regulations, practice and aid

On counts near 12 million people with disabilities Today In France [1]. And yet, out of the 156,000 people with a handicap having contributed to the barometer of handifying care in 2024, 24 % said they could not access the care they need [2].

An essential mission of liberal doctors

First of all, let us recall that since February 11, 2005, the law has set, for premises of health professionals open to patients, legal criteria for accessibility to people with disabilities [3].

The legal framework on one side, the land on the other

The law essentially integrates Physical accessibility criteria type absence of steps, presence of an elevator, width allowing the passage of a wheelchair … Even more, it generalizes this principle of accessibility to all types of disabilities, whether physical, sensory, psychic or mental.

To respond to this issue of improving the reception and the care of people with disabilities, the disability committee of the National Council of the Order of Doctors (CNOM) launched a large survey aimed at measuring the daily practices of doctors in terms of management of disability situations [4]. “On the one hand there are laws, on the other the reality on the ground, Established Dr. Claire Siret, president of the Seine-et-Marne Departmental Council of the Order of Doctors and the CNOM Handicap Commission. These exchanges emerged from a huge lack of means, time, training and information. »»

Although insufficient, the first results show that 41 % of professionals interviewed by the CNOM declare that they have already brought changes concerning Accessibility to disability to their office. “Today there is no more tolerance deadlines, the obligation is imposed on everyone, Recalls Dr. Siret. More and more premises are suitable, especially in important structures such as multi -professional health homes (MSP). »»

An ethical fight for all disabilities

The accessibility of health premises is not only a legal question. It is a societal awareness and an ethical fight. For Dr. Siret, “Accessibility must become natural, normal, inclusive. It should no longer be an exception. ”

A commitment for all types of disabilities, not only for Motor handicaps. There are indeed visible and recognized handicaps, to which are added the sensory, mental, mental and cognitive handicapsbut also those which affect psychological suffering, invisible infirmity … “We have seen with the survey that for the moment, attention is mainly paid on accessibility to motor handicaps, points out the president of the CNOM Public Health Section. Many things remain to be done for other types of disability. »»

The accessibility of premises, but also know-how

Indeed, when we talk about accessibility, we are not only talking about accessibility of premises and equipment, but also accessibility of skills and skills to meet the needs of people with sensory, mental, psychic and cognitive disabilities.

From making appointments to consultation and care, everything must be specifically thought out and adapted: Provide a longer slotpropose if necessary a Care Consultation (white consultation, without care), limit the time spent in the waiting room… For patients with specific needs, and in particular for dyscommunicant patients, it is important to adapt the communication method and ensure that the patient is obtained without forcing care. Of the Simple and imagined communication tools [5]the Presence of caregiverthe explanation of all gestures and sometimes a consultation organized in two stages are keys for a successful consultation.

In practice: how to make your office accessible?

It is in the awareness of the need for adaptation that the first step resides. It seems obvious, but it is not always the case.

Learn and mobilize the teams

“Patients with disabilities do not move in the firms that are not accessible. Health professionals therefore do not necessarily realize needs. No disabled patient, no problems, so no need to solve them ”regrets Dr. Adrien Dumas, generalist, leader of the MSP des Longues alleys, in Saint-Jean-de-Braye (45). This doctor, a former university clinic chief reported that within his establishment 94 % of professionals thought that the MSP, installed in the premises of a former clinic, was adapted to the reception of people with disabilities. In response to a call for projects from the Regional Health Agency (ARS), the MSP received an occupational therapist who made a Accessibility audit and established development recommendations, going far beyond regulatory imperatives.

Draw up an inventory of accessibility of the cabinet

“Reading the relationship acted as a real awareness, observe the Dr Dumas. We found that even when legal standards were respected, many things could be improved. »

The Visit of an occupational therapist On the ground highlights legal obligations, but also acts as a revealer which goes much further, in particular with regard to accessibility to less visible, non -motor disabilities. This type of inventory would have every interest in becoming widespread. “Better yet, the expertise of an occupational therapist could be one of the ITes of the specifications to be presented during the MSP opening projects, offers Dr. Dumas. Because it is much easier for healthcare professionals to anticipate accessibility upstream, than to order new work for a door that would open in the wrong direction. »

Put into practice the simplest actions

“When we talk about upgrading a cabinet, we immediately think of a big project, but in reality Most adjustments can be made easily, Without a substantial budget »assures the manager of MSP.

Space markup dedicated to armchairs in the waiting room, sifted light For visually impaired or with a sensory handicap, Falc display (easy to read and understand), magnetic curls For hearing impaired, tablets to be fixed On the offices to allow chair people to file medical documents or write a check … “In the MSP toilets for example, the doors were automatically closing, making their access difficult for people in a chair. It was enough to remove the cylinders to make them accessible to patients with reduced mobility ”illustrates Dr Dumas. So many adjustments inexpensive in time and money, which significantly improve the accessibility of a cabinet.

Program and implement the recommendations

“Of course, continues Dr. Dumas, Equipment like Personals adapted With patients in armchair, or in a situation of obesity, represent a greater investment. But it is always possible to postpone expenditure, to request financial aid or to pool the means. » At the health home for long aisles, only a few examination tables are electric and wide enough to accommodate certain patients with disabilities. Health professionals are therefore changing an examination room when they receive a patient who needs it.

Aid available to facilitate reception

Standards require investments and financial means, some health professionals do not have.

Financial aid

For the physical accessibility of the firm, there are financial aid, but you still have to know them. Among these aids, we will notably remember the Territorial Accessibility Fund (FTA) as well as the possible subsidies of local authorities.

The valuation of time devoted to disability

“It is often difficult for health professionals to talk about money, recognizes Dr. Siret, But the consultations dedicated to people with disabilities last longer when they are well conducted, and doctors must be remunerated for this work. »» A financial valuation of the acts is provided in certain cases: white consultation, consultation for children with specific needs, consultation dedicated to the first medical certificate of the Departmental House of Disableds (MDPH).

Human aid

A doctor alone can carry out a consultation with a patient with disabilities, but he may face difficulties in mobilizing the patient from his chair to the examination table for example or even to communicate with a child with a neurodevelopment disorder. “This type of consultation often requires the intervention ofa third party, alerts the chairman of the CNOM Handicap committee. But health professionals cannot always rest on family caregiver or on caregiver which is not in its role and which is already asked a lot. Helping doctors to welcome patients in good conditions is also to give them the human resources to do so. »»

The valuation of the accessibility of the firm for patients

To enhance the accessibility of a firm or simply to inform patients with disabilities of the firm’s capacity to welcome them or not, health professionals are invited to enter the official directory of the accessibility of firms, hosted on health.fr [6]. “The important thing is not to be completely up to standard. Even for offices that are not accessible, it is important to be identified as such to avoid patients to find themselves in difficulty when arriving at the doors of the cabinet ”says Dr. Adrien Dumas. Doctors can also inform the accessibility criteria of their medical office on online appointment sites.

Handiconnect.fr: tools available to health professionals

The summary of regulations and good practices to accommodate a patient with disabilities in a city firm is published by handiconnect.fr in the form of two advisers intended for health professionals:

Conclusion

“Doctors are all volunteers to take care of patients with disabilities, it’s obvious, Certifies Dr. Siret. But sometimes they come up against the complexity of this care, are discouraged by the political context and renounce. »» Small developments, however greatly facilitating for people with disabilities, can be implemented easily. For the biggest sites, do not give up arms, patient, health associations and public service institutions are there to help you.