A patient who moves and wishes to retrieve their medical file sometimes encounters ambiguity: is the primary care physician required to transfer the entire file, and within what timeframe? This concrete situation illustrates how poorly understood the obligations of the primary care physician are among the general public, even though they condition the quality of the care pathway.
Transmission of the medical file: a often neglected obligation
When changing primary care physicians, the continuity of care hinges on one specific point: the transfer of the medical file to the new practitioner. The medical code of ethics, particularly its article 47, requires the outgoing physician to facilitate this transmission, provided that the patient requests it.
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In practice, responses vary on this point. Some offices send the file within a few days, while others take several weeks without follow-up. However, the patient has the right to access their file directly and obtain a copy. If the physician refuses or delays, one can refer the matter to the departmental conciliation commission or the Order of Physicians.
To better understand the obligations of a primary care physician on En Pleine Santé, it is essential to distinguish between what falls under the public health code, the code of ethics, and agreements with Health Insurance, as these three frameworks overlap.
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Primary care physician and the duty to inform the patient
The duty to inform is not limited to announcing a diagnosis. The primary care physician must clearly explain the prognosis, available treatment options, and the risks associated with each option. The patient must be able to give free and informed consent before any medical act or prescription.
This duty also encompasses prevention. A primary care physician who follows a diabetic patient, for example, is required to inform them about regular screenings to be performed (eye exam, renal assessment) and to ensure that these tests are well scheduled in the care pathway.
In case of a dispute, it is up to the physician to prove that they have adequately informed the patient. The burden of proof lies with the healthcare professional, not the patient. A simple oral exchange is not always sufficient to establish this proof, hence the importance for the practitioner to document the information provided in the medical file.
Coordination of the care pathway: what the primary care physician must really do
The primary care physician is designated as the hub of the coordinated care pathway. In practical terms, this means they direct patients to appropriate specialists, synthesize examination results, and adjust the overall treatment. Without this coordination, the patient risks receiving contradictory prescriptions or redundant tests.
This responsibility also entails a rational use of the healthcare system. Recent parliamentary work on medical deserts emphasizes that the primary care physician should encourage a reasoned approach to specialist consultations and hospital emergencies, prescribing only the truly necessary actions.
Here are the concrete actions expected within this coordination:
- Write a liaison letter for each referral to a specialist, including the relevant patient history and specific questions posed to the colleague.
- Centralize hospitalization reports and analysis results in the medical file, then discuss them with the patient during the follow-up consultation.
- Update the medical summary at least once a year for patients with chronic conditions.
Medical confidentiality and termination of follow-up: the limits of the primary care physician
Professional secrecy applies to all information collected within the context of the care relationship, including regarding the family of the adult patient. A physician may only communicate medical information to a relative with the explicit consent of the patient, except in emergency situations or if the patient is unable to express their will.
The primary care physician may also terminate follow-up, but not arbitrarily. Article 47 of the medical code of ethics governs this termination. Accepted reasons are limited: retirement, relocation of the practitioner, long-standing disagreement, aggressive behavior, repeated absences from appointments, or requests contrary to medical ethics.
In all cases, the physician must allow the patient sufficient time to find a new practitioner and ensure continuity of care during this transition. A sudden abandonment of follow-up without notice constitutes a breach of ethics.
Medical liability in case of fault: what the law provides
The liability of the primary care physician can be engaged on several fronts. In civil law, a patient who suffers harm related to a diagnostic error, a lack of information, or a delay in care can seek compensation. Proof of fault, damage, and the causal link between the two remains necessary.
On a disciplinary level, the Order of Physicians can sanction a practitioner who does not comply with their ethical obligations. Sanctions range from a warning to temporary or permanent prohibition from practicing.
A often overlooked point: the primary care physician is not held to an obligation of result but to an obligation of means. They must implement updated medical knowledge and available means to treat their patient, without guaranteeing recovery. This distinction is crucial in assessing a fault by the courts.
The obligations of the primary care physician form a coherent set that protects the patient at every stage of the care pathway, from the first consultation to a potential termination of follow-up. Knowing these rules also allows one to understand when and how to react if the framework is not respected.