. : That made which impression be a Chairman of the ?

. : That given pleasure. That arrives a little late, because one can be a Chairman before the term of the most active party of his life. It does not remain about it less than it is a prestigious Chair because for all the hand surgeons it is a summit. I am thus very happy and I hope to contribute as well as possible to the success of the congress of the .

 

. : What is what the ?

. : The Group of Study of the Hand. It was created in 1966 by 5 surgeons: Jacques , Jacques , Pierre , Raoul and Unpleasant Raymond. They designated Robert Merle of , Chairman of the first meeting, to be made forgive not to have put it in the group. It was at the beginning a species of club of hand surgeons. The existed as a club until in the Sixties ten where it was transformed into French company of the Hand surgery. They had passed from 5 to 20, then 40 and now society gathers 250 people. This French scientific society has many foreign members and by its oral hearing it is the first of society of the hand in Europe.

 

. : Is this to say that the hand surgery separated remainder of the csotcina.comedic surgery?

L.: Yes and not. I believe to have written in the Seventies that the hand surgery was the girl of csotcina.comedy and figure. It emerged from the meeting of these two specialities all while being detached some a little. But this independence remains very relating to the teaching hospital point of view since the csotcina.comedic surgery and the plastic surgeon is official specialities whereas the hand surgery is not a speciality, it is a competence.

 

. : Should the cord be cut?

. : Ideally all the hand surgeons dreamed that their surgery becomes autonomous and is recognized like a speciality with whole share. Separately certain Scandinavian countries like Finland and Norway, it are not a speciality in any the large countries of Europe. Questioned on this subject, the French people responsible always said that there was no question of multiplying the number of specialities in general, and to individualize the hand surgery in particular. The “” was reiterated. I believe that it is interdict to dream. It is already a beautiful projection of a preceding chairman of the society which to have made recognize by the consulting of the command a competence of hand surgery. Thus the hand surgeons will be initially csotcina.comedists or plastics technicians.

 

. : Which is your personal feeling?

L: When one wants to individualize a speciality it is necessary to organize a course of formation to him. One would need that the future hand surgeons can make general surgery, then of the csotcina.comedy followed by long training courses of plastic, repairing or reimplantation; finally they would be able in their last years of to make only hand surgery. But that poses a problem which is not solved since it varies from one country to another: where is the hand surgery stopped? On the level of the wrist or elbow? Is it about the surgery of the upper limb? And at this moment is not this csotcina.comedy located simply on a member? It is seen well that the current location, for uncomfortable that it is, corresponds to conceptual uncertainties with respect to this surgery.

 

. : What do you think of the current Parisian situation of the hand surgery?

L: The disappearance of services organized and targeted on the hand surgery is at the origin of a turbid situation. Me I can speak only about what I know. At the hospital Georges , after one asked us with insistence to come on the spot to create a S.O.S hand, it proved that the operation of this S.O.S hand interfered with the possibilities of this new hospital. I.e. that because of multiple mailmen, it was not possible to do all that was provided for. Should have been treated on a hierarchical basis the local medical policy. In this hierarchy, it appeared that the hand surgery was not the priority and that the activity of my service was in the final analysis more awkward than developing. One awaited my departure and one was satisfied of the disappearance of this service like palliative with a certain number of local problems. From this moment, I decided to make my at the hospital Saint Antoine, to follow my collaborator and friend, , which took the succession of Andre . It is a service of 70 beds in a hospital which did not put in priority the management of and whose strategy makes a broad place with the greeting of the urgencies hand. Insofar as the main part of the surgeons who constituted my service at the hospital then with the finds in Saint Antoine, it is completely possible to recreate here, at least partially, a service dealing with the hand in urgency and formant of the future hand surgeons.

 

. : Was the situation that you had in an ideal situation for a S.O.S hands?

L.: Retrospectively, yes. Obviously, on the spot and in the fire of the share never the things do not appear ideal to you. But compared with the situation that I knew with the , the situation of was ideal for two reasons. On the one hand because it had been created by Raymond Vilain who had made a shoe with his foot, and I did not have any more whom has to slip there my small feet to go under excellent conditions. In addition, it was the only department of csotcina.comaedics of the hospital and with many beds. Its activity which constituted, because of the size of the hospital a big part of the activity of this hospital, made an interlocutor impossible to circumvent of it with respect to the administration which ratified to some extent an operation which was divided into 50% with hand, 20% of plastic surgeon and 30% of general csotcina.comedy.

