Pavel Vorobyov fired. Online conference with Professor P.A.

It is bitter to realize the moral and ethical collapse in today's medicine. Several well-known sad examples. History first. A six-year-old boy dies in the yard under the wheels of a speeding car. And suddenly it turns out that he was drunk. Yes, not just drunk - he was found to have an almost lethal dose of alcohol in his tests. With such a concentration, it’s not like walking with your grandfather by the hand and running around the yard, it’s just right to lie in intensive care. But the forensic expert was not embarrassed by this concentration. It was important to fulfill the order (that there was an order - obviously). Which he did. Pretty sure he just dropped the alcohol into the test tube. The drop must have been large. But even here it did not occur to me to come to my senses with such a monstrous result. It can be assumed that such "experiments" were carried out by this expert doctor before, but they got away with it, since there was no publicity. In any case, they began to recall similar stories with his participation.

I am against personally blaming a person who has committed this or that ethically ambiguous act. Usually, events and the environment push for offenses. That is why law enforcement agencies should primarily deal with the prevention of offenses, and not punishment for what has already happened. Punishment is akin to revenge, it can no longer help, and its social significance is zero. I consider it right to abolish the death penalty in most developed countries: there is no preventive sense from it.

Pathologists, forensic experts are constantly pushed by leaders of all ranks to “change statistics”. If a patient, after an operation on the stomach, also received a myocardial infarction in the hospital, from which he died, he will not be written a heart attack at an autopsy. He will write a stomach ulcer. Because today is Cardiovascular Death Reduction Month. And if they manage to transfer him to intensive care, death will follow the department from which he was transferred - not after intensive care. All doctors know about these bends of statistics, and everyone is silent. And before, the pathologist was an impartial arbitrator for the doctor, a source of knowledge, the most accurate diagnostician. Each case of death was also examined by the commission, all discrepancies and ambiguities were clarified.

The second story happened recently in St. Petersburg, where a surgeon was put on trial for allegedly forgetting a clamp in the patient's stomach. The patient turned out to be a well-known criminal authority who was imprisoned, and a few months later, in another medical institution, another doctor “discovered” this clamp on an x-ray. The clamp is not a needle, it is large and can be felt by hand. Not to mention the ultrasound. He was not there - and suddenly appeared. The doctor who "found" the clamp understood the absurdity of this. Couldn't refuse? Knife put to the throat? Did you follow the order? In any case, he sacrificed his conscience, his honor. Because of him, the career of a colleague was ruined, and this is only a small part of the consequences.

Every doctor had to find himself in a scrupulous position. The team of the Hematological Research Center headed by my father, Academician Andrei Vorobyov, for many years defended the interests of a patient involved in the “YUKOS case” and suffering from both a tumor of the blood system and HIV infection. It was possible to rescue him from the cell and place him in hospital conditions.

I had to take part in the fate of the rector of the medical university, whom the investigation placed handcuffed in a hospital, where all the doctors were actually his students. To further humiliate. We appealed to all instances, including the president of the country, and it worked. The rector was released on bail, later he was tried for bribes, but there were no more bullying.

A fresh, blatant case of violation of medical ethics: a patient with a concussion was discharged from a large research institute to the "monkey" the next day after receiving a traumatic brain injury. Well, they wrote it out, so they wrote it out. Although it is supposed to lie down for some time after such a blow, usually for several days, to be observed, to keep calm. Sometimes it happens that a day later a hematoma occurs in the brain at the site of a seemingly “minor” craniocerebral injury. After a day, you can let go home with a recommendation to lie down for a couple of days. In general, the sick leave is given for two weeks. And the consequences of this injury can appear after a fairly long time.

But do not send the patient to the police, which, in fact, inflicted this injury on him. Maybe the policeman who beat the guy was a hundred times right according to the instructions. But a doctor is not a police officer. His job is to help the sick. It has always been so. Even Nazi doctors could help.

In Volokolamsk, the wounded from Panfilov's division were in the hospital, from which they were tried to be taken by carts to Moscow. But the speed of the German advance was high, and the convoy soon returned back along the forest roads. Then the head physician Nikolai Plotnikov hung a sign at the entrance to the department with an inscription in Russian and German: “Typhoid. Quarantine". A German doctor who came to the hospital confirmed the quarantine without entering the wards. And I could check. All other prisoners of war of this division were burned alive in a barn, and the wounded in the hospital remained alive. This is a first-hand story told when medical honor was discussed.

The head of the research institute, who gave the patient to the police, himself a specialist in traumatic brain injury, proudly declares that nothing terrible has happened, the concussion passes in a minute. He is not embarrassed that this is contrary to all the canons of neurosurgery. Further, he declares publicly, the victim can be escorted out of the hospital. It was the cynical form of this statement that provoked a strong reaction from the medical community.

