How many patients per shift can take the local doctor than a General practitioner different from a physician who can treat conjunctivitis and otitis media? How many days is the diagnosis and what the doctors clinics think about the patient “want” — “Pravmir” on condition of anonymity, spoke with the Deputy chief doctor of the Moscow polyclinics and recorded her comments on key issues.
Photo: RIA Novosti
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Than the General practitioners are different from physicians?
The General practitioner has the basic knowledge on each specialty is ophthalmology, otorhinolaryngology, neurology, partly surgery, orthopedics, cardiology, endocrinology.
For example, a person for a long time suffer from low back pain, and had fever — a General practitioner able to diagnose and prescribe treatment, to determine the total symptomatology or manifestation of the disease outside its professional competence.
Therapists not trained in the mastery of certain manipulations and ownership of hardware, such as an Ophthalmoscope or with a rhinoscope, while a General practitioner may, for example, to measure eye pressure.
General practitioners receive professional training for 5-6 months to learn, is a specialty like any other medical. It falls already on the professional background of the therapist or the cardiologist, or endocrinologist, who received retraining.
Narrow specialists in more heavily loaded patients who do not need their help, and get there due to various reasons — including because of the mass of information from social networks and mass media. After reading all this, patients get lost, find themselves in a lot of diseases and need a doctor-the filter is able to understand how the patient needs specialized help to narrow specialists were engaged in their work.
There are two options for patient referral to more specialist: the failure of the treatment when it has not led to the desired result, or manifestation of the disease is too thin and it refers to the expertise profile of the expert. Another example: a patient came with a banal conjunctivitis — the General practitioner has the necessary equipment for inspection, he has the right to prescribe treatment and evaluate its results.
Did the patient not to go to specialists?
We still have a trend that the patients themselves determine the indications for referrals to specialists. This should not be. The word “want” should be excluded, it is not fundamental to get to the doctor.
Why do people go to the doctor? He is ill or is receiving ongoing drug therapy for this at least once in three months should see a doctor if they need adjustments. Or man came for preventive examination or check-up. Other reasons for seeking medical attention can not be. Everything must be under medical indications. This is a General practitioner.
The system of medical care is divided into levels. The first doctors providing primary care, those patients can enroll themselves. The second level — cardiologists or neurologists, the doctors to whom patients are referred by the decision of the first level. The patient is attached to the doctor the second level and has the right to sign up to it myself. Such patients are included in the group dispensary observations — for example, patients with diabetes of the 1st type are subject to mandatory supervision once a month, myocardial infarction within the year are observed at the cardiologist, plus patients with viral hepatitis, epilepsy, multiple sclerosis, myasthenia gravis, these diseases is not enough.
The maximum number of patients per shift — 35 people. The grid spacing of a therapist and a 12 — minute appointment, 15 minutes for a General practitioner, a surgeon, for example, 10 minutes since a lot of repetitive techniques. The duration of intake is also regulated by the orders of the health Department.
How much time General practitioner to establish the diagnosis?
We are given 10 days to conduct a number of studies and guide to the right specialist. Any physician to whom the patient, may suspect cancer. There is an order, which clearly stipulates the routing of the patient depending on the localization – what research to do and where to send on, they do not even need to think much — just follow instructions.
Our task is to respect the allotted time, it now paid much attention. If we don’t do it alone, you have to send the patient to the CDC or the hospital. When you call the patient within 10 days we should establish the diagnosis — any.
Territorial program of state guarantees of rendering medical service to stipulate the terms: to the physician the availability of the records in the same day, the doctor of the second level — 7 days, CT and MRI — 26 calendar days, other studies for 7-10 days. And that’s why we have to build the clinic, to the same neurologist has not been swamped with grandmothers with degenerative disc disease, and his advice could get people do with the relevant issue.
Manifestation (the first manifestation) of disease, chronic pain syndrome, aggravated due to the fact that people, for example, processed — all of this safely absolutely can cope with a General practitioner. It is not necessary to be afraid of, experienced General practitioners can at times be better and more qualified novice neurologist.
And if you need to see a doctor urgently?
There is always the opportunity to help patients in the queue. If the on-call General practitioner patient comes in, which turns out to be purulent otitis media — that is, a certain manipulation, it is a “red card” will be written to Laura. But the ENT still poluchilsa specialty.
Generally the second level is those doctors who do not provide emergency assistance. To prescribe pain relief can the same a General practitioner, the set of drugs in clinics is very limited — this is not a hospital. If the patient needs specialized hospital care, its there just right.
Now you can sign up to the doctors in different branches of the polyclinic is best for patients?
