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Why French doctors still make house calls

Does the SOS Medecins service save money?

The public health institute existed prior to 2003, but it wasn’t until the heat wave that it became apparent how useful gathering, analyzing and sharing information about patients would have been. Had the kind of cooperation that developed post-2003 existed, doctors might have realized sooner that so many people were dying and could have taken action. Each night, the data from the calls that come into SOS are fed into a database that is analyzed by the institute the next morning for signs of any patterns.

“Going [to one’s home] provides information that is extremely precious, that we wouldn’t get from an office visit,” Smadja said.

And thanks to a shared database of information culled when patients call SOS, the institute can pinpoint when and where epidemics break out, issue an alert and coordinate a response. This winter, doctors noticed and reacted to a high number of flu, bronchitis and acute gastroenteritis cases, said Daniele Iles, a doctor with the institute. Additional data collected from hospitals and walk-in services showed an increase in asthma.

Despite its track record, SOS is not immune to proposals in France for health care reforms to cut costs and improve efficiency.

For example, the National Assembly is debating whether to allow doctors to choose where they will live and practice or require them to move to regions that are becoming medical wastelands.

While there is no shortage of generalists on the French Riviera, people have to drive long distances to find a hospital in some villages in northern France, Smadja said. But concerns over not having enough doctors in small villages seems to be getting lost in the din over other proposed health care reforms.

Meanwhile, fewer medical students are choosing general medicine. And although more women are entering the field, they are less likely and less willing to join a service that requires working on the weekends and in the middle of the night. The government is considering incentives such as free housing or tax breaks, said Smadja, who did not think doctors should be forced to live somewhere they do not wish.

He also recommended that more medical schools provide training and field experience in emergency medicine, a specialty that requires a vast knowledge and competence in order to administer the correct care and comfort a patient quickly. When doctors discover exactly what it means to work for SOS, they enjoy the challenge, Smadja said.

“When they come to us, they stay,” he said. “It’s a passionate medicine.”

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