Does the state of medicine affect the state’s defense? It also influences how ... After all, we are talking not only about the physical fitness of the servicemen themselves, but also about their confidence that the home country is able to take care of their loved ones when the officers and soldiers themselves do their duty to protect the interests of the Motherland. And they, like their relatives and friends, naively believe in the veracity and objectivity of the reports of the officials responsible for domestic medicine. However, the harsh reality is ready not only to lower them to the ground, but also, perhaps, to send somewhere deeper ...
In the clinic as on holiday
The author, having done exactly a year ago, in August 2017, the operation to remove basal cell carcinoma on his face at the Oncology Research Institute of Tomsk NIMC, and without encountering any problems, he expected that the whole state of Russian medicine is approximately the same as there.
By the way, if it were not for the personal appeal to this center, the outcome would have been much more sad, since the Novosibirsk oncology in the person of the oncologist at the place of residence and the city oncological center recognized the author as healthy and recommended the “appeal in a year”.
And in Tomsk, a jaw lesion was diagnosed, immediate operations were performed, including plastic surgery, and moreover they did it completely free of charge. Then it took to be registered with the oncologist at the place of residence. It is possible to appeal to him only if there is a referral from the district therapist. And here the first surprises begin ...
In the clinic as a job
My attempts to sign up for the district doctor 31 July 2018 of the year on the website of public services were surprising, since the record was possible only on August 13. A call to the registry allowed to register already on 10-e, which caused quite reasonable assumptions either in the incorrect work of the site, or in the discrepancy between the data of the polyclinic registry and the data of the site.
After visiting the therapist, it turned out that the fluorography room in the clinic has not been working for a long time due to a malfunction and when it works, it is unknown. So you have to go to the next clinic, whose X-ray equipment serves much more than 100 thousands (!) People.
Our, one of the newest Novosibirsk polyclinics at ul. Tyulenin, 9, with great fanfare, opened in 2011 in the presence of the then mayor, and then the governor of the region, Vladimir Gorodetsky.
He said that “the construction of a new polyclinic in a growing microdistrict, whose population will soon reach 80 thousand, will help reduce the burden on head clinic No. 29, to which there have been many complaints because of the large flow of patients.” The estimated construction cost was 364 million rubles. Funding was mainly from the city budget.
Currently, the population of this district, which was called upon to serve the new clinic, has long exceeded the number already in 110 thousand people and continues to grow steadily.
But ... Incomplete general practitioners - 40 percent, and doctors of "narrow" specialties and even more. Polyclinic areas are involved a maximum of 50 percent ...
Thus, the promises of Vladimir Gorodetsky were not fulfilled. The situation has also worsened, as the burden on the basic 29 clinic, whose branch is a new institution, has increased even more.
Of course, the load on one doctor in such a situation significantly exceeds the norm. And the volume of documents executed by him is growing from year to year. As a result, the doctor often turns into a thoughtless Robot, more caring not about the cure of the patient, but about the preparation of correct reporting.
The head physician is responsible for staffing the polyclinic, but what can he do if the shortage of doctors in the city and region is the same, that is, 40 percent?
In addition, it is almost impossible to replenish the staff in the same 29 clinic with medical workers living in other parts of Novosibirsk, as they simply refuse to travel to 08.00 to work via chronic traffic jams on Teacherskaya Street ...
Attempts to enroll in the so-called “narrow” specialists, even if there is a referral from a therapist, are fraught with almost insurmountable difficulties.
In particular, I was ordered to come for the coupon at the 16 August registry on Thursday, at 07.30. Arriving there at 07.20, I discovered a queue of about 60 people. Having defended it, I heard from the window that there are no tickets anymore, and it is necessary to arrive “tomorrow at 07.30”. Came to 07.00, but found a queue of even greater length. And the answer of the registry was the same, but this time, “come on Monday, there will be an entry on September 3”. Of course, the situation repeated on Monday.
Exactly at 07.30 am the registry opens. Such is the picture. Queue people in 70 ...
By the way, in the queue you can hear a lot of stories about the true situation in medicine. For example, a retiree 73-years told how he, having received a cataract in both eyes, turned to a local ophthalmologist for help, and he sent him for an operation. The patient tried to ask him to operate on a quota. However, in response, he heard that he could wait for the operation for ... 5 years. And the man laid out 56 thousand rubles for the operation of his, as he put it, “death-money”. There are dozens, if not hundreds or thousands of such stories.
