Que devient l’hôpital en régime néolibéral ? Entretien avec Stéphane Velut

Abstract

ObjectivesThis interview with Professor Stéphane Velut, neurosurgeon and writer, is an occasion to reflect on the current challenges of transforming the functioning of public hospitals today. In recent years, he has made his voice heard in public debate by publishing several essays and tracts. This interview allows him to expand upon some of his theses, by giving voice to his experience. Professor Velut's lively and passionate speech is in constant dialogue with the human sciences and literature. His taste for words led him in particular to develop a sensitivity to and a critique of the rhetoric employed by contemporary hospital administrators. MethodsThis dialogue is based on open questioning. Professor Velut is asked about his own experience as head of department and surgeon. The interview makes it possible to explore the many influences, from Victor Klemperer to Régis Debray, which help him think about the era and the issues specific to it. The analysis of the social and political context of French medicine over the last forty years is widely discussed: from the emergence of health democracy with the AIDS epidemic to the most recent upheavals caused by the SARS-CoV-2 pandemic. ResultsThe new logics of care, evolving towards an ever greater requirement of technicality, systematicity, and evaluability, lead to a standardization of medical practice, which tends to eliminate any singularity, both that of the patient and the clinician. DiscussionToday, it is administrators, economists, and communicators who seem to hold the power to decide what is desirable for the hospital. The analysis of their “metalanguage” reveals a singular enterprise of watering down, which de-realizes the reality of the concrete objects of the caregiver: illness, care, death. This metalanguage contrasts with the language of clinicians, grappling with a reality other than that of evaluation and quantification, in their proximity to the suffering of each patient. ConclusionThe neoliberal management of the hospital, controlled by economic imperatives; modern forms of management, indexed against the principle of subsidiarity; finally, the new systematized and protocolized conceptions of care lead to a loss of autonomy for clinicians and caregivers who are no longer expected to be actors capable of thinking for themselves. In contrast, the concrete, even artisanal exercise of surgeon, in which the work of the surgeon's hand (like that of the craftsman) is irreplaceable, is a form of clinical practice that preserves the singularity of the encounter and the possibility of inventiveness. The practice of surgery allows the practitioner to take the singularity of each participant into account; in this, it can be compared to the practice of psychiatry.