South Ural Panorama.

Important health in the house

Today, World Family Day, a holiday relatively new holiday, but conquering increasing popularity in the world, where family medicine is the usual, and in Russia, where "remembered" about this profession only at the beginning of the nineties. This day was offered to celebrate the World WONCA organization, uniting general practitioners (family).

Today, World Family Day, a holiday relatively new holiday, but conquering increasing popularity in the world, where family medicine is the usual, and in Russia, where "remembered" about this profession only at the beginning of the nineties. This day was offered to celebrate the World WONCA organization, uniting general practitioners (family).

– WONCA's main mission – improving the quality of life of people around the world, supporting the highest standards of medical care in general practices, – so referred to family medicine, "says Guest" Jupe "Oleg Kalev, Chief Specialist in Community Practice (Family Medicine) of the Chelyabinsk Ministry of Health Areas, Honored Science Worker, Doctor of Medical Sciences, Professor.

– Oleg Fedorovich, I think that most of our readers vaguely imagine what a family doctor is. In this role, we see the district therapist most often …

– In fact, such a practice in Russia was – the traditions are laid in Zemstvo medicine, which we know well from literature. It is the Zemstvo doctors who often serve large territories in one person were universal and knew how much. They often led his patients since the birthday, they knew well, treated, as we say, not just illness, but the whole body. The concept of "home doctor" was maintained in Russia for a long time and after the revolution, but gradually disappeared.

– What is the difference between such a doctor from the district therapist?

– The usual therapist is engaged in diseases of the internal organs – this is the heart, lungs, kidneys, liver and others. A general practitioner is engaged in a broader spectrum – he can explore and eyes, and ears, and the throat, to provide primary surgical assistance, put a simple diagnosis, and if necessary, send the patient to a narrow specialist. Such medicine in the area already exists, many patients are serviced by general practitioners.

– Can everyone be to such a specialist?

– By law – yes. But while there are few family doctors, and those who want can be much more. Therefore, the question is not easy. Yes, the patient has the right to choose a physician, but, unfortunately, it is really not secured. In clinics, where there are family doctors in the state, patients are attached to them on the precinct principle. And I must say, many patients are very satisfied, especially those who have illnesses identified in the early stages.Prevention is supposed to be one of the main benefits of family medicine.

– Oleg Fedorovich, what should a family doctor ideally be like?

— I watched the work of such specialists abroad. We collaborated with scientists from the US Rochester and Yale universities who came to Chelyabinsk, gave lectures on the organization of general practice medicine – it was a very useful experience. But most importantly, I worked in Austria with one of the best family doctors in Salzburg and had the opportunity to observe from the inside what it is. Together we conducted receptions, went on calls, for preventive examinations. From the early morning there was a reception, then at 14:00 lunch, and then an endless working day with a detour of patients. “My” doctor is 62 years old, he has more than four thousand (!) Patients, others have much less. But the patients chose him, preferring high professionalism and human qualities.

The doctor's office is usually located in the house where he lives, but there may be a special room.

What surprised me? The doctor meets each patient, leaving the table. He shakes his hand firmly. Someone will pat on the shoulder, pat on the cheek, expressing complete goodwill, ask how are you? And this is not a formal question, he really remembers and knows many by sight, aware of their problems. Earnings depend on the number of accepted patients: more patients, more services, higher wages.

"My Doctor" is incredibly popular. And I understand why. After the examination, he himself takes tests, makes an ultrasound, a cardiogram, knows the diseases of the ear, throat, nose, eyes well, and can do dressings. In the morning, he manages to take up to fifty people – there are no queues. Gives time to the patient exactly as much as needed: some five minutes, some an hour.

And they go to an appointment not only with medical problems, they often “consult”: their son drinks, an elderly relative behaves inappropriately, someone needs to apply for disability, get a certificate for driving a car. The latter is especially interesting: no one drives a motorist around the offices. After a complete examination and express analyzes, the family doctor puts his signature in the columns: “narcologist”, “psychiatrist”, “ENT” and others. The professionalism and knowledge of the patient allows him to take on this responsibility. Everything is fast, accurate, competent and honest.

