply changes in terms of post-occupational monitoring in particular, but other appointments are obviously possible for workers in conjunction with their prevention and occupational health service.

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VISITES DE FIN DE CARRIÈRE ET DE FIN D'EXPOSITION De nombreux changements législatifs ont eu lieu ces derniers mois concernant l'action des médecins du travail. Un accent particulier a été mis sur la traçabilité des expositions et la surveillance médicale qui en découle avec la création des visites de fin de carrière et de fin d'exposition. Ces nouveautés impliquent des modifications en matière de surveillance post-professionnelle notamment ; d'autres rendez-vous restent évidemment possibles pour les travailleurs, en lien avec leur service de prévention et de santé au travail.

Asunto(s)

Enfermedades Profesionales , Exposición Profesional , Servicios de Salud del Trabajador , Humanos , Personal de Salud , Exposición Profesional/prevención & control , Enfermedades Profesionales/prevención & control

RESUMEN

Possession of weapons and hunting license.Firearms are the cause of more than a thousand deaths each year, representing a significant public health goal. For type B and C firearms, sport shooting, and hunting licences, the attending physician plays a crucial role, issuing a certificate in each case according to very specific terms and conditions.

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Détention d'armes et permis de chasser. Les armes à feu sont la cause de plus d'un millier de décès chaque année, représentant ainsi un objectif de santé publique conséquent. Pour les armes à feu de type B et C, le tir sportif et le permis de chasse, le médecin traitant joue un rôle crucial, délivrant à chaque fois un certificat selon des modalités bien particulières.

Asunto(s)

Armas de Fuego , Deportes , Humanos , Concesión de Licencias

Asunto(s)

Medicina Legal , Atención a la Salud , Humanos , Justicia Social

RESUMEN

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.

Asunto(s)

Consentimiento Informado/legislación & jurisprudencia , Trastornos Mentales/terapia , Servicios de Salud Mental/legislación & jurisprudencia , Psiquiatría/legislación & jurisprudencia , Humanos

RESUMEN

Medical secrecy in occupational medicine (I). The occupational physician is not isolated and works within a multidisciplinary team of an occupational health service. It must communicate with other health professionals, but also with the employers, the representative bodies of the staff... Due to numerous provisions of the Labor Code and the particular position of the occupational physician, counselor of employers and employees, and also of a secrecy particular to the world of work, namely the secret of manufacture, medical secrecy holds a special place in the triangular relation of work doctor, employee, employer. The occupational physician must communicate with the employer and the employee in order to carry out his duties as effectively as possible, but in practice it may be difficult for the occupational physician to make his recommendations and recommendations known in order to improve the working conditions of employees without being able to argue on medical information.

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Secret médical en médecine du travail (I). Le médecin du travail n'est pas isolé et oeuvre au sein d'une équipe pluridisciplinaire d'un service de santé au travail. Il se doit de communiquer avec d'autres professionnels de santé, mais aussi avec les employeurs, les instances représentatives du personnel… Du fait de nombreuses dispositions issues du code du travail et de la position particulière du médecin du travail, conseiller des employeurs et des salariés, mais également d'un secret particulier au monde du travail, à savoir le secret de fabrication, le secret médical tient une place particulière dans la relation triangulaire médecin du travail, salarié, employeur. Le médecin du travail doit communiquer avec l'employeur et le salarié afin de réaliser au mieux sa mission, mais, en pratique, il peut s'avérer difficile pour le médecin du travail de faire entendre ses préconisations et recommandations pour améliorer les conditions de travail des salariés sans pouvoir argumenter sur des informations médicales.

Asunto(s)

Confidencialidad , Servicios de Salud del Trabajador , Medicina del Trabajo , Médicos , Humanos

RESUMEN

Death certificate : recent changes and instructions for use. Since January 1, 2018, doctors must write death certificates on new models. The year 2017 saw a number of changes regarding funeral legislation and death reporting, concerning, among other things, the practice of custodial care and the data to be completed, which will be analyzed by the Center for Epidemiology on Medical Causes to produce national mortality statistics. The death certificate may be prepared in electronic format or, failing that, in paper form available from regional health agencies.

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Certificat de décès : modifications récentes et mode d'emploi. Depuis le 1er janvier 2018, les médecins doivent rédiger des certificats de décès sur de nouveaux modèles. L'année 2017 a vu apparaître plusieurs changements relatifs à la législation funéraire et à la déclaration des décès, concernant entre autres la pratique des soins de conservation ainsi que les données à renseigner qui seront analysées par le Centre d'épidémiologie sur les causes médicales de décès pour produire les statistiques nationales de mortalité. Le certificat de décès peut être établi sur support électronique ou, à défaut, sur support papier disponible auprès des agences régionales de santé.

