« Arrêtez de tirer sur le pianiste ! »* Le point de vue du médecin généraliste sur l'inertie thérapeutique

The growing concern to provide care of better quality to patients was at the origin of the implementation, during the last decades, of measures to improve the practices of doctors. The assessment of medical practices stood out as an adequate appeal. The observation of a difference between the practices and the recommendations became a privileged space of reflection. The therapeutic inertia is in the heart of this debate and as far as we lack, at present, relevant qualitative tools to understand the deep reasons of the said inertia, it is necessary to be particularly suspicious with regard to the reasons sometimes too simplistic mentioned to explain this observation and with the solutions that often not take into account sick patients to offer them, under any circumstances, a better quality of care. It is a concrete situation analysis that allows us to differentiate the true inertia from the pen names inertia and to suggest actions plan aiming to have a real impact on the improvement of the quality of care of patient with diabetes, who are mostly not only diabetics. An approach centered on the patient seems to be, at present, the only solution that is really capable of taking into account, at the same time, the entirety and the complexity of the situation that general practitioners have to manage daily. One cause of true inertia is the routine and the everyday acceptance of the “difficult situations” within the patient doctor couple which tend to encourage them not modifying the habits of each other. An interesting working track to fight this inertia is to improve the reflexivity of doctors. Thus a question arises on the assessment of reflexivity in the evaluation of medical practices.