— What surprised you?

– For example, the presence of a variety of diagnostic and medical equipment. Only he had four types of blood pressure monitors! He prescribes only one medicine for a patient with high blood pressure. Seeing my surprise, he explains: “Why confuse it with a long list? The patient then will not take anything at all. And take one medicine. I notice that we would immediately take such a hypertensive patient to the hospital, to which a colleague objects: “This is also white-coat hypertension, at the sight of which the pressure jumps. Soon it will pass and the result will no longer be so terrible.

I was also struck by the fact that only doctors themselves do tests, injections, ultrasound. Sometimes they give consultations directly on the phone: an experienced doctor feels who needs to come to quickly, to whom later.

We went to the nunnery for service, to the mountains to the farmers. And there was an interesting meeting. It turned out that one of the farmers, a war veteran, upon learning that I was from Russia, rushed to me with hugs. He said that he was in captivity, that the Russians treated him well. He simply explained his impulse: “Thank you for returning home and still alive …” But this is so, a lyrical digression. We helped him. We visited a nursing home, a school, a boarding house for the elderly. I saw how they were waiting for a doctor, they knew him by sight. And for everyone he found encouraging words. In general, I was struck by the warmth, informal relationships that connect all family doctors with their patients. This is a prerequisite that has become a natural state for most doctors. By the way, there are no controlling authorities, no checks. If something does not suit the patient, he simply goes to another doctor, no one writes complaints, in conflict situations everything is decided by the court.

– Oleg Fedorovich, here we have 107 offices of general practitioners in the Chelyabinsk region. Does something similar exist in the doctor-patient relationship?

– There is no such thing as I saw in Austria. But with a real free choice of the doctor we go to, I think such a relationship will inevitably arise. After all, the earnings of a family doctor will depend on how many patients give preference to him. And the human factor is a very important component, to which patients attach great importance.

— And who trains general practitioners in Chelyabinsk?

– Prepared by the Ural Medical Academy of Additional Education, now our Medical Academy. The department I head is called “internal medicine and family medicine”. Both university graduates and doctors undergo special training. Within six months, lectures are given to listeners by specialists from seventeen departments, and at the highest level. These are surgeons, neuropathologists, dermatologists, oncologists and others. Of course, this is only the basis, a platform for a new specialty – you cannot become an ace in six months. But if we improve ourselves, constantly work on improving our professional level, then as a result we will have general practitioners, generalists. Work is underway, but often we are held back by the lack of necessary laws and amendments to them. I have repeatedly addressed letters to both President Medvedev and Prime Minister Putin with a proposal to create faculties in medical universities that train family doctors. He substantiated everything, gave the necessary arguments …

– And what do they answer you from the very top?

– They answer that my letters have been transferred to the Ministry of Health. From there, in turn, they write that they are working on it.Indeed, they are working, changing some rules, making changes and amendments to laws, but there is still a lot of confusion.

– Is something being done in Chelyabinsk and the region?

– A lot is being done. In a number of hospitals, offices of general practitioners have been opened and are operating quite successfully. It would be more correct to say departments, but offices, so offices. They include rooms for receiving patients, procedural, auxiliary rooms, where there is the necessary diagnostic and medical equipment. Everything that is possible is done on the spot: initial treatment of wounds, injections, simple manipulations dictated by the need for first aid. And there are already more than a hundred such offices in the region. In 2004, a concept for the development of family medicine was adopted in the Southern Urals, where the goal was clearly set – to open 170 such departments by 2010. With a slight delay, but the figure will be reached. We are currently training a group of 31 doctors who will take up positions in the newly opened offices.

Especially valuable is the activity of family doctors in remote areas, remote corners, where the only doctor, of course, must be a generalist. By the way, I already know many family doctors who have been successful in this profession. And I am absolutely sure that this preventive direction will be in demand and will develop successfully.

Of course, there are still many problems in the development of the service of general practitioners, but today I would not like to talk about it. The main thing is that a start has been made, the process is underway. I would just like to congratulate everyone involved in family medicine on our professional holiday. And for patients present and future – attention to themselves and good health.