Private medicine: money or health? As a rule, in this section we place materials based on the personal experience of patients, good or bad – it depends on the situation. However, on the eve of the Day
Private medicine: money or health?
As a rule, in this section we place materials based on the personal experience of patients, good or bad – it depends on the situation. However, on the eve of the Medical Worker's Day, literally a cry from the heart “from the other side of the barricades” came to the editorial office – from the doctor himself. The questions that he raises seemed interesting to us, and we decided to bring them up for general discussion. Structural first. For ethical reasons, we will not name the name and surname of this doctor, if only because the matter is not in his personal person, but in the fundamental state of affairs.
The emergence and rapid growth of private medicine is already an objective reality, no matter how much someone would like the opposite. I would like to discuss one very simple, but, it seems to me, very important question: is private medicine a business or a social project?
What is the difference? But there is a difference. The business is focused on making a profit in every possible way. The social project is aimed at improving the quality of human life in one aspect or another. Well, as I understand it. And in private medicine it is impossible to combine it. Anyway, for now.
Initially, private centers, as a rule, were created for a doctor. Doctors who could not fully realize themselves in municipal medicine due to lack of funding or bureaucratic obstacles found an investor and opened their own offices. Now more and more people come to this industry who are very far from medicine, and with their own rules and principles of doing business. And what do we get as a result? A few points to which I would like to draw attention.
First. There is such a thing, called differently: multiple sale or complex sale. In retail, this is considered aerobatics, and among the people it is illustrated by a well-known anecdote: “How could you sell a rubber boat, a set of picnic furniture and a wetsuit for a tennis racket? “Yes, the racket has nothing to do with it: he came to ask where linoleum is sold here.” In the worst case, the buyer, having come home, regrets only the cost overrun. However, it is practically impossible to sell him something that he categorically does not like, and the sale takes place, as a rule, within the framework of the cash he has with him. In medicine, the situation is fundamentally different. As my former head physician used to say, and then there comes a moment when you sell a TV, a car, an apartment, just to survive.
A friend of mine was diagnosed with a chronic disease in a well-known medical center. Many people over 35 have it. If the process is not controlled and left to chance, then yes, unpleasant consequences are possible, but not fatal.However, "kind people" in this center told him that in three years, if not treated, there would be cancer. As a result, in two months he underwent diagnostic and treatment procedures for almost 50,000 rubles. And it wouldn't be the end if I didn't know about it. All together – consultation of a very good specialist, diagnosis, treatment and the final result – now cost my friend less than 10,000 rubles. But it's not even about money: for two months a person walked under the fear of oncology. How to measure this?! And how will this nervous tension come back to haunt us in the future? Yes, this is also a complex sale, but how to relate to this? There are milder cases, which are harder to find fault with, when instead of two or three tests, 10-15 tests are prescribed. Well, the doctor “wants” to get a more complete picture, what can I say!
Another point: some centers have a plan. Or the average check, you can call it whatever you like. And if the doctor does not fulfill it, then he quits. Somewhere in the sales department of some equipment, this is a normal phenomenon, but in medicine it turns out that if a doctor has practically healthy patients all day who need, let's say, only a consultation and an affectionate word, then he will have one of them make sick and treat to keep your place.
Third. Such a businessman looked that medicine – oh, cool business! Builds a center, buys equipment. Opp-paaa! It turns out that doctors are still needed. And the personnel war begins: they lure, lure. Well, all right, if it was possible, and the staff was recruited from qualified and experienced specialists. And if not? They take the first ones that come across in order to somehow fill the staff unit: the equipment should not be idle! I will never forget the eyes of a 30-year-old girl who arrived in a wheelchair. A half-educated doctor, seduced by money, who decided to work independently in a private medical center, having no experience, looked at her brain tumor. The girl was in a wheelchair, she already knew everything, and I will never forget her look. If she had got to a good specialist in time, the ending of this story would have been different. And this, unfortunately, is not an isolated case.
There is another subtlety here. Yes, there are also many young doctors in municipal hospitals, but there are older and more experienced comrades next to them, there is feedback from other departments. In private centers, the doctor often stays alone with the patient. Therefore, if he did not have enough accumulated experience, then most likely he will not: correct him, teach him, point out mistakes and shortcomings, and there is no one to share responsibility for the life and health of the patient with him! From other medical institutions, where the patient fled from such an ignoramus to solve his problem, they are unlikely to call and arrange a “debriefing”. There may be geniuses who are able to sit and analyze their work, draw conclusions and learn from their mistakes, but there are only a few of them, and the money-making system does not allow spending much time on analysis and training.Everything is thrown to fulfill the plan!
Telemedicine could help, but, unfortunately, it does not solve the problem either. Imagine, in Moscow, for example, there is an expert doctor, he has several cities, from which requests come in a flood. At the same time, he does not see the patient, he communicates only with those documents that he received, and there are many of them, and there is no time to think much, and he has to trust the doctor or specialist who sent all this. And sometimes not a doctor, but a nurse, there are such perversions. I don't think we can go any further!
Specialized diagnostic centers that conduct only research: MRI, CT, ultrasound and others – the question arises for them. I look at the price – a separate examination of the kidneys and a separate examination of the adrenal glands are prescribed. Anyone who is familiar with anatomy understands my bewilderment. How can you do a study of the adrenal gland without looking at the kidney? The kidney is visible in any case! Or how – to pretend that "not visible"?! Another question: if there is still a pathology in the kidney, what will the specialist do? Make the patient pay? How fair is this to the patient? Will he shut up then? Well, it's quite a crime! Just add it to the description? Again, not entirely fair compared to those who underwent the same study, but did not receive a description of the kidney. I'm interested in the train of thought in these marketing researches. The same applies to the study of the liver, pancreas, and other organs and systems. Maybe I don't understand something?! Enlighten me! I am always ready to learn, just justify this "knowledge".
. Many, many questions. And I understand that questions will inevitably arise about the moral and ethical character of a doctor who agrees to fulfill such requirements of his masters and leaders. But this is a separate conversation concerning education, culture, moral values of our society as a whole. So far, I’m interested in the way of thinking of the owners and managers: if medicine is just a business for you, then everyone needs to accept and understand this … But if the patient’s health is at the forefront, then the rules of the game should change so that doctors have no reason spin patients on unreasonable expenses. You can, of course, leave everything as it is, then the negative attitude towards doctors, distrust of private medicine will only grow, which is unlikely to contribute to the development of this type of business and improve the health of Russians.
Do I have suggestions? Yes, I have. But for now, I'd like to hear other opinions.