 

. : In what the organization of this service was it so favourable with the urgencies hands?

L.: Curiously the answer requires reflection. We will return a little on my Master and mentor Raymond Vilain, but one cannot say that the first as of its qualities was the organization. I think that the things gradually were done and amalgamated around the hand. For example the facility with which the who made orthotic devices could enter as an operating room or attend the consultation avoided long explanations. In the same way for the social workers and the nurses who were formed little by little with types of rather specific bandages. This environment was set up gradually and appeared natural. So much so that was difficult to me to pin with precision what made the specificity of this organization. It is only retrospectively that I became aware that in the final analysis most of the satellite structures of the surgical unit turned around the hand.

 

. : Which kind of man was Vilain?

L.: On a certain side, Vilain was brilliant. And as all the geniuses it had
remote regions and moods daily which were not always serene. Nevertheless it was a man with qualities teaching, intuitive and creative completely exceptional. He created the concept of S.O.S Hand and he had this faculty to appoint the things six months before the others. Another thing, a little less known, it is that Raymond Vilain was a plastics technician who had dealt with transversely the majority of burned in Paris in the Sixties. It was that which made its bandage in all the services of flarings. And when it was asked him why it made the bandages per week once, it answered: “it is because I can pass only once by week”. From the moment when it dealt with the flarings, it made evolve/move the concept of burns, the concept of wounds and I will say even the place of the plastics technician within the departments of csotcina.comaedics. Quite naturally, it took into 68 an csotcina.comedic department which was that of which went to Ambroise Paré. And of this “small service” of csotcina.comedy regarded as second area, he told: very well me I take it; I am plastics technician but I will be surrounded csotcina.comedists. Thus the origin even of this service was a mixture of plastics technicians and csotcina.comedists and that thrived during about thirty years and that was extraordinary for the surgery in general and the hand surgery in particular. To transform a disadvantage into an advantage it is typically the Unpleasant one.

 

. : And wounds?

L.: It is true that Vilain is also the man of the wounds. He had understood the spontaneous change of a wound and as private individuals the role of the germs which colonize it and make a kind of gardening, of household that it is necessary to know to supervise and orchestrate. Its famous “Peace on the wound with the germs of good will” quite simply meant not to bludgeon an antibiotic wound to prevent that the saprophytes disappear which are spontaneous detergents. With this ecological vision of the germs, Raymond Vilain was 20 years old in advance on his surgical generation. He posed the problem of why antibiotics. For what that is used? Is it really essential? Which are their disadvantages? Things which appear obvious to us now were questions that nobody was posed at the time. From a teaching point of view, it was brought to take a caricatural posture while proclaiming: “Me I prohibit almost antibiotics in my service because it should me be convinced that the regulation of a is essential before the aforementioned doesnot can or does not have to be used”. Its vision was consolidated by work of the famous bacteriologists who were and which worked at this time at the Pasteur Institute on microbial ecology. Unpleasant said besides that it had an etho-ethnological design of the germs.

 

. : By attack the prejudices, wasn't it dogmatic with wrong way?

L.: So readily! But it of it was perfectly conscious contrary to certain dogmatic and in addition that amused it; and this is why he will be forgiven to him much. It is true that it could take a little forced positions. I remember a congress of the when one started to have the first results of the in the hip surgery, Raymond Vilain simply told: “but when you one in your apartment if you call firemen imagine the state of your apartment! ” It could give the impression to go a little far but it was a tactic within the framework of a teaching strategy.

 

. : Which kind of surgery did it make?

L.: It made hand and figure; it was one of the last department heads “part-time job” thus after midday it was with the American or in the private clinics of . Its interns, of which me at the time, naps gone to help it and one saw there rather simple surgery like always in these cases there. At the hospital, it made sometimes an intricate surgery but it did not hesitate to launch its pupils over an ambitious surgery. Unpleasant, it was less one Master with the technical direction which an extraordinary intellectual mentor. It was the charisma in a pure state, related to a verbal and intellectual brilliance, and a direction of the innovation which allured the children which we were.

