. : Why this congress 2000?

. : This congress 2000 is the third of the kind. With group we made into 87 a first symposium to evaluate our retreat over the first 15 years of the experiment of . A few years after we made a new symposium on the results with more than 20 years by confronting the various experiments French, European, American and worldwide.

 

. : Which are group members ?

. : Group is a group of “” Rhone-alpine, which, if I then to tell, currently has three generations. Oldest are Claude Régis Michel, Charles and Rene . Three buddies of boarding school, friends of always, and who worked one in Lyon, the second with St-Etienne and the third in Grenoble. It is me which joined together them around a group called , Association of Rhône Alpes csotcina.comedic surgeons, and in which I represented, with Jean Louis of Grenoble, the second generation; it is the experiment of us five which made group to which the fortysomethings joined, the 3° generation of younger csotcina.comedic surgeons. F. Michel,
P. , A. ,
. , D. ,… etc

 

. : It is thus the third congress…

. : It is the third symposium which we organize with group . It is obvious that one spoke about the long-term outcomes and in particular about the results to more than 25 years at young subjects, operated before the 50 years age. Especially what I wished to do it is the balance-sheet of the assets, of the certainty of the experiments of the total prosthesis of hip in second half of the century. We tried to study them through 4 chapters. The first related to the history and Christian brushed the history of the prosthesis head 22,225; it is a little what it had published in csotcina.comedic Maîtrise. I made the route of the group which one could have entitled “Route of children of ”, i.e. reasons of our initial choice and justifications of our developments. Then, we tried to validate the assets through three great chapters: couples of friction, anchorings, and innovations.

 

. : What did you note like results with original?

. : With initial, couples metal-polyethylene, head 22,nobloc, cemented, at 25 years of retreat: 83% of good performances and 17% of recoveries.

. : Did the hold the route?

. : It is quite obvious that in the 83% which remain there are potential unsealings, important wears but they are people which always have their prosthesis in place, according to the Scandinavian criteria with a clinical excellent result. We tried to improve the performances of this prosthesis and as much of surgeons we thought that wear had to be decreased. We thus tried to find a new couple of friction and the couple ceramics-polyethylene seemed promising. For that one needed a prosthesis for Morse taper. For this reason we made evolve/move our prosthesis with two possibilities a head of 22.etal and a head of 22.2 zirconia ceramics; no alumina because there are risks of fractures. The second flap of wear it is the problem of polyethylene. To change a into polyethylene when it is sealed that made of the major damage. We told ourselves that it was simpler in the event of wear to rather change the insert than anchoring. For this reason one also evolved to a cup “ Iso made” with an insert typical EP .

 

. : What did you note with your options?

. : We are only three years old of retreat with zirconia-polyethylene. We made the same observations as i.e. one observes a double wear compared to metal-polyethylene over the first nths and then one with the impression that is stabilized. One still needs the proof of time to validate these observations.

 

. : You do not want to reconsider your amendments?

. : For the moment we do not have reasons to change. Approximately, before 70 years we recommend a stem of the type cemented with sufficient cement, and thus not of type (which for us is a a little cemented prosthesis without cement), with a zirconia head, a cup and an insert polyethylene 22.2. However, we currently carry out tests on new polyethylenes. After 70 years we remain conventional with a standard prosthesis .

 

. : Can you prove that your amendments improved the results?

. : Among old people not. Among young people, we put ourselves questions. In surgery, there is always the other side of the coin. With our , we think that in the event of wear the change of will be easier but we were not confronted yet with this problem.

 

. : Do you regret some to cement the femoral stem?

. : Absolutely not. I find that it is simpler to cement because that makes it possible to hide the small defects. For a prosthesis without cement, it is always necessary to be absolutely perfect what is not easy the every day. However, there is future for without cement. It is a completely different philosophy. One can roll very well with a car which has the engine with before or the engine to the back.

 

. : Which conclusion for this symposium?

. : I fire from the symposium following philosophy: for the moment apart from nothing is validated with more than 20 years and even if the couple ceramics-ceramics has existed for more than 20 years, there is not yet a series of prosthesis which is 20 years old of retreat.

 

. : You are a surgeon of the hip?