However, there is an opinion that any patient, not satisfied with the work of the clinic, can state their requirements in a letter to the head doctor of the medical institution and the medical insurance organization, after which they will inevitably be obliged to fulfill their obligations to ensure the provision of free medical care.
But ... What is this organization of the work of public health requiring such an approach ??? And is it, this is health care?
Many visitors are already tired of going to the reception endlessly. A "Book of complaints and suggestions," the wallboard, where patients write their reviews, are filled with complaints.
In the clinic as in penal servitude
The Novosibirsk Region is considered to be a region with a high incidence of cancer. The incidence of cancer in 2016-th year was 469,8 cases for 100 thousand population (in the Russian Federation - 402,5). The high level of patients with 1 – 2 disease stages - 61% attracts attention.
As of 2015, the number of oncologists in the Novosibirsk region was slightly more than 60 percent.
The most surprising thing is that both the Russian and the regional Ministry of Health in this state of staff say that “the priority direction of development of the oncological service is to increase the detection of malignant tumors, especially the 1 – 2 stage, survival, optimize patient routing, introduce modern screening programs, improve the quality of care , especially the availability of chemotherapy and radiation therapy, training ... "
What does this mean in translation from the official language into Russian? But what ...
At 110, the thousands of the population of the Novosibirsk regions Rodniki, Snegiri and Severnyy account for an 1 oncologist who was on vacation at the time of the appeal.
Standards are supposed to have an oncologist 1 on 500 identified cancer patients. All those of the Novosibirsk region about 80 thousands. A simple calculation shows that such medical specialists should be around 160. But…
Incomplete only in the 29-th clinic and its branch on the street. Tulenin, 9 is an oncologist's 3-4.
At the same time, it seems that no one thinks about turning the declaration into real actions.
Only from this fact it can be concluded that in fact the work on the detection of cancer at an early stage is completely failed.
My appeal to the direct line of the regional Ministry of Health allowed us to establish that calls to it are not recorded, and appeals from citizens are received in writing according to a set pattern that is available on the site. And the answer to them is given within 30 days.
That is, a potential patient, for whom, perhaps, the decision on admission by a doctor can literally be a matter of life or death, according to the Ministry of Health of the Novosibirsk Region, can wait 30 days ...
It is amazing, but in order for the regional Ministry of Health to own information about the real situation with queues in each clinic, it is enough to put a penny video camera in their lobbies and display the image from them directly to the offices of responsible medical people. And to provide effective methodological assistance in ridding patients of queues at clinics.
But this simple thought does not come to bright bureaucratic heads.
In addition, it turned out that the old service “City Electronic Registry”, which previously could have been registered with a doctor on the Internet, no longer works. A new service on the website of public services, according to registry workers, makes it possible to enroll to an oncologist for some reason only from 00.00 to 06.00 in the morning (?!) ...
Yes, and this site works very incomprehensibly, issuing messages like "The request did not yield results", etc.
And 22 August 2018, the appointment to doctors, at least in Novosibirsk, was not completely possible, because the electronic registration system in the entire city did not work completely ...
Summarizing, we can agree with the opinion of the Minister of Health of the Russian Federation Skvortsova about the unprecedented flourishing of Russian medicine and the general increase in the life expectancy of Russians.
It remains to assume that with such an organization of health care, requiring excellent physical fitness of sick citizens, they will die out. And so will increase the performance of domestic health care.
Sad ending
Indoors in the registry are an indication that medical workers visiting patients in the community should use the shoe covers provided by the citizens themselves. You can imagine that the patient, having found the temperature of degrees in 39, before calling the doctor, would immediately rush to the pharmacy for shoe covers?
Nearby you can see the information that 29-I clinic in 2018-th year participates in the project "Creating a new model of medical organization" (lean production). Production of what ??? Sick? Or healthy?
And if you work and decide to seriously take care of your health, it is better to take a vacation and be prepared for the fact that you have to go to medical institutions every day from morning to evening.
And if you are a pensioner, get ready to endure all the burden and deprivation of Russian medicine.
Of course, in the current situation there is no fault of either the doctors or the other polyclinic workers. They are forced to work according to the rules that they are let down by the federal and regional ministries. And they were so convinced that the medicine should not cure people, but provide them with services, that the very concept of “health” turned out to be “zamenetized” and “bureaucratized”.
Probably, medical officials are not familiar with the biography of the great Russian surgeon Nikolai Pirogov. And they never read Anton Chekhov's Stories of the Zemstvo Doctor. And if they read, they did not understand anything.
Let the still healthy citizens envy already sick.
PS And how in other regions of Russia?