I repeat once again: the doctor's task is to observe exclusively the rights of the patient, to take care of the patient. Moreover, in this case, it was not about a murderous bandit, but about a young man who was beaten awake at 4 o'clock in the morning in the room in which he was on duty. Not to mention the gross violation of medical confidentiality, which, according to the law, should be prosecuted up to the initiation of a criminal case. The situation is out of all bounds of decency. After such an act, done, perhaps, out of cowardice or thoughtlessness, a person with honor should, it seems to me, resign from the position of director with a request to be transferred somewhere “in the wilderness, to Saratov”, to atone for sins, working in intensive care.

The times when people valued their honor, alas, have passed, I'm sure nothing will happen, this story will soon be forgotten. Yes, and discussions on social networks show that many do not understand the level of decline for the entire medical class. However, the population will still have one more notch against the current Aesculapius - not only among them there are few qualified, literate, not only many bribe-takers, but they also grovel before any authority.

PROFESSOR PAVEL VOROBYOV ABOUT OUR MEDICINE Suddenly fired! On Friday evening, a bitter message appeared on the social network Facebook from Professor Pavel Vorobyov, head of the Department of Hematology and Geriatrics of the IPO of the First Moscow State Medical University named after I.M. Sechenov: “Yesterday they called me from the personnel department and said that I was fired. From First Medical. From the institute where I lived for more than 40 years and worked for 36. Of these, 18 years were in the position of head of the department of hematology and geriatrics. Which I created "Not a single comment, not a single reprimand, always only positive and achievements in work. About 700 scientific publications, including abstracts and foreign articles. About 100 books, manuals, reference books. More than 20 defended dissertations under my supervision." Chairman of the Moscow City Scientific Society of Therapists, Professor Vorobyov told Pravmir what he thinks about the health care reform in the country. - Pavel Andreevich, how did you find out that you no longer work at the Sechenov Moscow State Medical University? - On August 4, I received a call from the personnel department of our 1st medical school (now - the First Moscow State Medical University named after I.M. Sechenov. - Ed.) And they said that I no longer work there. Recently, my contract has been extended for a year, this year - for three months - without explanation. Nobody made any claims to me. We had no conflicts with management. There is, I know, dissatisfaction with my civic position, my professional attitude to what is happening in healthcare, but this is not a conflict. I feel that my rights have been grossly violated. Both humanly and legally. - You have repeatedly criticized the progress of healthcare reform in Russia, so now you have felt it yourself? - And for the second time. For the first time, my department was expelled from the 7th emergency hospital, the largest in the city. It was reduced, part of it was closed. This was in 2014. For the last 18 years at the Sechenov University, I have been the head of the Department of Hematology and Geriatrics, and the hospital was our clinical base, there are not enough beds at the institute. Somehow they settled down, of course, but 34 years in the hospital is a whole medical life. - You have said more than once that healthcare reform is essentially the destruction of our medicine. Now your position has only strengthened? - Everything is just like that. Over the past few months, 10 percent of junior and middle medical personnel have quit in Russia. Think about the number - it's 40-50 thousand people! They just ran away. This has been going on for several years now. The latest figures indicate that this "reform" does not stop. People leave on their own. Low wages, huge workloads. The salary of a nurse in the country is now 5-7 thousand rubles. People take 2.5 bets to earn at least 15-16 thousand. Now in hospitals, it seems, they will serve patients for money. They may have to hire their own nurses. Someone has to change underwear, diapers, make dressings ... - During the reform, nurses were also removed from polyclinics, deciding that the doctor would cope with the registration of records himself. How has this affected the work of clinics? - They did it just because there are simply not enough nurses. They decided to portray reformist activity by removing the function of a nurse altogether. It is not right. Worldwide, on the contrary, three to four nurses work for one doctor. The nurse makes all the records, documents. By international standards, a doctor spends five minutes with a patient, and the nurse does the rest. Now we have a doctor sitting and making notes both in the card and in the computer ... But the doctor can be completely relieved of this work, for example, with the help of dictaphone records that are transcribed by call centers. All over the world, this practice has existed for decades, but we can’t figure out how to arrange everything. - Our polyclinics have switched to a new standard of work - has it improved the quality of patient care? - Yes, now our polyclinics are already working according to the new “reformist” model, but this has not led to an improvement in the provision of care. The amount of paper work has not decreased, it is not always easy to make an appointment, and an electronic appointment is also not convenient and accessible to all patients. Recently, there have even been cases when people died in line at the registration desk. These are formalized games of officials who have nothing to do with health care reform. They do not improve the efficiency of serving the population, but the efficiency of spending. Medicine should be paid, whoever cannot pay, let him get sick and die himself. And who does not want to work like that, can go into business - we hear such advice. - The authorities said that in the course of the reform the salaries of doctors would increase and that they already amounted to 80 thousand rubles ... - The salaries of doctors are growing - due to the fact that they are fired. 