. : Not only. My idea first was to make pediatric surgery but since I did not have a hospital outlet, I chose one part-time job with a half-time activity of pediatric surgery at the hospital, and a liberal activity downtown. But in a city like Lyon, one cannot live that pediatric surgery and thus I centred myself on an activity which seemed to me adapted to my tastes, I started to make prosthetic surgery. Gradually this prosthetic surgery devoured me, until quasi an exclusiveness.

 

. : Who were your Masters in surgery?

. : My Master in infantile surgery was Claude Régis Michel. But also Albert because in his service there were an activity of adult csotcina.comedy assured also per Henri and an activity csotcina.comedy of the child ensured by Claude Régis Michel. I was the last senior registrar of Albert formed at this school, I was thus trained at the same time as an adult and a child, because the service was mixed.

 

. : How can one be pupil of and not make a knee?

. : But I did much knee. I even developed an index of levelling of the ball joint. Since I did not have a post in pediatric csotcina.comaedics, I made my at Albert and Henri . I had the extraordinary chance to be formed by all the pupils of Albert at whom I made my day school into 66, which determined my vocation of csotcina.comedic surgeon.

 

. : Why this interest for ?

. : I chose my first half of the year of at Albert , because I was rather well classified to go at his place. It was an owner who adored his external, which loved its interns, which supported his senior registrars and which hated its aggregate. When one was external at , one was adored, adulated. It was unmarried, it did not have a child and it regarded us as his. The other reason, it is that my intern for my first half of the year at Albert , was Gilles .

 

. : And then?

. : It was extraordinary. Gilles , it was joined together, I want to say an idea to each minute, a new operation the every day, with of course of good operations and less good. But Gilles belonged to the geniuses of the csotcina.comedic surgery. Already, intern, it had invented the adhesive with bone. The rotatory prosthesis of the knee, it is Gilles who invented that into 75. It was a character always full with enthusiasm. I remember my first year of boarding school, when I was chief at his place; every morning one told with Joseph Million who was my Intern at the time, “a new prosthesis was born, a joy is given to us”. With Henri , they formed a magic couple. There was of them one which had completely unslung imagination and the other perfectly reasonable, perfectly structured. He told him: “Gilles that, that can walk, but that will not go. He limited his enthusiasm. When it was in Saint-Etienne, it was him the owner and for us the young people, it was more difficult to limit its exaltation because in general it is the owner who must limit the youthful heat of his pupils.

 

. : When you told him: “Owner, stop a little…” how did it take it?

. : One could all tell him, it took it well and with humor. That did not make it change course immediately but from time to time one could perceive an inflection in his indications. Among this expansion of ideas, much remained. For example, the use of the tendons of the goose leg in the surgery of the , which was decried so much is now accepted and it was him the promoter of the method. The cup with double mobility known as of , today is widely disseminated.

 

. : And ?

. : Albert had another type of intelligence; it was elegance, pragmatism and mathematics with the service of the csotcina.comedic surgery. It was a mechanic. He knew perfectly the engines of cars and he counted very quickly. He let develop the imagination of his pupils. And it appointed much of it. There was Alain who was his aggregated first, then Henri , Claude Régis Michel, with the pediatric surgery, Gilles in St-Etienne, Paul in Dijon and finally, Jean-Luc before his departure with the retreat, they was all of very inventive people.

 

. : But why was it tended with its aggregate?

. : Albert was somebody who liked to dazzle and impassion. For example, if one wanted to be a chief one did not have especially to choose two six-month periods as intern at his place. He had horror to have the impression to repeat something. He considered that at the end of six months he had delivered his teaching and that one did not need to make second half of the year if not one was imbeciles, or one had not understood anything with his teaching. I think that for this reason he liked the external ones particularly, because the external ones were new spirits and that they listened to it religiously. It brought us Sunday with him in the hill climbs, it took along us to the restaurant. It was really a father. It was a limpid intelligence. He had a clearness of reasoning which made that one very easily understood with him semiology, and until the end of its career he made conferences of boarding school. He occupied also many of his interns.

 

. : How were you interested in the pediatric surgery?

. : Albert , in the line of , belonged to this generation which was formed with the csotcina.comedic surgery of the adult and the child. At , there were the two pathologies joined together in the same service and thus for me there was no discontinuity between the two. For understanding the pathology of the adult well it was necessary to understand the pathology of the child. Amongst other things Albert was that which had noticed the first, , during one of his voyages. He had seen a radiography with a stem of on a scoliosis whereas he had under his responsibility the processing center for the scolioses. For him that was a revelation to see a stem in the back with two hooks which rectified a vertebral malformation. In addition was impassioned by the problems of lengthening and this is why I am there interested very early. There was thus for me no hiatus between the adult and the child. I went indifferently to all the conferences.

