'Social Security 100% is clear to me': This GP's battle for access to care

Dr. Maddie Dinantis is one of those people who never gives up. Under any circumstances. A strength of character that certainly comes from his mother, a former social worker. Since its installation in 1992 in the working-class area of ​​Belleville, in Paris, GPs have fought to ensure their patients get the care they need. more “Field actress” that “lobbyist”She ardently advocated for third-party payment until it became widespread, and today she demands a large Social Security bill. She also worked alongside Médecins du Monde to protect victims of lead poisoning and migrants. At 65 years old, this “utopian” seeks to pass on her philosophy to the new generation of doctors. “That's what I'm most proud of.” We met her at the health center where she works.

Friday, February 16 at 3 pm on Capital Heights. The steep streets of Belleville are almost deserted. The weather is nice and spring is coming. Young people sit on the terrace of a Norman crêpe restaurant, finishing their meal without any haste. Across the street, at the Pyrénées-Belleville health centre, the waiting room is full. The afternoon is devoted to direct consultations. Patients sign up for a list to be seen quickly. In September, the MSP left Rue Pyrenees to move to Rue Botha, adjacent to the famous Belleville Park and Belvedere, to expand and accommodate health mediators. “We have been able to increase the provision of careSays proudly Dr. Maddy Dinants. “We're not firing anyone.” Ten years ago, the GP established the first health center in the neighborhood in collaboration with Dr. Marie Chevillier and private nurse Isabelle Guéguen. At that time, there was only one other place in Paris, in the 19th arrondissement. Teamwork puts off more than one person. But certainly not Madi Dinantis. “It was clear to me”“, trust. This step is synonymous with “Back to basics For the 65-year-old GP, who moved to the neighborhood for the first time on January 1, 1992, in a group practice on rue d'Enverge, a few meters from the new MSP.

On the eve of the school holiday, doctors, nurses and health mediators from the building gather in the break room next to the reception desk, before returning to work. The atmosphere is cheerful and the laughter is frank. The smell of coffee fills the room. Isabelle Gueguen brought her Chou-Fleur hamster back for her colleagues to take care of while she was on vacation. He seems completely comfortable in his new environment. We rush to put our finger between the bars of the cage to try to pet this little ball of fur. We also debrief about lunch: lasagna “excellent” Tasted in “canteen”. “It's an association that prepares meals with local people. You go to eat and give what you want. There are a lot of poor people who don't donate anything.”“, explains Maddy Dinantis. “Once a month, we prepare a meal with our patients.” On this Friday, the GP was not in the kitchen but was doing dishwashing chores. “Every 15th of the month.”You also go to the “Health Café” to interact with users in a friendly atmosphere. Since becoming SECPA (Structure Coordinated Participatory Exercise*), the MSP has received funds to fund health mediation. “What we did voluntarily at that time is now funded by Social Security.”Maddy Dinants rejoices.

Today, mediation has disrupted the organization of the health center – and in general the neighbourhood. Patients are now cared for as a whole, and are supported both inside and outside the medical office, as Maddy Dinantis passionately explains. She takes us into a small, corridor-like office: white walls reflected in slightly aggressive artificial light. This is the only room available on a Friday afternoon. “I wanted to reserve a real office for us, but we have a new intern.”commented the eldest member of the temple, happy to see this place that she had greatly contributed to building in all her excitement.

First battles

Originally from the 13th arrondissement of Paris, where her parents still live, Maddy Dinants arrived in Belleville by chance. “An old GP in the area was retiring and suggested we take over his practice.” “we”It is she and Dr. Michel Thibaut, with whom she began her liberal practice after an exemplary education. “It was clear to me that I would not create this project alone. I also wanted to collaborate with pharmacists and speech pathologists in the neighborhood.” The Doctors Syndicate warned her at the time: Beware of the conspiracy! He was told. It's absurd for a young woman who already believed that working in a team would fulfill her “more effective“Ten years later, she welcomed a new partner, Anne Rethaker, and then another, Marie Chevellard, with whom she founded MSP. The three ended up leaving the neighborhood. “I'm the only one who doesn't moveLaughs the GP, her laughing eyes behind her bright red round glasses.

Since the beginning of her career, she has been a general practitioner “Great interest” To the most disadvantaged – many of her patients – she decided, with her sisters, to systematically practice third-party payment. “For me, that was the basis. I don't know how much anymore [le tarif de la consultation] It was denominated in francs at the time, but providing it was a problem for some patients. I found myself with a bunch of banknotes or checks, which did not suit me…Paying through a third party was the perfect solution.” “Perfect” But not really legal…at the time, it was “Forbidden” To general practitioners. Dr. Dinantis ignores current legislation in the name of access to care. “Once a month I would receive a message from CPAM telling me that they would not pay for my consultation because third party payment is only allowed in the case of CMU”Says. She still keeps a copy in her closet, as if it were a relic of a bygone era. “My colleagues and I prepared a paper and were able to get our salaries.” The ban was lifted in 2011, and third-party payment was finally rolled out in 2017. One battle among many has been won…