2 doctors left, the third received a salary increase. But he will not work for three. Doctors have long been working at the limit of their strength. - What is the purpose of this healthcare optimization in this case? - This is a reform to save money. "There is no money, but you hold on." For example, statistics on pneumonia at home have recently been published. Mortality in the city increased by 30 percent. It's fantastic! Lungs should not die from pneumonia at all, banal home pneumonia, there are various antibiotics ... I only explain this by the poor organization of medical care. Now such patients are not hospitalized on time. For example, there are new restrictions. Without a high temperature with pneumonia, they will not be admitted to the hospital. But older people with this disease usually do not have a high temperature. As a result, people come to the hospital already in intensive care. How have the ambulance rules changed? - The rules of work and ambulance, and planned care, and the rules of hospitalization have changed. Now you can not put a person on examination. All examinations are performed on an outpatient basis. But in practice, this is unrealistic, inaccessible to the population. The clinic is in one place, you need to go to the other end of the city to do the examination. And all the time they demand money for something to do quickly. For example, MRI and CT, what needs to be done urgently when determining tumors, is often prescribed after a few months - the turn. If you want to do it fast - pay money. Because one of the tasks of healthcare now is making money. And this can only be done by robbing the sick. The ambulance no longer takes patients to the hospital without a clear threat to life. And the fact that the threat to life can come a few minutes after their departure does not bother anyone. Calls are transferred to the "ambulance", which can arrive in a day. - What is happening in the regions? In the regions, everything is the same, multiplied by the remoteness of the territories. There is sometimes no ambulance at all now. The number of FAPs (feldsher-obstetric station) in the regions is 2 times more than the number of feldshers. There is no one to work there. But at the same time, medical facilities are generally being removed in small settlements. If you want to be treated - go to the nearest city, it takes two days to visit the clinic! - You once said that our reform follows the American healthcare model. This is true? - Practically yes, only we are late. Obama is already turning American healthcare to our Soviet principles. And many European countries have also already appreciated the convenience and quality of our healthcare system. And we, on the contrary, for some reason refuse it. That same “English model” is the Soviet model, it was simply adapted to the life of England. The basic principles are the primary link of health care, accessible to all, the division into the provision of assistance at two levels - the primary stage and the secondary one. But the main emphasis is on the primary link, where doctors and general practice nurses. - And how do you assess the change in the health insurance system in our country? - This is just pure theft of money. According to the most conservative estimates, 10 percent of our insurance goes not to treatment, not to the sick, but to the maintenance of the system. And the most important thing is that it has nothing to do with improving quality, efficiency, and so on. And, by the way, there have been no changes in CHI in recent years. Many principles were incorporated into the system in the early 1990s. Nobody reads the laws here: for example, the right of a patient to move from one polyclinic to another is not an innovation at all, it has been around since 1993, but it didn’t work, people were simply not told about this possibility, and we ourselves do not strive to know our rights . How are health workers unions reacting to the situation? And can they change it? - The official medical trade union does nothing. There is an independent trade union "Action", which is trying to do something, but is constantly being persecuted. I myself do not believe in parties or trade unions. - At one time, doctors were quite active, they went to rallies. Why is there no such activity now? - Yes, people protested. But nothing happened. Everyone was deceived. All the promises of the authorities turned out to be zilch. Someone was given a handout with money, someone was not. The doctors gave up. - At one time, our authorities said that the healthcare reform was going wrong... - These were empty statements. I am sure that they did not have any specific plans to reverse the reform, to make any adjustments. Everything is going the same way as it was going on, they simply do not hear criticism on the ground, and those who criticize are persecuted. The editors of the portal PRAVMIR turned for comments to the First Moscow State Medical University. I. M. Sechenov and the Ministry of Health of the Russian Federation. We are still waiting for comments from the university, but for now we present the answers of the Ministry of Health to our questions. Is it true that in recent months 10% of junior and middle-level personnel have quit the healthcare sector, which is 40-50 thousand people? Why did this happen? According to the Federal State Statistics Service, in 2016 (Q1) the number of nurses in regional and municipal medical organizations decreased by 11,755 people (-0.9%) compared to the same period in 2015 (Q1), and in comparison with all 2015 - by 8,687 people (- 0.7%). However, the rate of decline in the number of