 

. : It managed to direct on all these topics?

. : Yes, but it should be said that with its it all its had aggregated there which was Claude Régis Michel there, Henri . One day Albert told to CR Michel, it would be necessary to go to the United States to see this surgeon who puts stems in the back to rectify the scolioses. Claude Régis
Michel left to the United States and thus it was the first to put a stem of in Europe, into 62. Thereafter whole Europe ravelled in the service to see CR Michel operating scolioses. Everyone came to learn, including Pierre .

 

. : You have an encyclopedic formation?

. : Enough yes. I regard myself as a spoiled child of the surgery. I was making function of chief at Gilles in Saint-Etienne while waiting for my post at Albert . Then I was chief at Albert and when left to the retreat I was chief at Henri . At the end of my I left to Claude Régis Michel where one opened the surgical unit of the center both whole into 79. I remained 12 years at the Civil hospices as half-time to make only pediatric csotcina.comaedics at the hospital but I made adult csotcina.comedy downtown then I was likely to open and create a department of csotcina.comedic surgery at the Holy Hospital Joseph in Lyon, Hôpital of center town, in order to continue this part-time job activity in which I believe much.

 

. : You were installed part-time?

. : I took the continuation of Claude Régis Michel in deprived, with the private clinic Emilie de when it reinstated full-time in the hospital. One worked together and one opened the block of the center. In , one made surgery of the scoliosis and surgery of the child primarily. We were three: Claude Régis Michel, Jerome , and myself. It is in the center that I developed the sector of processing of the inequalities length of the members, while continuing to discuss many scolioses. From 1984, I was interested in the surgery of people of small size.

 

. : And as there remained to you a few moments of free in the course of the day, you made trade unionism?

. : The trade unionism it is not the same thing, I fell inside when I was small. I was already chairman of the trade union of the interns because I always thought that in a landing gear it was to better be in the engine that in the tailes coach. I always considered that it was necessary oneself to organize its life and to try to direct it… I had hesitated besides between the surgery and the but finally, I was a little too old for the , and then I liked the surgery too much. But I think that it is very difficult to make of the policy and of the surgery at the same time because the policy, like the surgery, it is an investment of every moment.

 

. : Which was the engine of your investment in the trade unionism?

. : What pushed me was canto be able to act on the future. I am not only but it is good that each one adds its contribution to the building.

 

. : You were not a simple stone; how is the angular stone vocation felt?

. : Especially because one is carried by his buddies. My project, when I became chairman of the trade union of the interns, it was to improve the outlets of the interns. It is me which made amend the law on the senior registrars. At the time, the senior registrars were in post for 7 years, which locked the outlets of many interns. I knew the period in addition when interns settled in 4th year of boarding school without being last as chief. I considered that it was necessary to be at least two years old of training of senior registrar to be able to be a good surgeon because it is a different level of responsibility.

 

. : Why two years?

. : Not that was two years plus one year, plus one year. At the time, they was 4 years plus 3 years is 7 years maximum and one could not pass directly to 2 years because one needed also a solution for those which wished to make a teaching hospital career. That which made a teaching hospital career could then prolong one year plus one year. That was not simple to make succeed this claim. Simone Veil was Ministre for health, and she was opposed to amend the duration of the . Was this the pressure of teaching hospital of the time? I do not know, but it should be said that it was comfortable for the owners to have somebody who remained a long time. But it was not the interest of the interns and the future surgeons who one had formed. We told to Simone Veil whom if it did not amend the decree, we would make a strike. A strike of the interns, it was something of inconceivable at the time. Never the boarding school had been put in strike. There had been well strikes of boys barbers to the ^E and the ^E century for problems of food or problems of discipline inside the hospital since they had the right to leave only one hour per day, but since the ^E century there had never been in Lyon of rebellion of the interns. One had put a deadline and one had prevented one year in advance. Every month, the countdown was made: more than nths, nths, etc… When the fateful date arrived all the interns of France put themselves in strike. It was in 1874 05, the first strike of the boarding school, all-out strike of the care, one ensured only the urgencies. It is a strike which practically lasted three weeks. One waited to have a signed letter of Simone Veil to begin again and the was amended with 2 + 1 + 1. With the passing, I think that it was a reform necessary. One had proposed many of other amendments in our enthusiasm of young interns, in particular the contractualisation of the activities of teaching of care and search, but only this flap was obtained. I think that made it possible to improve the outlets of the boarding school, of improving the formation of the surgeons. That did not solve the improvement of the teaching hospital careers completely.

