Happy birthday, Kouchner law



In the history of caregiver-patient relationships, there is clearly a before and an after the law of March 4, 2002. Imagined in response to the health scandals of the 1990s (AIDS epidemic, contaminated blood, mad cow disease, etc.), written after of the Estates General organized between September 1998 and June 1999, this so-called Kouchner law, officially entitled “law relating to the rights of patients and the quality of the health system”, places the patient at the center of care. No more paternalism and medical omnipotence! From now on, the patient has a say in the treatments that concern him. Free and informed consent? Established by the Kouchner law. The possibility of refusing treatment? Established by the Kouchner law. Direct access to medical records? The Kouchner law. The power of consultation given to user associations, the famous “health democracy” ? Again the Kouchner law.

Twenty years later, the Order of Physicians and the Assistance Publique Hôpitaux de Paris (AP-HP) wanted, each on their own, to measure the impact of the law on both practitioners and patients. So what’s up, doctor? The vast majority of professionals questioned believe that this law has changed not only the practice of the profession, but also the behavior and expectations of patients. An evolution essentially seen as going ” in the right direction “, since it helps patients to better understand their rights or to be more attentive to their health. The rather positive observation is also corroborated by the barometer of France Assos santé – a group bringing together several user associations – which notes that patients actually feel “knowledgeable” and aware of the steps and remedies to be taken in the event of a problem.

So everything would go for the best in the best of worlds? Not that easy. First, because the order of physicians emphasizes that, even after twenty years, the patient’s rights paradoxically remain better known by the physician than by the patient himself. Ouch. Then, because for nearly 42% of caregivers who responded to the survey conducted by the AP-HP, the new behaviors of patients have paradoxically made the exercise of care… more ” annoying “. Re-ouch. Impressions of knowing more than the doctor (thank you Google!), demands, ingratitude… the “rebalancing” of the caregiver-patient relationship may have been perceived by some professionals – especially the older generations – as a reversal of the situation leading to a form of medical consumerism, where doctor and care would be a given.

Does too much patient power kill patient power? Still not. The Kouchner law is recognized by all as a step forward, which would even benefit from being supplemented, tomorrow, by new rights (in connection with the digitization of health, in particular). Still, within the AP-HP, more than 90% of respondents suggest that patients be made aware of the fact that they also have… duties. Back to paternalism? Rather a search for fairness for a balanced contract of trust.

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