paramedical workers in 2015 decreased by almost 2 times compared to 2014. (1.6% versus 2.8%). The staffing of paramedical positions in general in medical organizations in 2015 increased to 91.7% (91.5% in 2014). A similar trend was noted with the staffing of full-time positions of nurses, which in general amounted to 92.1% in 2015 (91.8% in 2014). The decrease in the number of junior medical personnel occurs against the background of an increase in the number of employees of medical organizations of other categories. This trend is due to the redistribution of part of the labor functions to other personnel if the work does not involve direct participation in medical activities and does not require certain knowledge and skills. Are doctors' salaries really growing because they are fired and the remaining doctors have to close 2-3 positions? What is the average salary of a doctor and its prospects? The part-time coefficient in the Russian Federation for paramedical workers remains stable at 1.3, which does not confirm the opinion about the increase in the burden on paramedical staff. In general, in the Russian Federation, according to Rosstat, in the 1st quarter of 2016, the average monthly salary of medical workers increased compared to the 1st quarter of 2015: for doctors - by 5.0% and amounted to 46.1 thousand rubles, for nurses by 4.7% and amounted to 26.8 thousand rubles; junior medical personnel, respectively, by 6.2% and amounted to 16.9 thousand rubles. Is it true that there are FAPs in the regions, but there are not enough paramedics, and people have to spend two days visiting a polyclinic in a remote area? The Ministry of Health of Russia pays special attention to the provision of medical care in certain regions of the country. It should be noted that in 2015, changes were made to the Regulation on the organization of primary health care for the adult population in terms of organizing assistance to rural residents. Thus, in rural settlements with a population of more than 2 thousand people, medical outpatient clinics should be organized to provide primary medical health care. If the number of inhabitants exceeds 1,000 people, but does not reach 2,000 people, a feldsher-obstetric station / feldsher health center (if the distance to the nearest medical organization does not exceed 6 km) or a general medical practice center / medical outpatient clinic (if the distance from the feldsher-obstetric station to the nearest medical organization exceeds 6 km). In settlements with a population of 300 to 1,000 people , feldsher-obstetric stations or feldsher health centers are created, regardless of the distance to the nearest medical organization in the absence of other medical organizations. Staffing is also important. The Zemsky Doctor program has been implemented since 2012. One-time compensation payments in the amount of 1 million rubles are made to program participants who have a higher education, who come to work in rural settlements or workers' settlements, and who have concluded an agreement with an authorized executive body of a constituent entity of the Russian Federation (Zemsky Doctor program). According to the Federal Compulsory Medical Insurance Fund, as of January 1, 2016, for the period 2012-2015, the total number of medical workers recruited under the Zemsky Doctor program to work in rural settlements and workers' settlements amounted to 19.02 thousand specialists , including in 2015 - 3 thousand people. For 2016, the program has been extended, while the age limit for program participants has been increased to 50 years, and the list of types of settlements covered by the program has been supplemented with urban-type settlements. At the same time, the ratio in co-financing of the program was changed: from the budget of the Federal Compulsory Medical Insurance Fund - 60%, from the budgets of the constituent entities of the Russian Federation - 40%. The professor says that there have been no significant changes in the compulsory medical insurance system. This is true? Recall that only in the last ten years there have been cardinal changes in the field of compulsory medical insurance of citizens. The main documents in this area have been adopted, we are talking about the Federal Law of November 29, 2010 N 326-FZ, the order of the Ministry of Health of the Russian Federation of February 28, 2011 No. 158n, the order of the Federal Compulsory Medical Insurance Fund of December 1, 2010 No. 230 " On approval of the procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance "and the order of the Federal Compulsory Medical Insurance Fund dated December 26, 2011 No. No. 243 "On the assessment of the activities of insurance medical organizations." The sphere of CHI is becoming more and more attractive to the private sector. How have the principles of the ambulance service changed? Now she does not take away without a clear threat to life? What are the new rules for hospitalization? We emphasize that the principles of the work of ambulance, as well as the procedure for its provision, have not changed. Emergency medical care is provided in case of a threat to life, and emergency care in all others. The procedure for providing emergency medical care was approved by order of the Ministry of Health of Russia dated June 20, 2013 No. 388n “On approval of the procedure for providing emergency, including emergency specialized, medical care”: clause 11. Reasons for calling an ambulance in an emergency form are sudden acute illnesses, conditions, exacerbations of chronic diseases that pose a threat to the patient's life, including: a) impaired consciousness; b) respiratory disorders; c) disorders of the circulatory system; d) mental disorders accompanied by the patient's actions that pose an immediate danger to him or other persons; e) pain syndrome; f) injuries of any etiology, poisoning, wounds (accompanied by bleeding that poses a threat to life, or damage to internal organs); g) thermal and chemical burns; h) to

