survey on express teleconsultations

Consulting a doctor, where you want and when you want, is the promise of telemedicine platforms. In recent years, they have installed fully equipped booths, particularly in pharmacies. Inside, you have to fill in your personal information yourself, give your vital card and enter your credit card number. Cost of the consultation: 25 euros. Like at the doctor. But for what support?

Less than four minutes of teleconsultation

That day, we enter a cabin for nagging discomfort in the neck. From the beginning, the exchanges are brief, the questions summary: “You haven’t changed the cushion? You haven’t carried weight? When you press on the neck, you have pain on palpation?”, asks the doctor on the other side of the screen. After 3 minutes and 58 seconds of discussion, the practitioner diagnoses a “twitch”. “It’s muscular. At your age, there are few other reasons”, he specifies before prescribing anti-inflammatories. There are also consultation gondolas in supermarkets. We went to one of them located in the parapharmacy section of a brand in the Paris region. After reporting sore throat and headache, the doctor asks: “when you swallow, does it hurt?” Without using the connected diagnostic devices at his disposal, the thermometer or the stethoscope for example, the practitioner suspects angina. He then issues a prescription and, at our request, a two-day sick leave. This second appointment ends after 3 minutes and 22 seconds. Far from the average duration of office appointments: 18 minutes, according to a study by the Ministry of Health. Since the health crisis, the number of teleconsultations has exploded. 80,000 in 2019, 9,400,000 in 2021, again according to the Ministry of Health.

Could this promise of medicine at hand also hide a frantic search for profitability on the part of certain private groups? In any case, this is what several doctors we contacted testify to. They work or have worked for teleconsultation platforms. “Basically, it’s 5 minutes per consultation. The doctors go quickly to the essentials, they prescribe something quickly. They don’t even try to make a diagnosis”, says a general practitioner. Others denounce their low share of remuneration and the need to multiply appointments to be better paid. “When you do consultations for 10 euros, if you want to earn a living, you understand that it is not possible”deplores another practitioner.

There is no drift or abuse

Nathaniel Bern, co-founder of Medadom

Some platforms do not hide their commercial strategy. We obtained a recruitment letter for a salaried doctor position. Future recruits are encouraged to take care of their productivity. It is written there: “on the basis of 20 hours of teleconsultation per week, you will receive 3000 euros gross monthly (…) To your fixed salary is added your variable salary: 40 percent gross of turnover”. Further on we can read: “Keep in mind that the more patients you see, the more your turnover increases.” This letter bears the signature of an employee of the Medadom platform. A French start-up among the most important in the sector. Contacted, the company did not wish to comment on this recruitment offer but by videoconference, one of its founders denied pushing doctors to increase their rates. “There is no drift or abusedefends Nathaniel Bern, co-founder of Medadom. That the doctor is remunerated, as in the liberal environment, according to the number of patients he will see, this is the classic remuneration model for a doctor. There will always be those who resist change.” Asked about the brevity of the appointments, Medadom also specifies:“consultation time is almost exclusively purely medical time. Indeed, all the administrative part, the taking of constants and the sharing of documents can be done upstream of the teleconsultation.” An argument that struggles to convince the order of doctors. According to the institution, these new practices could lead to the commodification of care acts. “I see it with a bad eyedeplores Dr. René-Pierre Labarrière, general practitioner and president of the professional exercise section of the order of physicians. I see this as the beginning of a production medicine that is unequal and dangerous. We’re on fast-food medicine.” Today, according to the law, doctors cannot devote more than 20% of their activity to teleconsultation. A threshold that the platforms would like to raise.