 

. : Did you have pressures of your owners?

. : A little bit. The every day one told me: “Mr when do you resume work?”

 

. : Do you think that could have been an obstacle with a hospital career?

. : Not, and I would even tell that at the time to be aggregate, to be a chairman of the trade union of the chiefs could be a serious aid. But after the boarding school, I did not deal with the trade union of the senior registrars because I never thought that to be a chief was a durable situation. Either one is chief for two years then one settles as a liberal, or one enters the teaching hospital die. For me there was no trade unionism of the chiefs. It was limited too much, and the interests were too divergent.

 

. : When did you take again service?

. : I started again when I became csotcina.comedic surgeon. I observed the life of the csotcina.comedic surgeons and after a few years it seemed completely natural and obvious to me that it was necessary to make trade unionism in the csotcina.comedists.

 

. : Why?

. : To make move, to try to improve the formation, to be interested in becoming profession and because the only financial claims of the trade unions displeased to me. To strike to improve the consultation of a franc it was not interesting. What interested me, be the reforms of structures. Thus it was the evaluation, demography, etc… At the time, one just started to speak about hard and slackness. The speciality was not recognized yet as such. I do not know any more on which date one recognized the speciality, but the trade union of the csotcina.comedists was created to make recognize the speciality of csotcina.comedy. The separation of the general surgery was fundamental.

 

. : But it is also the starter of the fragmentation of the surgery and the loss of the comprehensive view…

. : This reasoning is exceeded. On the theoretical level, it is good to have a knowledge encyclopedic and overall but on the plan practices not. One is really good that in what one often does, I think that it is necessary to be able to reason on a shoulder or on rachis and to give therapeutic guidelines but that does not want to say that one will make the gesture. The interest of the patients it is the . In the private clinics, one left the visceral surgery and then there was hard and a slackness; then there were two hard, and now one will have in more one hand surgeon everywhere.

 

. : How do you see the things now?

. : Today the problem is not any more to recognize the speciality. The problem is on the one hand to promote the speciality, to make so that it is the first surgical speciality and on the other hand to promote teaching, the evaluation, to form young people and to deal with the demographic problems. But one should not neglect the incomes of the surgeons.

 

. : With is your direction, where the gaps?

. : In spite of an alternation in the ministries, one with the impression which a policy of continuity was followed. One always made the bad policy options and this for several reasons. One made reforms not according to the interest of the patients but only from one certain idea of the economy which is completely exceeded I will take two examples. Today there are problems of medical demography but since I deal with medical trade unionism, I realized that these problems were never anticipated. One always amended the selection not according to the needs for the population but according to the hospital needs. With regard to the specialist physicians the number of interns was given according to the requests of the department heads in the . Thus, one could form too many specialists very well or not enough according to whether the speciality were more or less dynamic in the area. I think that to control the problem of the costs, it medical demography and to control demography should be evaluated the needs are necessary to control. These needs were never really given. I do not see how one can make of the policy without making a market research. You imagine a car manufacturer who would manufacture any car without worrying about the needs for the population. The second example of defect of the medical policies, it is the problem of the accounting control which is in my opinion a fundamental error. One cannot admit that there exists an accounting control for the medical expenditure. The control must be and not accountant. One must look after people because they need to be neat. They is false to think that health costs and is only a bottomless, health pays.

 

.: I.e.?

. : Health brings back today in France more money than it does not cost. The hospital is the first employer in all the cities. The health expenditure in France they is about 600 billion and the gains on the industry of health it is more than 600 billion. I am making currently make a study on the economic capacity of the liberal medicine of the Rhone-Alps area to try to show that with the direct benefit and the induced benefit. In addition, there is a true industry of health in France, with a hospital potential which is surplus. I do not see why one would not discuss medicine as one although one would export. In the same way one could import patients who would be neat in France since one has a tool to do it. The other countries of the late European Community in this field would not have to develop this tool. That would make re-enter of the currencies. I think that it is necessary to have a comprehensive view of medicine if one wants to be effective in the trade unionism in csotcina.comedy, and one cannot have only the narrow sight of our speciality. For this reason I invested myself in something which I regard as a progress of most important on the administrative level, it is the creation of the professional unions of the private doctors.

