Etude du suivi par le généraliste des enfants de parents séparés
Study of the follow-up by the general practitioner of the children of separate parents
En Belgique surviennent plus de 31.000 divorces par an et l’on estime que 600.000 enfants vivent en situation de séparation parentale. Les implications professionnelles pour le médecin généraliste (MG) et liées à ce type de famille n’avaient jamais encore été étudiées. Cette étude voulait répondre à la question suivante : en pratique quotidienne pour le médecin généraliste, que se passe-t-il dans le cadre du suivi médical des enfants de parents séparés ? Les hypothèses concernaient de probables changements de conditions de travail pour le MG, de possibles troubles diagnostiqués chez ces enfants et la nécessité éventuelle d’adapter certaines attitudes professionnelles. Seule une recherche qualitative centrée sur le vécu professionnel du MG pouvait répondre à ces questions exploratoires. Entre septembre et décembre 2004, huit “ focus groups ” de 15 généralistes furent organisés à Bruxelles et à Mons ; cette méthodologie est reconnue efficace pour dépasser les concepts supposés au départ en favorisant l’interaction entre les participants. Finalement 242 cas de séparations parentales provenant de la pratique quotidienne, furent l’objet de débats intégralement dactylographiés et analysés avec l’assistance du logiciel QSR N5. Ainsi le point de vue du MG est le suivant : 1) Le divorce affecte les conditions de travail du généraliste avec par exemple le morcellement du suivi médical de l’enfant et le fait d’être “ instrumentalisé ” par les familles. 2) Le conflit entre les parents après la séparation augmente les difficultés professionnelles du MG. 3) La séparation parentale induit le choix du MG entre différentes attitudes professionnelles (exemple : tenter ou non de “ gérer ” le conflit familial). 4) Principalement lié au conflit entre les parents, le divorce favorise notamment chez l’enfant des ABSTRACT In Belgium, on 10 millions of inhabitants, there are more than 31.000 divorces per year and we estimate that 600.000 children are experiencing separation of their parents. The general practitioner (GP) have inevitably the responsability of the medical follow-up of some of these children. The possible professional implications related to these young patients, concerning the GP have never been the subject of a study so far. Consequently the aim of this research was to reveal what is happening in the daily practice of the family practitioner related with the children of separete parents.There were some hypothesis notably about particular working conditions for the GP in connection with possible consequences for these children and possible necessity of special professional attitudes. A qualitative research in focus group was organized with GPs in order to get an interaction between the participants and to go past the concepts supposed before the study. Therefore between September and December 04, 8 focus groups of 10-18 generalist practitioners were set up in Brussels and Mons. Each meeting was axed around couples separated for less than 3 years and children between 0 and 15 years. Finally, 120 GPs discussed about 242 cases of divorces from their practice.The debates totally typed word by word were analysed with assistance of the software QSR N5. The point of view of the GPs is: 1) A divorce affects the working conditions of the general practitioner, for example the parcelling out of the medical follow-up of the child and the fact “ of being used ” by the family. 2) The conflict between the parents after the separation increases the difficulties désordres d’ordre psychologique ou comportemental, des problèmes liés à leur santé physique et des difficultés scolaires entre autres. 5) Certaines options prises par le MG influencent positivement l’évolution de l’enfant, comme par exemple de parler aux deux parents. 6) Certaines actions du généraliste aggravent la situation de l’enfant, comme le fait de délivrer certains documents officiels dans un contexte de conflit entre parents (certificat, rapport, attestation, constat). En conclusion, cette étude démontre que la séparation parentale affecte le suivi médical des enfants par le médecin généraliste et que les attitudes professionnelles de ce dernier, peuvent influencer positivement ou négativement l’évolution de ces jeunes patients. Pour la première fois, des conséquences négatives pour l’enfant suite à un divorce sont décrites en soins primaires. Ces résultats devront être confirmés par des études quantitatives. Rev Med Brux 2006 ; 27 : S 279-86
In Belgium, on 10 millions of inhabitants, there are more than 31.000 divorces per year and we estimate that 600.000 children are experiencing separation of their parents. The general practitioner (GP) have inevitably the responsability of the medical follow-up of some of these children. The possible professional implications related to these young patients, concerning the GP have never been the subject of a study so far. Consequently the aim of this research was to reveal what is happening in the daily practice of the family practitioner related with the children of separete parents.There were some hypothesis notably about particular working conditions for the GP in connection with possible consequences for these children and possible necessity of special professional attitudes. A qualitative research in focus group was organized with GPs in order to get an interaction between the participants and to go past the concepts supposed before the study. Therefore between September and December 04, 8 focus groups of 10-18 generalist practitioners were set up in Brussels and Mons. Each meeting was axed around couples separated for less than 3 years and children between 0 and 15 years. Finally, 120 GPs discussed about 242 cases of divorces from their practice.The debates totally typed word by word were analysed with assistance of the software QSR N5. The point of view of the GPs is: 1) A divorce affects the working conditions of the general practitioner, for example the parcelling out of the medical follow-up of the child and the fact “ of being used ” by the family. 2) The conflict between the parents after the separation increases the difficulties for the GP in his daily practice. 3) The parental’s separation influences the choice of professional attitudes of the GP, notably vis-a-vis the conflict (for instance to try or not to try the conflict’s management). 4) Mainly in conflict situation, parental divorce is a risk for the child; psychological or behavioural disorders, physical health problems, school difficulties, ... 5) Certain professional attitudes of the general practitioner can influence positively the evolution of these children, for example to speak to the two parents. 6) Some professional actions aggravate the situation of the these children, for instance to product certain official written documents (attestations, reports, certificats, ...) in a conflicts context. In conclusion, this study desmonstrates that parental separation affects the medical follow-up of the children by the GPs and that professional attitudes influences positively or negatively the child’s evolution. For the first time, some negative consequences of the divorce on children are described in the first line. All this results must be confirmed by quantitative research work. Rev Med Brux 2006 ; 27 : S 279-86