Professor Pavel Vorobyov: doctors gave up, and nurses ran away from hospitals

"Yesterday they called me from the personnel department and said that I was fired. From First Medical. From the institute where I lived for more than 40 years, and worked for 36. Of these, 18 years were in the position of head of the department of hematology and geriatrics. Which I created. Neither one remark, not a single penalty, always only positive and achievements in the work. About 700 scientific publications, including abstracts and foreign articles. About 100 books, manuals, reference books. More than 20 defended dissertations under my supervision."

Chairman of the Moscow City Scientific Society of Therapists, Professor Vorobyov told Pravmir everything he thinks about health care reform in the country.

- Pavel Andreevich, how did you find out that you no longer work at the Sechenov Moscow State Medical University?

- On August 4, I received a call from the personnel department of our 1st medical school (now - the First Moscow State Medical University named after I.M. Sechenov. - Ed.) And they said that I no longer work there. More than a month! We have a system of fixed-term contracts at our university, teachers are elected for 5 years, and then the contract is constantly renewed. I have had it since 2008. For the last three years, it has been extended to me for 1 year, and not for 5 years, as usual. In the spring of this year, the contract was extended for only 3 months without explanation. It was supposed to end at the end of June. I wrote an application for an extension addressed to the rector Petra Glybochko, there was no answer, but there was no talk that I was being fired. In recent months, I have talked with both the rector and three vice-rectors. Nobody made any claims to me. We had no conflicts with management. There is, I know, dissatisfaction with my civic position, my professional attitude to what is happening in healthcare, but this is not a conflict.

I feel that my rights have been grossly violated. Both humanly and legally.

– You have repeatedly criticized the course of health care reform in Russia, so now you have felt it yourself?

- And for the second time. For the first time, my department was expelled from the 7th emergency hospital, the largest in the city. It was reduced, part of it was closed. This was in 2014. For the last 18 years at the Sechenov University, I have been the head of the Department of Hematology and Geriatrics, and the hospital was our clinical base, there are not enough beds at the institute. Somehow they settled down, of course, but 34 years in the hospital is a whole medical life.

– You have said more than once that healthcare reform is essentially the destruction of our medicine. Now your position has only strengthened?

- Everything is just like that. Over the past few months, 10 percent of junior and middle medical personnel have quit in Russia. Think about the number 40-50 thousand people! They just ran away. A doctor without a nurse is an empty place. The nurse treats, the doctor only makes appointments.

But this has been going on for several years. The latest figures indicate that this "reform" does not stop. People leave on their own. Low wages, huge workloads. The salary of a nurse in the country is now 5-7 thousand rubles. People take 2.5 bets to earn at least 15-16 thousand.

Now in hospitals, it seems, they will serve patients for money. They may have to hire their own nurses. Someone has to change underwear, diapers, do dressings ...

- During the reform, nurses were also removed from polyclinics, deciding that the doctor would cope with the registration of records himself. How has this affected the work of clinics?

- They did it just because there are simply not enough nurses. They decided to portray reformist activity by removing the function of a nurse altogether. It is not right. All over the world, on the contrary, 3-4 nurses work for one doctor. The nurse makes all the records, documents. By international standards, a doctor spends five minutes with a patient, and the nurse does the rest. Now we have a doctor sitting and making notes both in the card and in the computer ... But the doctor can be completely relieved of this work, for example, with the help of dictaphone records that are transcribed by call centers. All over the world, this practice has existed for decades, but we can’t figure out how to arrange everything.

- Our polyclinics have switched to a new standard of work - has it improved the quality of patient care?

– Yes, now our polyclinics are already operating according to the new “reformist” model, but this did not improve assistance. The amount of paper work has not decreased, it is not always easy to make an appointment, and an electronic appointment is also not convenient and accessible to all patients. Recently there have even been cases where people dying in line at the register.

It's formalized officials games that have nothing to do with health care reform. They do not improve the efficiency of serving the population, but the efficiency of spending. Medicine should be paid, whoever cannot pay, let him get sick and die himself. And those who do not want to work like this can go into business - we hear such advice.

- The authorities said that in the course of the reform, the salaries of doctors would increase and that they already amounted to 80 thousand rubles ...

– Doctors' salaries are rising - due to the fact that they are fired. 2 doctors left, the third received a salary increase. But he will not work for three. Doctors have long been working at the limit of their strength.

- What is the purpose of this healthcare optimization in this case?

- This reform is to save money. "There is no money, but you hold on." For example, statistics on pneumonia at home have recently been published. Mortality in the city increased by 30 percent. It's fantastic! From pneumonia shouldn't die at all. lungs, banal home pneumonia, there are various antibiotics ...

I explain this only by the poor organization of medical care. Now such patients are not hospitalized on time. For example, there are new restrictions. Without a high temperature with pneumonia, they will not be admitted to the hospital. But older people with this disease usually do not have a high temperature. As a result, people come to the hospital already in intensive care.

How have the ambulance rules changed?

- The rules of work and ambulance, and planned care, and the rules of hospitalization have changed. Now you can not put a person on examination. All examinations are performed on an outpatient basis. But in practice, this is unrealistic, inaccessible to the population. The clinic is in one place, you need to go to the other end of the city to do the examination. And all the time they demand money for something to do quickly. For example, MRI and CT, what needs to be done urgently when detecting tumors, is often prescribed after a few months - the turn. If you want to do it quickly - pay money. Because one of the tasks of health care now is to make money. And this can only be done by robbing the sick.

The ambulance no longer takes patients to the hospital without a clear threat to life. And the fact that the threat to life can come a few minutes after their departure does not bother anyone. Calls are transferred to the "ambulance", which can arrive in a day.

– What is happening in the regions?