 

. : About what is it?

. : It is an employers' federation created in 1993 by and which makes it possible to the doctors to be organized as they intend it to try to regulate all the problems of their speciality apart from the problems of ethics. It is a room which is financed by the doctors, managed by the doctors and who allows the doctors for the first time to make studies. Until now, they are the different ones which made studies in our place. One told us, look at demography he does not have there enough doctors in Lozere, there is too much on the French Riviera. Now, the studies one can make them us same and one knows very well that the figures of the health insurance are not right.

 

. : Did you consider the medical activity and on demography?

. : Yes, with Jean . In addition we studied thoroughly three specialities in the Rhone-Alps: csotcina.comedic surgery, gastro-enterology and pediatry. From these three specialities, one managed to define what was one medical full-time, i.e. to digitize in way very thorough what was the real activity of the doctor, by knowing the time spent to the telephone, time to fill of papers, the time spent to the bed of the patient, the time passed in consultation, with the surgical unit, etc… One completely peeled the daily work of the doctor. From the moment when one medical full-time was defined, one can vary certain parameters. If one decides for example whom the csotcina.comedists will on the spot take of the guards rather than obligations because of the respect of the rest periods and the current laws, it will be necessary to increase the number of csotcina.comedists by 31%. One also studied the variation of the number of csotcina.comedists according to the ageing of the population with index INSEE 2010/2020. One realized that finally there was not a very large angle of attack of the ageing of the French population on the demography of the csotcina.comedists + 11% in 2010 and 17% in 2020) and that it was not our principal activity only to discuss the femoral neck fractures. We thus have now a model which makes it possible to appreciate, according to the closures or of the laws which are made, the possible repercussions on medical demography.

 

. : Who validates this model?

. : One made it validate by epidemiologists.

 

. : On which mining area of population?

. : One made a survey near all the experts of the Rhone-Alps area, knowing that the Rhone-Alps it is 10% of France, if one multiplies by 10 one on the scale of France.

 

MO. : But are these conclusions opposable?

. : Yes, it is opposable. The study on demography is the only study which currently exists and with the ministry one makes use of it by saying that one does not make use of it. We start to be listened because now we have arguments to defend us and make proposals. For example one knows that the csotcina.comedic surgeons work as much as the anesthetists, i.e. 70 hours per week. And so on the following day one imposes the 35 hours to us, it will be necessary to double the number of csotcina.comedists.

. : How to solve this dilemma?

. : For the moment nobody is concerned with it. For the hospital ones, it would be necessary to decrease the painfulness of the work in particular of the guards; it is their first claim. Then the incomes should be improved. It should be known that K operational increased only by 20 centimes in addition to 10 years. The csotcina.comedists are the new poor of medicine. We are those whose income increased the least by all the medical specialties since 1992 including the general doctors.

 

. : Why the government release would ballast?

. : The government will be well obliged to release when there is a linked medical face. Until now, the splitting of the doctors supported the capacity, to divide to reign, it is conventional and effective. Therefore I think that the first duty of a doctor, it is to militate on the trade-union level and to adhere to its trade union. Linked we can much of things but divided we will be always devoured. Today, there is a mailman of unity that doctors are the professional unions. They include the doctors who are installed downtown, but also the hospital doctors who have a liberal activity at the hospital, therefore it quasi totality of the doctors.

 

. : Which is the percentage of csotcina.comedists syndicated in France?

. : 25%. There is thus an effort to make. The contribution of 550f is completely deductible from the taxes. I know that there are other important contributions, but the activity of the surgeons is multiple: the care, the formation and the administration and the aid of a trade union of the speciality are essential.

 

. : There remains to you time for leisures?

. : When I was internal, in my room, I collected boards and wine. I still have bottles which I bought during my boarding school, perhaps they is not good any more to drink. I played Rugby until the 33 years age, then when I stopped playing, I devoted all my free time to collect contemporary art, in particular “the new realistic ones” which are for me one of the last movements important in contemporary art but this is another history…