In 2012 we began the consolidation of outpatient clinics — has the head office and branches. This is due to licensing of mediaconnect, specialists of the second level, as a rule, are in all the branches, only more rare specialty — for example, a pulmonologist, immunologist or a gastroenterologist may be in any one branch, but the availability to him is equivalent for all patients. One of the conditions of such Association clinics — accessibility of branches for 40 minutes.
The therapist is bound to the service area, but to other doctors can be arranged in different clinics. But I do not welcome: the patient should be treated by one doctor, he knows his dynamics, he will not waste the time of admission to the introductory questions. As with General practitioners — should come to one and the same. Sometimes, patients do not like the local doctor, and you can change it, Yes. But again, when a person watches a doctor is the key to success, he is able to notice the changes.
Count — the number of times a patient may change doctor — not qualified, it is absurd, you will agree. And then, it is done with the consent of the doctor must. If something suddenly very ill, of course, you come to the doctor’s office, but by appointment – try to get to my therapist.
But if I just need to see a doctor?
We have patients who come in every day. That is, “and talk?”. We try to evaluate them and to interview them separately so they don’t hit record. As a rule, this behavior is associated with certain psychological problems, cognitive disorders, age-related plan, a psychiatric illness — they can sign up to the two doctors a day.
There are lonely people, they come just to talk — why not? In clinics now area a comfortable stay, it is warm and bright, better than some of the houses. And to work with such an audience is incredibly hard.
But it’s impossible to limit the quantitative access to doctors, MEDICAL also does not provide — as we will hold the line when a person may require assistance, and when he came just like that? Here already it is necessary to evaluate them and work with them manually — administrators, me and the head — to explain: if you want to come, come, we’ll talk — but don’t flood the doctors receive.
Why I’m calling the doctor in the morning, and he comes to dinner?
Now the service is divided as follows: there are local doctors, each 1,200 people and has offices for the provision of home care and private home-care service that deals with disabled patients. It’s three different groups of doctors.
We try to make two doctors — the district at the clinic and leaving for home has served the same territory, the same family.
The doctors who visit you at home, flexible hours, the ratio of two persons per hour during eight-hour day. The ratio includes the time on the road. Received call should be worked out for 8 hours, we need to build a route of a doctor so that it a minimum of time spent on the road, so time to make the call is irrelevant — you could call the clinic in the morning and get it to you in the afternoon. In the season there are up to 40 calls per person per shift, doctors to stay at work until go round them all.
From nursing service to the most difficult group of patients are very demanding and capricious. In these cases, the departures are at least once a month. Each physician has two nurses, each of them has up to 200 patients. The multiplicity of patronage in each case determined by a doctor — some people need to treat bedsores or bandaging once a day, someone to visit, once a week, someone to come every two weeks.
Why is the doctor sitting in front of the electronic card, but still writes in a paper?
Now we deal with the created structure, now it crystallizes, maybe there will be some organizational decisions, but as long as it works. We don’t really like the fact that the local doctor was separated from nurse, now the latest are at the nurses ‘ station, and doctors work alone and somewhat lost. We try to bring them back. The General practitioners of manipulation are many, and we returned to the nurses. For every five offices of these doctors are handling the office — there can make dressings, to remove simple sutures, visual acuity test, to take an electrocardiogram. And it can make a sister to relieve the doctor.
Everything has become easier with the introduction of electronic cards, but until the transition period — paper and electronic — is pretty hard.
And while transmitted to paper, or rather, a copy is made to a medical institution, if the patient, for example, has moved and is now getting help elsewhere. The original is at the first medical facility. Photocopies of medical documents we can issue your application according to FZ № 59 it’s done in 30 days, but usually it’s much faster.
How to pass medical examinations?
The examination is held once in three years, and in the remaining two years of people once can pass a baseline medical examination. Changed set of research — it dropped, removed an UZI, for example, which, incidentally, many dissatisfied patients.
There is a separate study in terms of oncological warning — at 21, a girls gotta do Cytology, 39 years — mammography, all after the age of 40 need to do gastroscopy and colonoscopy, but the examination by a doctor, is somewhat different.
Professional examination and the examination is conducted in the office or the office of medpreparaty. There is no need to sign up specially, just come and say to the Registrar — I want to pass a baseline medical examination or medical examinations.
Unfortunately, it’s not very popular, apparently, until it is made compulsory, the situation will not change. We have people, on the one hand, very demanding, and with another — medical illiterate. They want to be treated, but do not want prevention, which will allow them to be treated. We need to change the psychology of society, perhaps even somewhere hard.