 

. : How was held your boarding school?

L.: I am one time when five contests of boarding school were passed. I was appointed with my third contest after having been provisional with the second, and to have passed the contest of the private hospitals which one called the “piles” as that of the peripherals of Paris where I made one year. I thus began a boarding school with St-Cloud at , which was a little satellite service of Robert that one was going to parasitize from time to time. At , there were the after-effects of the last important epidemic of poliomyelitis with an enormous recruitment. I practiced much extension of the tibia there, of of femur according to the technique of pol. the Core which was then the uncontested Master of the surgery polio. That gave me the taste of csotcina.comedy. Then I was appointed and I passed to the Public assistance. With the whole beginning, I made ENT SPECIALIST at in Pitié Salpêtrière. As it was known that I was a little csotcina.comedist, one especially asked me to take the grafts . After I went to , with Free Moslem, an exceptional choice at the time. The intern was king, I still tremble about it, because absolutely all was done. In this service, I can say it now, I operated with one of my colleagues Alain , a wound of the core. It was a firearm injury of the thorax with tamponade and nonpenetrating wound of the myocardium. With us two, we evacuated the hematoma and extracts the ball as in films from cow-boy.

 

. : What did you make on the wound of the myocardium?

L.: One sutured it after a long discussion. Because I wanted two points in X and claimed to him that only one point in X was enough. But time that one put to put a point in X made prohibitory the fact of putting two of them.

 

. : Let us continue the exchange rate of your boarding school…

L.: After I was at with , the Master of has which it had machined its aspiration drain. was a marvellous man. When I arrived, he celebrated his 1515ème parotid, he had flabbergasted me. He was to be reached of Parkinson because he trembled maliciously. But when it approached the parotid one, , it stopped trembling. He walked along the facial one and then he re-installed the instrument and then one intended the instruments to click on the table, they were dreadful. Despite everything, it had excellent results. After I was internal in at Vilain with as colleagues Philippe and Jacques . We had chosen this service whereas Raymond Vilain was not yet departmental manager. He was still department head of the consultation of , where he had prevailed during many years. Its escapades of staff waiting room were famous. He made re-enter a circus in the hospital with the elephants which paraded. All the valid patients were with the windows and applauded. As it had taken the service in the course of six-month period and that we were not very busy, it took us along all the three to the first exchange rate of hand surgery which took place in Montpellier with Yves . We have all of only one blow discovered the hand surgery. It has been for this time that all, in particular Philippe and myself, we were centered on the hand surgery.

 

. : Then?

L.: I was at which took the service where was still. I thus had two owners at the same time. In Ambroise Paré we made a dinner of memorable owner with to explain to him that even csotcina.comedy could be subtle. Then, I was in in last year initially at then in Merle of of which it was the last six-month period.

 

. : How did you find it?

L.: Very large distant Mr but, it was already an icon. From time to time one felt the humorous smile or the sentence which showed its acuity of spirit; but for our promotion, it was a detached figure.

 

. : You made your at Unpleasant; how was it perceived in the small medium of the hand surgery?

L.: Unpleasant could have with people only cordial aggressive coldness or friendly relations. The medium did not exist. It one was impassioned. It was very friendly with Jacques who was calm and to which the very middle-class character adapted completely with his. Raymond Vilain was wire of teacher like , and as it had the love of the Republic and good citizenship. With Raoul , they had at the same time friendly and stormy reports; Raoul “but how did you told him can waste such a talent? ” What Vilain appreciated only fairly.

 

. : One readily describes it like a man of spectacle…

. : It was a man
of spectacle. It is the only departmental manager of the Public assistance which in its youth had been artist. He held a spectacle of cabaret during two hours and half telling funny stories and making the requests, the answers in front of a subjugated public: exceptional! To quote its hospital aphorisms out of the context does not have a direction, so much they were provocative.

 

. : As an expert, how do you see the development of the doctor-patient ratios?