In the regions, everything is the same, multiplied by the remoteness of the territories. There sometimes at all there is no ambulance now. The number of FAPs (feldsher-obstetric station) in the regions is 2 times more than the number of feldshers. There is no one to work there. But at the same time, medical facilities are generally being removed in small settlements. If you want to be treated, go to the nearest city, It takes two days to visit the clinic!

– You once said that our reform follows the American healthcare model. This is true?

– Practically yes, only we are late. Obama is already turning American healthcare to our Soviet principles. And many European countries have also already appreciated the convenience and quality of our healthcare system. And we, on the contrary, for some reason refuse it. The one "English model" is the Soviet model, it was simply adapted to the life of England. The basic principles are the primary health care, accessible to all, division into two levels of assistance - primary and secondary. But the main emphasis is on the primary link, where doctors and general practice nurses.

- And how do you assess the change in the health insurance system in our country?

– This is just pure theft of money. According to the most conservative estimates, 10 percent of our insurance goes not to treatment, not to the sick, but to the maintenance of the system. And most importantly, it has nothing to do with improving quality, efficiency, and so on.

And, by the way, there have been no changes in CHI in recent years. Many principles were incorporated into the system in the early 1990s. Nobody reads the laws here: for example, the right of a patient to move from one polyclinic to another is not a novelty at all, it has been around since 1993, but it didn’t work, people were simply not told about this possibility, and we ourselves do not strive to know our rights .

How are health workers unions reacting to the situation? And can they change it?

“The official medical union does nothing. There is an independent trade union "Action", which is trying to do something, but is constantly being persecuted. I myself do not believe in parties or trade unions.

- At one time, doctors were quite active, they went to rallies. Why is there no such activity now?

Yes, people protested. But nothing happened. Everyone was deceived. All the promises of the authorities turned out to be zilch. Someone was given a handout with money, someone was not. The doctors gave up.

- At one time, our authorities said that the healthcare reform was going wrong ...

These were empty statements. I am sure that they did not have any specific plans to reverse the reform, to make any adjustments. Everything is going the same as it was going on, the criticism on the ground is simply not heard, and the critics are persecuted.

When hospitals simply close, this is not reform

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- Pavel Andreevich, how did you find out that you no longer work at the Sechenov Moscow State Medical University?

On August 4, I received a call from the personnel department of our 1st medical school (now - the First Moscow State Medical University named after I.M. Sechenov. - Ed.) And they said that I no longer work there. Recently, my contract has been extended for a year, this year - for three months - without explanation. Nobody made any claims to me. We had no conflicts with management. There is, I know, dissatisfaction with my civic position, my professional attitude to what is happening in healthcare, but this is not a conflict. I feel that my rights have been grossly violated. Both humanly and legally.

- You have repeatedly criticized the progress of healthcare reform in Russia, so now you have felt it yourself?

And for the second time. For the first time, my department was expelled from the 7th emergency hospital, the largest in the city. It was reduced, part of it was closed. This was in 2014. For the last 18 years at the Sechenov University, I have been the head of the Department of Hematology and Geriatrics, and the hospital was our clinical base, there are not enough beds at the institute. Somehow they settled down, of course, but 34 years in the hospital is a whole medical life.

You have said more than once that healthcare reform is essentially the destruction of our medicine. Now your position has only strengthened?

Everything is just like that. Over the past few months, 10 percent of junior and middle medical personnel have quit in Russia. Think about the number - it's 40-50 thousand people! They just ran away. This has been going on for several years now. The latest figures indicate that this "reform" does not stop. People leave on their own. Low wages, huge workloads. The salary of a nurse in the country is now 5-7 thousand rubles. People take 2.5 bets to earn at least 15-16 thousand. Now in hospitals, it seems, they will serve patients for money. They may have to hire their own nurses. Someone has to change underwear, diapers, do dressings ...

During the reform, nurses were also removed from polyclinics, deciding that the doctor would cope with the registration of records himself. How has this affected the work of clinics?

They did it just because there are simply not enough nurses. They decided to portray reformist activity by removing the function of a nurse altogether. It is not right. Worldwide, on the contrary, three to four nurses work for one doctor. The nurse makes all the records, documents. By international standards, a doctor spends five minutes with a patient, and the nurse does the rest. Now we have a doctor sitting and making notes both in the card and in the computer ... But the doctor can be completely relieved of this work, for example, with the help of dictaphone records that are transcribed by call centers. All over the world, this practice has existed for decades, but we can’t figure out how to arrange everything.

- Our polyclinics have switched to a new standard of work - has it improved the quality of patient care?

Yes, now our polyclinics are already working according to the new “reformist” model, but this has not led to an improvement in the provision of care. The amount of paper work has not decreased, it is not always easy to make an appointment, and an electronic appointment is also not convenient and accessible to all patients. Recently, there have even been cases when people died in line at the registration desk.

These are formalized games of officials who have nothing to do with health care reform. They do not improve the efficiency of serving the population, but the efficiency of spending. Medicine should be paid, whoever cannot pay, let him get sick and die himself. And who does not want to work like that, can go into business - we hear such advice.