Asunto(s)

Certificado de Defunción , Médicos , Causas de Muerte

RESUMEN

Medical secrecy in occupational medicine (II). The occupational physician is not isolated and works within a multidisciplinary team of an occupational health service. It must communicate with other health professionals, but also with the employers, the representative bodies of the staff... Due to numerous provisions of the Labor Code and the particular position of the occupational physician, counselor of employers and employees, and also of a secrecy particular to the world of work, namely the secret of manufacture, medical secrecy holds a special place in the triangular relation of work doctor, employee, employer. The occupational physician must communicate with the employer and the employee in order to carry out his duties as effectively as possible, but in practice it may be difficult for the occupational physician to make his recommendations and recommendations known in order to improve the working conditions of employees without being able to argue on medical information.

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Secret médical en médecine du travail (II). Le médecin du travail n'est pas isolé et oeuvre au sein d'une équipe pluridisciplinaire d'un service de santé au travail. Il se doit de communiquer avec d'autres professionnels de santé, mais aussi avec les employeurs, les instances représentatives du personnel… Du fait de nombreuses dispositions issues du code du travail et de la position particulière du médecin du travail, conseiller des employeurs et des salariés, mais également d'un secret particulier au monde du travail, à savoir le secret de fabrication, le secret médical tient une place particulière dans la relation triangulaire médecin du travail, salarié, employeur. Le médecin du travail doit communiquer avec l'employeur et le salarié afin de réaliser au mieux sa mission, mais, en pratique, il peut s'avérer difficile pour le médecin du travail de faire entendre ses préconisations et recommandations pour améliorer les conditions de travail des salariés sans pouvoir argumenter sur des informations médicales.

Asunto(s)

Confidencialidad , Servicios de Salud del Trabajador , Medicina del Trabajo , Humanos , Médicos

RESUMEN

The criminal record is a tool to combat repeated infringement. It is a list of infringements committed by a single person. The second report is accessible to the French National Medical Council and to hospital administration for doctors working in the public healthcare sector. There is no text establishing prohibition of medical practice with an infringement registered in the criminal record. However, to be qualified and licensed in the practice of medicine, doctors must be recorded to the French National Medical Council. This one verify the content of the criminal record. In contrast, any suspension or medical practice prohibition, pronounced through a verdict of the court or a professional order, must be entered in the criminal record. Medical blunders with criminal sanction can be entered on the criminal record and therefore suspend a permission to medical practice; even whithout a disciplinary sanction. Must be free from criminal convictions is not a legislative or regulatory necessity but an ordinal requirement. As it was, a medical student can continue his studies with an infringement registered in the criminal record, if he is not a French National Medical Council registrant and if he is in fact not working in the public healthcare sector.

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Le casier judiciaire est un outil pour lutter contre la récidive qui consiste en un relevé de l'ensemble des infractions d'une seule et même personne. Le bulletin n° 2 est accessible pour l'Ordre des médecins ou pour les centres hospitaliers dans le cadre des médecins travaillant dans le secteur public. Il n'existe aucun texte instaurant précisément l'interdiction d'exercer la médecine avec un casier judiciaire non vierge. Cependant, l'exercice légal de la profession implique une inscription à l'Ordre qui lui-même contrôle le contenu du casier judiciaire du médecin. A contrario, toute suspension ou interdiction d'exercice de la médecine prononcée par une juridiction répressive ou ordinale doit être inscrite au casier judiciaire. Les fautes médicales ayant entraîné une sanction pénale peuvent être inscrites au casier judiciaire et donc suspendre une autorisation d'exercice de la médecine, sans sanction disciplinaire. Le fait de posséder un casier judiciaire vierge n'est pas une obligation législative ou réglementaire mais une exigence ordinale. De fait, une mention sur le casier judiciaire n'empêche pas la pratique médicale tant que la personne n'est pas inscrite à l'Ordre des médecins ni salariée d'une administration publique.

