Where to go for treatment?
How to choose the right medical institution and a reliable doctor
Tatiana Bateneva, "News of Science"Today, city and district polyclinics mainly serve the elderly and the disabled.
Working Russians often have no time to spend time there and do not want to, unless they need a sick leave. But if serious medical care is needed, we prefer to look for a "good hospital" or a "knowledgeable doctor". But where and how to find them?
To be treated by acquaintance
An option familiar to us from Soviet times: the doctor is the uncle of our friend's neighbor, who treated the mother–in-law of the same friend and cured him wonderfully. Practically no different from the option "to be treated in a polyclinic" – both there and there the probability of success is almost the same. The only advantage is the high probability of a doctor's benevolent attitude towards you, who will not want to spoil his reputation in the eyes of a friend's mother–in-law.
Therefore, if such a doctor is persistently recommended to you – someone's relative or friend, try to carefully find out the answers to a number of questions:
– In which medical institution does the doctor work and for how long? If he is in a large multidisciplinary hospital or in a specialized center for this disease, most likely, he really has a lot of experience. If in a small departmental clinic or in a sanatorium, the probability of real experience and clinical skills is less.
– Have you been retrained in your specialty for a long time? If you haven't refreshed your knowledge of the specialty for a long time, it's worse for you – it will be treated the old-fashioned way.
– How old is the doctor? Very young – experience may not be enough. Very old – the knowledge may be extensive, but somewhat outdated. Middle–aged or elderly, but energetic - the portrait is very pretty.
– Is there an academic degree, title, or other status signs? Although sometimes a pure practitioner will give a head start to an academician, it is better if there is. Ambition is a positive sign for a doctor.
– Is there any glory? The sign is ephemeral, but often you learn more about the doctor in the queue in front of the office than in any CV. Talk to patients, listen to the average medical staff – everyone in the hospital knows their "stars".
To be treated in the direction of
If you were unable to diagnose or prescribe treatment in a polyclinic, if the prescribed treatment helps little or does not help at all, ask for a referral to a specialized diagnostic center or hospital. But keep in mind that not every direction will lead to the right place. Don't rely on luck.
Find out (now it can be done on the Internet, and before – only from conversations with "comrades in misfortune") what diseases are dealt with in this center or clinic, what methods are treated, what diagnostic equipment is available. Unfortunately, patients do not have access to hospital medical statistics. And it would be very useful to know the percentage of complications and mortality in the clinic, whether there are complaints about it, lawsuits.
Of course, most state medical institutions are not posh. But too shabby furnishings, dirt, broken furniture, torn bed linen are signs of a poorly managed hospital, thieving and dishonest bosses, and discouraged staff. It is even worse when this poverty and uncleanliness are combined with a richly decorated administrative building or floor – from here there is one road: to the prosecutor's office.
If, upon admission to the clinic, they begin to explain to you on the move that you will have to pay for some of the tests and studies, do not rush to get your wallet. These statements are not bad to check (read to the end, find out where it can be done).
In many specialized medical institutions, in addition to the referral, it is necessary to provide a whole "bouquet" of ready-made analyses and studies, and fresh ones. Find out about it in advance, otherwise they may refuse hospitalization or offer to do it all with them, but for money. In addition, it will extend the period of "lying down" for several days.
To be treated by advertising
Newspapers, magazines, and TV programs are filled with loud advertising of various medical services. Is it possible to believe her? With great care.
The most modest and business advertising – a list of services, address, phone numbers - causes more confidence. All epithets and metaphors ("for the first time in Russia", "the most famous", "unique", "only with us", etc.) immediately cross out and do not listen. Most likely, lies.
Do not trust any "paranormal" or "ancient", "folk" or "psychic" – double lies. Firstly, there is nothing like that, and secondly, they will be ripped off like a stick.
Suspicion should be aroused by too loud and copious titles of doctors, excessively laudatory stories of "grateful" patients, photos "before" and "after" treatment – they are easy to print and draw on a computer.
Too rich interior, too well–trained staff, too pretentious atmosphere of a paid clinic - also, most likely, counting on rich suckers. A normally working private doctor and a private clinic that does not rip off patients should have all this at a decent, but not marble-gold level.
Be treated according to the rules 
The most difficult thing is to evaluate the professional properties of a doctor, because most of us, even the most advanced, have little understanding of medicine. But there are some indirect signs of a good doctor.