The authorities said that in the course of the reform, the salaries of doctors would increase and that they already amounted to 80 thousand rubles ...

Doctors' salaries are rising - due to the fact that they are being fired. 2 doctors left, the third received a salary increase. But he will not work for three. Doctors have long been working at the limit of their strength.

- What is the purpose of this healthcare optimization in this case?

This is a cost-saving reform. "There is no money, but you hold on." For example, statistics on pneumonia at home have recently been published. Mortality in the city increased by 30 percent. It's fantastic! You should not die from pneumonia at all, banal home pneumonia, there are various antibiotics ...

I explain this only by the poor organization of medical care. Now such patients are not hospitalized on time. For example, there are new restrictions. Without a high temperature with pneumonia, they will not be admitted to the hospital. But older people with this disease usually do not have a high temperature. As a result, people come to the hospital already in intensive care.

How have the ambulance rules changed?

The rules of work and ambulance, and planned care, and the rules of hospitalization have changed. Now you can not put a person on examination. All examinations are performed on an outpatient basis. But in practice, this is unrealistic, inaccessible to the population. The clinic is in one place, you need to go to the other end of the city to do the examination. And all the time they demand money for something to do quickly. For example, MRI and CT, what needs to be done urgently when determining tumors, is often prescribed after a few months - the turn. If you want to do it fast - pay money. Because one of the tasks of healthcare now is making money. And this can only be done by robbing the sick.

The ambulance no longer takes patients to the hospital without a clear threat to life. And the fact that the threat to life can come a few minutes after their departure does not bother anyone. Calls are transferred to the "ambulance", which can arrive in a day.

- What is happening in the regions?

In the regions, everything is the same, multiplied by the remoteness of the territories. There is sometimes no ambulance at all now. The number of FAPs (feldsher-obstetric station) in the regions is 2 times more than the number of feldshers. There is no one to work there. But at the same time, medical facilities are generally being removed in small settlements. If you want to be treated - go to the nearest city, it takes two days to visit the clinic!

- You once said that our reform follows the American healthcare model. This is true?

Practically yes, only we are late. Obama is already turning American healthcare to our Soviet principles. And many European countries have also already appreciated the convenience and quality of our healthcare system. And we, on the contrary, for some reason refuse it. That same “English model” is the Soviet model, it was simply adapted to the life of England. The basic principles are the primary link of health care, accessible to all, the division into the provision of assistance at two levels - the primary stage and the secondary one. But the main emphasis is on the primary link, where doctors and general practice nurses.

- And how do you assess the change in the health insurance system in our country?

This is just pure theft of money. According to the most conservative estimates, 10 percent of our insurance goes not to treatment, not to the sick, but to the maintenance of the system. And the most important thing is that it has nothing to do with improving quality, efficiency, and so on.

And, by the way, there have been no changes in CHI in recent years. Many principles were incorporated into the system in the early 1990s. Nobody reads the laws here: for example, the right of a patient to move from one polyclinic to another is not an innovation at all, it has been around since 1993, but it didn’t work, people were simply not told about this possibility, and we ourselves do not strive to know our rights .

How are health workers unions reacting to the situation? And can they change it?

The official medical union does nothing. There is an independent trade union "Action", which is trying to do something, but is constantly being persecuted. I myself do not believe in parties or trade unions.

- At one time, doctors were quite active, they went to rallies. Why is there no such activity now?

Yes, people protested. But nothing happened. Everyone was deceived. All the promises of the authorities turned out to be zilch. Someone was given a handout with money, someone was not. The doctors gave up.

- At one time, our authorities said that the health care reform was going wrong...

These were empty statements. I am sure that they did not have any specific plans to reverse the reform, to make any adjustments. Everything is going the same way as it was going on, they simply do not hear criticism on the ground, and those who criticize are persecuted.

The editors of the portal PRAVMIR turned for comments to the First Moscow State Medical University. I. M. Sechenov and the Ministry of Health of the Russian Federation. We are still waiting for comments from the university, but for now we present the answers of the Ministry of Health to our questions.

Is it true that in recent months 10% of junior and middle-level personnel have quit the healthcare sector, which is 40-50 thousand people? Why did this happen?

According to the Federal State Statistics Service, in 2016 (Q1) the number of nurses in regional and municipal medical organizations decreased by 11,755 people (-0.9%) compared to the same period in 2015 (Q1), and in comparison with all 2015 - by 8,687 people (- 0.7%).

However, the rate of decline in the number of paramedical workers in 2015 decreased by almost 2 times compared to 2014 (1.6% vs. 2.8%).

The staffing of paramedical positions in general in medical organizations in 2015 increased to 91.7% (91.5% in 2014). A similar trend was noted with the staffing of full-time positions of nurses, which in general amounted to 92.1% in 2015 (91.8% in 2014).

