Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
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<strong>KCE</strong> Reports 1771<br />
• Advising thhe<br />
pati<strong>en</strong>t to waait<br />
at home for the Emerg<strong>en</strong>cy medical<br />
services annd<br />
the ambu<strong>la</strong>ncee<br />
/ MUG (Mobile Emerg<strong>en</strong>cy E Goupee)<br />
/ PIT (<br />
Paramediccal<br />
Interv<strong>en</strong>tion Teeam)<br />
and requesting<br />
to these serviices<br />
;<br />
• Transfer off<br />
the call to the coompet<strong>en</strong>t<br />
GP Circ cle : the pati<strong>en</strong>t will<br />
obtain<br />
answers froom<br />
the GP on dutty<br />
himself.<br />
3.1.1. Legal and deontologiccal<br />
frame<br />
3.1.1.1. Leggal<br />
frame<br />
Technical leveel:<br />
no legal am<strong>en</strong>ndm<strong>en</strong>t<br />
necessar<br />
The organizatioon<br />
of the duty is the responsibility<br />
Circles have at pres<strong>en</strong>t the posssibility<br />
to organize<br />
the advantagess<br />
of the triage systtem<br />
provided by th<br />
However if the GP Circle works with a telephonis<br />
person does nnot<br />
have the commpet<strong>en</strong>ce<br />
and tr<br />
optimal action tto<br />
be tak<strong>en</strong> for a mmedical<br />
situation.<br />
Operational levvel<br />
– Handling of<br />
the call by a tel<br />
At pres<strong>en</strong>t therre<br />
is no uniform national call c<strong>en</strong><br />
c<strong>en</strong>tral numberss<br />
of the GP Circlees.<br />
The Decision oof<br />
the European CCommission<br />
of 30t<br />
however that frrom<br />
15th April 20010<br />
Member Stat<br />
the number 1166117<br />
avai<strong>la</strong>ble to organizations tha<br />
medical on-call services in their tterritory.<br />
G<strong>en</strong>eral probleems:<br />
• There is no strict definitio<br />
beginning and the <strong>en</strong>d of th<br />
can vary pper<br />
circle. For the<br />
set from 6 pm to 7 am.<br />
• There is noo<br />
legal frame to d<br />
the telephoonists<br />
within this<br />
(guidance for the telephon<br />
problem annd<br />
decision option<br />
long he/shee<br />
acts within the b<br />
• The use off<br />
protocols limits t<br />
service (chhoice<br />
that he/she<br />
justified forr<br />
a more effici<strong>en</strong>t c<br />
16<br />
ry.<br />
y of the GP Circlee.<br />
These<br />
duty systems butt<br />
without<br />
he 1733 project.<br />
st who is not a dooctor<br />
this<br />
raining to decide on the<br />
lephonist :<br />
tre: the system uuses<br />
the<br />
th November 20009<br />
states<br />
tes are required tto<br />
make<br />
at provide non-emmerg<strong>en</strong>cy<br />
on of « time period<br />
» of the duuty<br />
: the<br />
he GP duty is no ot uniform in Belgium<br />
and<br />
1733 project, the e on call period has<br />
be<strong>en</strong><br />
determine the res sponsibility and liaability<br />
of<br />
s new system. The T use of « prootocols<br />
»<br />
nist for the des scription of the pati<strong>en</strong>t’s<br />
ns) limits the liabi ility of the telephoonist<br />
(as<br />
boundaries of the guidelines).<br />
the pati<strong>en</strong>ts’ freed dom to choose the<br />
health<br />
e has during offic ce hours). This ccould<br />
be<br />
care provision.<br />
Affter-Hours<br />
Primaary<br />
Care<br />
• There is no llink<br />
betwe<strong>en</strong> the GP duty service<br />
medical servicces,<br />
hampering inntegration<br />
of these<br />
PParticu<strong>la</strong>rities<br />
peer<br />
decision option:<br />
• De<strong>la</strong>y in mediical<br />
care : who takkes<br />
the responsib<br />