Asunto(s)

Criminales , Médicos , Atención a la Salud , Humanos , Masculino , Médicos/legislación & jurisprudencia

Asunto(s)

Conducción de Automóvil/legislación & jurisprudencia , Prevención del Suicidio , Aeronaves , Conducción de Automóvil/psicología , Francia , Humanos , Concesión de Licencias , Seguridad

RESUMEN

BACKGROUND: Family physicians (FPs) have a central role in the detection and management of child abuse. According to the literature, only 2-5% of initial reports of child abuse come from the medical profession. METHODS: The objective of this study was to assess levels of knowledge of risk factors for child abuse by Family Physicians (FPs) and the attention that the physicians pay to these risk factors. We conducted a mixed-method survey based on semi-structured interviews. 50 FPs practicing in the Somme County (northern France) were interviewed with closed and open questions. The FPs' level of knowledge of risk factors for child abuse and obstacles in the detection of child abuse were assessed. RESULTS: The FPs' level of knowledge of risk factors for child abuse was similar to that reported in the literature. However, FPs knew little about the significant role of prematurity. Likewise, the FP's training did not seem to influence their knowledge of risk factors. Fear of an incorrect diagnosis was the main obstacle to reporting a suspected case. The FPs considered that they were often alone in dealing with a difficult situation and considered that the judicial system and the social services were not sufficiently active. CONCLUSIONS: Few FPs had actually received specific training in the detection and management of child abuse but many stated their need for this type of training. FPs encounter many obstacles in the detection of child abuse, which sometimes make the FP reluctant to report a suspected or potential case. Medical education need to be improved in this field.

Asunto(s)

Actitud del Personal de Salud , Maltrato a los Niños/diagnóstico , Medicina Familiar y Comunitaria , Médicos de Familia/ética , Adulto , Niño , Maltrato a los Niños/prevención & control , Educación Médica Continua , Medicina Familiar y Comunitaria/ética , Femenino , Francia , Humanos , Masculino , Médicos de Familia/educación , Factores de Riesgo , Encuestas y Cuestionarios , Recursos Humanos

RESUMEN

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.

Asunto(s)

Médicos Generales , Violencia Laboral , Adulto , Miedo , Femenino , Francia , Médicos Generales/psicología , Médicos Generales/estadística & datos numéricos , Visita Domiciliaria , Humanos , Masculino , Persona de Mediana Edad , Motivación , Visita a Consultorio Médico , Satisfacción del Paciente , Abuso Físico/psicología , Abuso Físico/estadística & datos numéricos , Relaciones Médico-Paciente , Médicos Mujeres/psicología , Médicos Mujeres/estadística & datos numéricos , Práctica Profesional , Control Social Formal , Encuestas y Cuestionarios , Teléfono , Robo , Conducta Verbal , Violencia Laboral/legislación & jurisprudencia , Violencia Laboral/psicología , Violencia Laboral/estadística & datos numéricos

RESUMEN

Road safety is for several years a major public health issue, given the number of casualties and annual deaths caused by road accidents in France or Europe. European directives of 2006 and 2009 were aimed harmonized community practices for the conduct, including medically. We studied the laws in force in each of the 28 countries of the European Union to make an inventory of the organization on this subject. The results showed that 25 countries introduce, at least once, including 21 medical check regularly. Age is the main factor that motivates control. The frequency of examinations increases with the age of the driver. In other countries, a sworn statement of the absence of pathology is enough. Although a medical examination is mostly carried out systematically, it the content is extremely variable, ranging from a simple vision test to a full review with psycho test. Management of professional secrecy is approached differently in different countries, although predominantly an exemption exists in the event of discovery of the inability of a patient. We note that there is a great diversity in the medical screening modalities unsuited to driving. These systems will be harmonized to comply with the wishes of European directives.

Asunto(s)

Accidentes de Tránsito/prevención & control , Aptitud , Conducción de Automóvil/legislación & jurisprudencia , Unión Europea , Humanos , Examen Físico , Médicos

RESUMEN

Every candidate for a driving license or any driver who meets a health problem must, on its own initiative, to submit to a medical examination. The list of approved doctors is available in the prefectures. There is a list of medical conditions that are incompatible with the licensing or involve restrictions on the use of the license. The treating physician is not authorized to carry out the assessment of medical fitness to drive for his own patients. This is the prefect who decides after consulting a licensed physician or medical committee composed of licensed doctors. If it deems medically necessary, the medical consultant outside medical commission may request the person to be summoned before the primary medical committee whose jurisdiction is then substituted for his. Possible advice is: fitness, temporary fitness, fitness subject to the license restrictions on use, or the inability of the candidate or driver to drive vehicles of the requested class. We emphasize the absence of shared secret between the attending physician and the medical officer or the Medical Committee.