The decrease in the number of junior medical personnel occurs against the background of an increase in the number of employees of medical organizations of other categories. This trend is due to the redistribution of part of the labor functions to other personnel if the work does not involve direct participation in medical activities and does not require certain knowledge and skills.

Are doctors' salaries really growing because they are fired and the remaining doctors have to close 2-3 positions? What is the average salary of a doctor and its prospects?

The part-time coefficient in the Russian Federation for paramedical workers remains stable at 1.3, which does not confirm the opinion about the increase in the burden on paramedical staff.

In general, in the Russian Federation, according to Rosstat, in the 1st quarter of 2016, the average monthly salary of medical workers increased compared to the 1st quarter of 2015: for doctors - by 5.0% and amounted to 46.1 thousand rubles, for nurses by 4.7% and amounted to 26.8 thousand rubles; junior medical personnel, respectively, by 6.2% and amounted to 16.9 thousand rubles.

Is it true that there are FAPs in the regions, but there are not enough paramedics, and people have to spend two days visiting a polyclinic in a remote area? The Ministry of Health of Russia pays special attention to the provision of medical care in certain regions of the country. It should be noted that in 2015, changes were made to the Regulation on the organization of primary health care for the adult population in terms of organizing assistance to rural residents.

Thus, in rural settlements with a population of more than 2 thousand people, medical outpatient clinics should be organized to provide primary medical health care. If the number of inhabitants exceeds 1,000 people, but does not reach 2,000 people, a feldsher-obstetric station / feldsher health center (if the distance to the nearest medical organization does not exceed 6 km) or a general medical practice center / medical outpatient clinic (if the distance from the feldsher-obstetric station to the nearest medical organization exceeds 6 km).

In settlements with a population of 300 to 1,000, feldsher-obstetric stations or feldsher health centers are created, regardless of the distance to the nearest medical organization in the absence of other medical organizations.

Staffing is also important.

The Zemsky Doctor program has been implemented since 2012. One-time compensation payments in the amount of 1 million rubles are made to program participants who have a higher education, who come to work in rural settlements or workers' settlements, and who have concluded an agreement with an authorized executive body of a constituent entity of the Russian Federation (Zemsky Doctor program). According to the Federal Compulsory Medical Insurance Fund, as of January 1, 2016, for the period 2012-2015, the total number of medical workers recruited under the Zemsky Doctor program to work in rural settlements and workers' settlements amounted to 19.02 thousand specialists , including in 2015 - 3 thousand people.

For 2016, the program has been extended, while the age limit for program participants has been increased to 50 years, and the list of types of settlements covered by the program has been supplemented with urban-type settlements. At the same time, the ratio in co-financing of the program was changed: from the budget of the Federal Compulsory Medical Insurance Fund - 60%, from the budgets of the constituent entities of the Russian Federation - 40%.

The professor says that there have been no significant changes in the compulsory medical insurance system. This is true?

Recall that only in the last ten years there have been cardinal changes in the field of compulsory medical insurance of citizens. The main documents in this area have been adopted, we are talking about the Federal Law of November 29, 2010 N 326-FZ, the order of the Ministry of Health of the Russian Federation of February 28, 2011 No. 158n, the order of the Federal Compulsory Medical Insurance Fund of December 1, 2010 No. 230 " On approval of the procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance "and the order of the Federal Compulsory Medical Insurance Fund dated December 26, 2011 No. No. 243 "On the assessment of the activities of insurance medical organizations."

The sphere of CHI is becoming more and more attractive to the private sector.

How have the principles of the ambulance service changed? Now she does not take away without a clear threat to life? What are the new rules for hospitalization?

We emphasize that the principles of the work of ambulance, as well as the procedure for its provision, have not changed. Emergency medical care is provided in case of a threat to life, and emergency care in all others.

The procedure for providing emergency medical care was approved by order of the Ministry of Health of Russia dated June 20, 2013 No. 388n “On approval of the procedure for providing emergency, including emergency specialized, medical care”:

Clause 11. The reasons for calling an ambulance in an emergency form are sudden acute diseases, conditions, exacerbations of chronic diseases that pose a threat to the patient's life, including:

a) impaired consciousness;

b) respiratory disorders;

c) disorders of the circulatory system;

d) mental disorders accompanied by the patient's actions that pose an immediate danger to him or other persons;

e) pain syndrome;

f) injuries of any etiology, poisoning, wounds (accompanied by bleeding that poses a threat to life, or damage to internal organs);

g) thermal and chemical burns;

h) bleeding of any etiology;

i) childbirth, threatened miscarriage.

Clause 13. The reasons for calling an ambulance in an emergency are:

a) sudden acute diseases, conditions, exacerbations of chronic diseases requiring urgent medical intervention, without obvious signs of a threat to life, specified in paragraph 11 of this Procedure;

14. When providing emergency, including emergency specialized, medical care, if necessary, medical evacuation is carried out.