L.: Even if the number of businesses increased, but in proportions which are without common measurement with those which prevail on the other side of the Atlantic, one is struck confidence that the patients generally have in their surgeon. The essential component it is less the increase in the complaints of the patients with respect to the medical profession than the development of the position of the magistrates. Those made evolve/move case law to obtain advantages or settlements with the patients who complain about their surgeon. The number of patients who are compensated increases more quickly than the number of complaints. It is a very strong tendency, and a meeting at the court of appeal showed that the magistrates are aware of it and that the phenomenon cannot be continued AD .

The direct pressure (many times) and indirect (increase in the premium accounts of insurance) on the doctors, still increased certain legislative texts on the right of patients, reached a point of rupture marked well by true recent worker's compensations. The assumption of responsibility of the therapeutic risk by the community is an answer remained partial insofar as this assumption of responsibility is implemented only to the IP higher than 24%, rate corresponding to very a small number of the granted prejudices.

 

. : What justifies a legal procedure in general?

L.: Very schematically, there are those which want to be avenged and the remainder. Those which want to be avenged because they are made indignant by this or that, put settlement or the money in last position and they are addressed to the penal one. On the other hand, there are those which seek straightforwardly, and they say it, an financial advantage, or of others which seek simply a detailed explanation that they never had. Those there pass by the Civilian or the Administrative court according to whether it is about private or from the public. The money has importance then. But a well led expertise, for me, is an expertise which consolidates the patient in an explanation given by somebody of outside on what arrived to him, even if it implies in a way direct or indirect, a financial angle of attack. There is an explanation and that it is very important, because that allows the “mourning” of the complication.

 

. : Don't you think that a complication is always unacceptable?

L.: Me I think that we are not enough pedagogs. For me, a thing is clear, it is that with the practice of the expertise I amended the quality of my
messages with my patients. Nicely while smiling, I tell them you know the surgery they are not mathematics; it is a human act; I put at your service all that I can do but there are failures, that can , that can be infected and people tell: “then made for best”. One leaves at this time in a corporate speech. The patient and the surgeon will put their bona fide to go together ahead. It is completely different from the style: “it is a small trick Dear Madam, I have the practice, I will do it to you in two minutes”. It is a speech which one still understands and who is returned brutally to the face of the surgeon in the event of problems.

 

. : Does the expert, hones angular procedure, fulfill his role always well?

L.: This system is evolving/moving. Firstly because one asks more and more the experts to focus oneself on such or such pathology. For example, within the framework of csotcina.comedy, I say that I focus myself on the infectious surgery and the hand surgery. Thus, if there is an infectious problem on a hip, I of seized. Thus I am on a level for which I announced my competence. Now, is this competence with the height of what I announced? It is another problem. But, I am not any more one general doctor, or a gynecologist who would have to discuss the relevance of an intervention on the shoulder. Secondly, it is necessary to know that it is completely possible to tackle an expertise, In addition it is made very usually. The avocados of the parties which are not satisfied with the results of the expertise can then attack it initially on the form since very often the so attentive expert is it makes small legal errors, on the content. It is more difficult to prove, as it is usually on the form as the avocados wedge you. To my opinion one manages little by little to avoid the gags, but all the gags are not avoided. It is true that there is no checking of the quality of the training of the experts. But the system . The expert forwards his competences and then they are the magistrates who choose it. But they it only when the expertise is of good quality. The magistrates want expertises clear which answer their request and which are not disputed by the parties. Lastly, the Court of appeal recruits the most tested Experts of the Courts of appeals.

 

. : You organize a roundtable on the in hand surgery, why?

L.: Because we have all tendency on the matter to adopt attitudes which are not scientifically validated and he is important that one day or the other one tells: “continue to do what you want but that does not correspond to nothing”. It is necessary to call in question our convictions. The surveys into the behavior of the members of the with respect to this problem showed at the same time convergences and disparities which one is not explained very well, and who could be the subject of very interesting experience sharing. There are many people who spontaneously appeared in connection with this roundtable. Obviously I think that we hold a very good subject there and that it should be discussed even if one does not completely manage to solve it.

 

. : How do you see the conclusions?

L.: I see them well taking shape on December 13rd with 11:20, Amphi blue!