TThe<br />
curr<strong>en</strong>t prottocols<br />
do not cllearly<br />
foresee p<br />
ccircumstances<br />
wh<strong>en</strong><br />
and how the mmedical<br />
care can b<br />
CConsideration<br />
musst<br />
be made whethher<br />
there is comp<br />
4422bis<br />
and 422terr<br />
of the P<strong>en</strong>al Codde<br />
(not r<strong>en</strong>dering<br />
ddanger).<br />
Article 4222bis<br />
of the P<strong>en</strong>al<br />
Code imposes t<br />
aassistance<br />
to a peerson<br />
in danger. Iff<br />
a GP is aware o<br />
a pati<strong>en</strong>t and omitts<br />
to r<strong>en</strong>der mediccal<br />
help, he/she c<br />
GGP<br />
was not in daanger<br />
him or herrself<br />
and/or if the<br />
oother<br />
persons. Todday,<br />
many GPs perceive<br />
this article<br />
aan<br />
absolute obligaation<br />
to visit pati<strong>en</strong>nts<br />
at home wh<strong>en</strong><br />
itt.<br />
It dep<strong>en</strong>ds on tthe<br />
interpretation of the circumsta<br />
ccan<br />
be held liable. .<br />
In<br />
case of de<strong>la</strong>y oof<br />
medical care, thhe<br />
question rises<br />
oor<br />
not to provide mmedical<br />
care withiin<br />
a certain timefr<br />
too<br />
a non-doctor? In particu<strong>la</strong>r,is it ppossible<br />
to deleg<br />
the<br />
‘serious dangger’<br />
in the scope of art. 422bis P<br />
ddoctor?<br />
One can argue that continnuity<br />
of the medi<br />
aassured<br />
by creatinng<br />
new responsibbilities<br />
and registra<br />
11733<br />
system andd<br />
that participation<br />
to the syste<br />
ppossible<br />
liability reesulting<br />
from art. 4422bis<br />
P<strong>en</strong>al Cod<br />
• The pati<strong>en</strong>t iss<br />
requested to go tto<br />
the GP on duty<br />
AAt<br />
pres<strong>en</strong>t the telephonist<br />
cannot oblige the pati<strong>en</strong><br />
ccheck<br />
if the pati<strong>en</strong>nt<br />
followed the insttruction<br />
to go to th<br />
AArticle<br />
9 of the Royal Decree (RRD)<br />
n° 78<br />
ddifficulties<br />
on wheether<br />
the GP is ob<br />
oor<br />
at the pati<strong>en</strong>ts’ home and not at<br />
aargum<strong>en</strong>ts<br />
sustainning<br />
the possibilit<br />
GGPs<br />
surgery.<br />
• The GP on duuty<br />
is requested to<br />
AAt<br />
pres<strong>en</strong>t this casse<br />
is not common<br />
iss<br />
not avai<strong>la</strong>ble oor<br />
in case the ca<br />
17 es and the emergg<strong>en</strong>cy<br />
e services.<br />
ility?<br />
articu<strong>la</strong>r situationns<br />
or<br />
be de<strong>la</strong>yed.<br />
pliance with the arrticles<br />
help in case of seerious<br />
he obligation to re<strong>en</strong>der<br />
f the serious dangger<br />
of<br />
can be held liable if the<br />
ere was no dangeer<br />
for<br />
e as implicitly impposing<br />
n a pati<strong>en</strong>t requessts<br />
for<br />
ances however if a GP<br />
if the decision whhether<br />
rame can be deleggated<br />
ate the assessme<strong>en</strong>t<br />
of<br />
P<strong>en</strong>al Code to a non-<br />
cal care and dutty<br />
are<br />
ation of calls within<br />
the<br />
m thus should cover<br />
e.<br />
y:<br />
nt to go to the GGP<br />
or<br />
he GP on duty.<br />
cann<br />
cause interpretation<br />
bliged to assure the<br />
duty at the hoospital<br />
t the GP surgery. Yet, there are seeveral<br />
y to have the afteer-hours<br />
service aat<br />
the<br />
o visit the pati<strong>en</strong>t :<br />
n and will only be applicable if the MUG<br />
apacity of the MUUG<br />
cannot handle<br />
the<br />
19
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