French doctors challenge new prescription decree

The medical world has expressed its outrage at a new decree signed by former prime minister Michel Barnier which will make it compulsory for doctors to indicate the illness of their patients on prescriptions. 

There is much concern among doctors, unions and pharmacists at the manner in which the decree was passed and its potential impact. 

This measure will not apply to all prescriptions but a list has not yet been released. 

In particular, the new rule will give doctors more administrative tasks at a time when there is a shortage of doctors in France. 

The decision was made to save the Assurance Maladie (the health insurance branch of France’s social security system) money and to reduce the misuse of medication. 

“I cannot understand what the people making these decisions are thinking. It just goes to show their total disregard and scorn for office doctors,” Dr Sophie Bauer, president of the Syndicat des Médecins Libéraux (Union of Liberal Doctors) told The Connexion. 

“The Assurance Maladie will get its wish and will have to reimburse less money for medication, but it will come at the price of patients getting less medication which they need.” 

Read more: When are doctor fees rising in France and will reimbursement be affected?

No GP consultation

The decision was taken without consulting the various doctor and pharmacist unions, a few months after doctors had been made to sign an agreement which has not yet come into effect. 

“I understand the idea behind the decree but without consultation with people in the field, it will not work. We have basically been told ‘you are doing your job wrong, this is how you should do it’ from people who are not in the field every day”, said Yorick Berger, pharmacist and spokesperson for the Fédération des Syndicats Pharmaceutiques de France (Federation of Pharmaceutical Unions in France).

“This decision is going to hit us head on as we have to deal with the consequences of it. It also may stop us from doing our jobs: providing our patients with their prescriptions.” 

The new measure is directly targeting doctors, according to Dr Bauer, of the Union of Liberal Doctors. 

Patient care first

“It is an attack on a doctor’s right to prescribe medication as they see fit. The doctors will need to prescribe either medication that goes in line with the recommendations put forth by the Haute Autorité de Santé or the medication will not be reimbursed to the patient. An issue with that is that the recommendations may be lagging behind if not totally obsolete.” 

On top of that, patients are increasingly not “monopathic”. Human beings are not well-oiled machines that can be healed with the same treatment in every case, and the doctor’s job is to be adaptable and flexible in order to provide the best care possible for their patients, she added. 

“As a matter of principle, this decree is an issue for us doctors. We (self-employed doctors) signed a convention médicale (medical convention) in June this year with the government. This is already an attempt to circumvent the agreements about prescriptions made in this contract,” she said.

Another issue raised by Dr Bauer was the potential reaction of patients, who will not necessarily appreciate this change. “This is likely going to increase violence against doctors, which is something we are battling against,” she said. 

Pharmacist Mr Berger echoed this sentiment. “If someone is in pain and being told they cannot get painkillers or that they have to pay for it, there is a possibility that they will get angry or violent.” 

Read more: Change to prescription rules in France to prevent addiction

Breaking doctor-patient confidentiality?

Online, the reaction has been almost exclusively negative. Some doctors have taken to social media to claim that it goes against the ‘secret médical’ (doctor-patient confidentiality), with Dr Jérôme Marty stating that it was doctors’ responsibility to disobey this decree. 

However, Dr Bauer points out that it depends who sees the documents as the pharmacist must also respect a patient’s privacy, a point which was repeated by a pharmacist union spokesperson when contacted by The Connexion. 

The list of medications that the new measure will apply to has not yet been released. The Assurance Maladie claims that it wants to reduce misuse of treatments, such as using Ozempic to treat obesity due to its weight loss side effect, rather than diabetes as it is meant to. 

“If we had been given a limited list of medication that we needed to provide a pathology for, that may have been reasonable but that is not the case. It is a symptom of the enormous lack of trust that the government has for doctors,” said Dr Bauer.

“Given the agreement we just signed, this decree is useless and vexing, and adds extra work.” 

She also stated that the union was looking into legal avenues to reject this decree. 

“We all need to take steps in the right direction, but with this decree we are being asked to do the splits,” said Mr Berger.