The doctor who left the hospital

Before the Holidays, I had a deadbolt installed on the door of my shed, I lost the key a week later.
Cat? Children? We never knew.
Still, I had to call the locksmith to come to my rescue, he arrived with his white van, his small instruments and his big, nimble toys. He solved my problem in a flash, I gave him a check and a big smile. He went back to rescue someone else.
When I called the locksmith, I was told: “we are sending someone” and not “bring your door to us”.
It’s obvious, isn’t it?

Stéphane Lemire thinks like that, but for the elderly. The guy is a geriatrician and waiting for an elderly person to go to the hospital to see a geriatrician is as insane as bringing his door to the locksmith. “When the person is still living at home, this is where we must intervene.”
It has been doing this for a year and a half.
When he left the University of Sherbrooke in 2005, after five years of study, he did like all the other geriatricians, he went to work at the hospital, did his shifts and a little outpatient clinic . “I realized that when I saw a patient in the hospital, it was one, two, three weeks that had passed.”
It was too late.
“What you have to understand in the elderly is that they degrade faster, that it takes them longer than a normal person to recover. For example, if a person is not mobilized for 24 hours, which often happens in the emergency room, their capacities fall sharply. ”
As a result, elderly people who walked and went to the bathroom became incontinent, unable to put one foot in front of the other. And this is where we call the geriatrician in reinforcement, to come and make a diagnosis on the new condition of the patient. Is it serious doctor? Once there, the geriatrician can only see the damage.
“It’s like a sword stroke in the water.” And it’s often like that, too, that the person ends up in a CHSLD.
Stéphane went to London from 2006 to 2009 to perfect his skills in applied health management. “I was convinced, and still am, that we must rethink the organization of care for the elderly. The geriatrician must assess the person when he is at his best, and not at the worst, when he is hospitalized. ”
Stéphane told me about his grandmother, Lorette, his “second mother”.
When he was young, Lorette made him do his homework. “It is a little thanks to her that I got where I am today. And it was a bit for her that I chose to devote myself to the elderly. ”From London, he spoke to her every night via Skype. “I was praying with her”.
One day, his girlfriend called him to warn him that Lorette would never be on Skype again. “My mother had called, the doctors had concluded that there was nothing more to do. They gave him comfort care. I jumped on the plane to go see her. She was in delirium. I looked at the results, she had twice the calcium level. ”
Nobody had seen that.
Stéphane stopped a drug, the calcium level went back to normal. “Two weeks later, my grandmother was back home, she was walking, she was washing her laundry by hand in the sink, she even patented a clothesline to dry it.”
She was 95 years old.
Stéphane came back from London puffed up. He returned to work at CHUL, where things had not really changed. “There, I was no longer allowed to whine. I asked myself: what can we do to improve the situation? I got into “project mode”, I had lots of ideas. ”
He tackled the emergency room, trained doctors, nurses and attendants to explain the “ba ba” of the elderly person to them. “I said to the attendants: you don’t like changing diapers? Sit the person, get them out of bed. If she wasn’t incontinent when she got there, she wouldn’t need diapers here any more. ”
It worked.
But Stéphane had another project in mind, almost a revolution: social geriatrics. A bit like Dr Julien’s social pediatrics, but with the elderly.
In 2012, Stéphane left the hospital, he gave up his big salary and set up the Ages Foundation the following year. He met Josée Arseneault, director general of the Friendly Service Basse-Ville, an organization that provides home support and that accompanies people, among other things, to their medical appointments.
About 2,000 people use it.
Summer 2014, Stéphane registered as a driver in the Friendly Service. “I didn’t tell them I was a doctor!” I transported them, I talked to them, I wanted to see if what I had in mind really met their needs and how it could be organized in a concrete way, so that it would work. ”
He did this three months.
He now has his office in a room kindly provided by the Friendly Service, he makes home visits three days a week, almost four, most often behind the wheel of a Communauto car. He sets up his free hand and settles files on the phone while he’s on the road.
The rest of the time, he tries to find money to make ends meet.
He knows that geriatricians are rare. “We have just reached the point where, in Quebec, there are more people aged 65 and over than people who are 18 and under. And despite that, there are about 600 pediatricians and only 70 geriatricians. And university admissions continue to increase in pediatrics … ”
All the more reason, he said, to rethink his profession.
Obviously, Stéphane’s bet is that his formula is snowballing across Quebec, that geriatricians can do like him, at the same salary as in the hospital. “The minister talks a lot about home support, this is where they want to go, but the actions are very hospital-centrist.”
The CLSC is now referring patients to him, he has also trained the domestic help staff of the Friendly Service so that they can detect elderly people who are losing feathers. “When I get to the person, they are not bedridden. I assess it, I make a diagnosis. If she needs to go to the hospital, she comes along with a bit of an end. ”
He is talking about people, not customers.
He would never go back. “I am more efficient than when I was in the hospital. I am in the field, I see people in their environment, I can intervene as soon as there is a decrease in autonomy, not three weeks after their admission to the hospital. I’m much more useful like that. ”
So far, he works for pinottes. Since geriatricians are not supposed to make home visits, Stéphane receives $ 46 the first time he visits a patient. “There is nothing planned for follow-up visits. It’s a package deal, the RAMQ gives me $ 46 everywhere and everywhere. ”
It’s half the price of a locksmith.

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