Asunto(s)

Examen de Aptitud para la Conducción de Vehículos/legislación & jurisprudencia , Conducción de Automóvil/legislación & jurisprudencia , Rol del Médico , Estado de Salud , Humanos , Difusión de la Información , Cuerpo Médico de Hospitales

RESUMEN

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.

Asunto(s)

Accidentes de Tránsito/prevención & control , Conducción de Automóvil/legislación & jurisprudencia , Concesión de Licencias/legislación & jurisprudencia , Humanos

RESUMEN

Alcohol consumption in itself is not forbidden in France. Two situations are reprehended by the law: public drunkenness - where only the behavior is sanctioned and not the alcohol level - and driving with a level of alcohol superior to 0.5g per liter. The management of a severe state of drunkenness - even though frequent - is on the one hand poorly managed and on the other hands badly mastered by doctors. The management of drunken patients lies essentially in a strong monitoring of the possible complications. The inherent question of the returning-back-home for a drunken patient should be approached according to the state of consciousness rather than the alcohol rate in the blood. No matter what the rate is, the authorization to release a patient depends on the preservation of his judgmental capacities. If those are altered, the doctor can then decide to keep - even against his will - the patient temporarily and until he has recovered his discernment. Patients still keep their right to refuse any medical treatment. Indeed, the law does not provide any answer concerning the particular issue of the refusal of medical care by the patient, especially in case of a severe alcoholic intoxicated state that let the patient incapable to express his will and to understand the range of the given information. There is no legal measure that can able a doctor to firmly forbid a drunk patient to be released and to take the wheel. Doctors have to try to dissuade them by proposing other alternatives but they cannot physically oppose themselves to the patient decision. However, proofs that the doctor tried his best to convince the patient not to drive while under the influence of alcohol can be demanded. Doctors have the duty to inform patients on every risk that alcohol can bring while driving but do not have any measure of pressure.

Asunto(s)

Intoxicación Alcohólica , Conducción de Automóvil/legislación & jurisprudencia , Francia , Humanos

RESUMEN

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.

Asunto(s)

Centros Médicos Académicos , Personal de Salud , Servicios de Salud del Trabajador/métodos , Servicios de Salud del Trabajador/normas , Calidad de la Atención de Salud , Violencia Laboral/prevención & control , Francia , Humanos

RESUMEN

Patients' rights have developed over recent decades in many countries, resulting in improved access to high quality medical care. The alliance between patients and physicians is a moral obligation, backed up by patient rights. Poor patient compliance with medical recommendations constitutes a public health issue, illustrating the difficulty of obliging patients to comply with treatment. The legal recognition of patients' responsibilities is defined in a few legislative and regulatory texts, but is primarily based on jurisprudence. Patients, who despite being fully aware and informed about the risks adopt a behaviour that is harmful to their health, tend to be considered as being irresponsible. This judicial approach raises a number of questions, as it fails to take into account the complexity of the human factors involved in a behaviour with either positive or negative health effects.

Asunto(s)

Conductas Relacionadas con la Salud , Derechos del Paciente , Relaciones Médico-Paciente , Humanos , Principios Morales

RESUMEN

The precautionary principle is generally acknowledged to be a powerful tool for protecting health but it was originally invoked by policy makers for dealing with environmental issues. In the 1990s, the principle was incorporated into many legislative and regulatory texts in international law. One can consider that the precautionary principle has turned into "precautionism" necessary to prove to the people, taking account of risk in decisions. There is now a risk that these abuses will deprive the principle of its meaning and value. When pushed to its limits, the precautionary principle can even be dangerous when applied to the healthcare field. This is why a critical analysis of the principle is necessary. Through the literature, it sometimes seems to deviate somehow from the essence of the precautionary principle as it is commonly used in relation to health. We believe that educational work is necessary to familiarize professionals, policy makers and public opinion of the precautionary principle and avoid confusion. We propose a critical analysis of the use and misuse of the precautionary principle.

Asunto(s)

Toma de Decisiones , Política de Salud , Salud Pública , Investigación Biomédica , Unión Europea , Humanos , Medición de Riesgo

RESUMEN

Stroke after internal jugular venous cannulation typically leads to acute carotid or vertebral arteries injury and cerebral ischemia. We report the first case of delayed posterior cerebral infarction following loss of guide wire after left internal jugular venous cannulation in a 46-year-old woman with a history of inflammatory bowel disease. Our observation highlights that loss of an intravascular guide wire can be a cause of ischemic stroke in patients undergoing central venous catheterization.