He is polite, clean, friendly, does not refuse to talk to the patient, answer his questions. A good doctor shares the principles of cooperation with the patient, accepted in modern medicine. If you are going to have a difficult study or operation, a good doctor will explain their essence in detail and clearly, honestly tell you about the risks, how the treatment process will go further. Many even draw a diagram on paper, explain the terms.
A good doctor does not pretend to be a know-it-all, he is no stranger to doubts if your disease is complicated. If he invites colleagues to a consultation, offers you the advice of a professor or a doctor from another clinic, do not consider it incompetence – this is most likely responsibility. If he says to you, "Let's watch for a couple of days," that's fine.
A good doctor loves disciplined, neat, optimistic patients and tries in every way to support and encourage these qualities. He can be gloomy or, on the contrary, smiling – doctors are also people! – but he is never rude or arrogant. He knows that he heals not only the medicine or the scalpel, but also the word.
A good doctor never starts talking about money with a patient – this is considered indecent. However, there have been changes here recently, as in our whole life. Previously, such doctors did not accept money and gifts at all. Now there is an unspoken rule: if after treatment the patient wants to thank himself, it is not shameful to take it. But many, especially doctors of the old school, it still cringes. If you really want to pay the doctor for his labors, find an appropriate and delicate form. And keep in mind that a good doctor is provided with alcohol, expensive sweets and stupid souvenirs in abundance, there is nowhere to go.
Who is right: a doctor or a patient?
The most frequent questions of our readers about medical care are answered by the heads of departments of the Ministry of Health and Social Development of Russia.
Olga Krivonos, Director of the Department of Organization of Medical Care and Health Development:
question: In the polyclinic, the doctor recommends medicine, but does not write out a prescription, but writes a piece of paper with the name and address of "his" pharmacy. Is it legal or does he have to give a prescription with a personal seal?
answer: The doctor should not recommend "His" pharmacy. Prescriptions must be written on a form of the prescribed form for all medications that he prescribes. The prescription is signed by the doctor and certified with his personal seal. The only exceptions are medications that do not require a prescription, for example: aspirin, citramon, etc.
q: The doctor says that the patient needs a complex diagnostic study, but he cannot direct, look for yourself where it is done. Is it right?
a: If the polyclinic doctor believes that the patient needs an additional examination, which is not done in this polyclinic, then the patient should be given a referral.
q: The patient goes to the doctor with high blood pressure – 200/120, but the prescribed medications do not help. Should the doctor refer the patient to the hospital or will he continue the "selection of therapy"?
a: If there are medical indications and the ineffectiveness of the treatment, the doctor should refer the patient to another medical institution where higher-level care is provided for additional diagnostic methods.
q: The patient was admitted to the hospital for emergency indications, but doctors find it difficult to diagnose. Should they call a consultant from a specialized institute or another clinic in this case?
a: With the severity of the condition and the atypical course of the disease, the attending physician should invite consultants and organize a consultation. The deputy chief physician is responsible for the treatment at the hospital, who must make a decision on cooperation with other institutions to provide advice, and in some cases, a decision on transfer to a specialized institution.
q: The patient does not agree with the opinion or actions of the attending physician and would like to replace him. Who should he turn to in this case?
a: The patient has the right to choose a doctor – both family and attending, taking into account his consent. He also has the right to choose a medical institution in accordance with the contracts of compulsory and voluntary medical insurance. To change the doctor, you need to contact the head of the medical organization.
Natalia Tochilova, Director of the Department of High-tech Medical Care of the Ministry of Health and Social Development of Russia:
Question: The patient should have a planned operation, but they are asked to buy medicines, consumables or devices (such as plates for fixing vertebrae, etc.) at their own expense. Is it legal?
answer: Medicines and consumables provided for by the standards of medical care (including implants, implants, other medical devices implanted into the human body, etc.) are included in the cost of providing high–tech medical care (VMP), which means they are free for the patient.
q: The patient received a "quota" for high-tech treatment. But in the federal center, he is required to pay for "additional" tests and studies.
a: The referral, which is issued for high-tech medical care, covers all treatment, including medicines and consumables provided for by the treatment standards. And all analyses and studies at the pre-hospital stage are provided by the regional health authorities, which issue a referral to the VMP. Therefore, upon admission to the federal center, the patient must have the results of all the studies that were performed in preparation for hospitalization. Without these documents, you should not go for treatment.
Where to complain?
For all questions related to the protection of the rights of the patient, you need to contact the head of the medical institution or the medical insurance organization that issued you the policy. If this did not help, contact the local health authorities or the territorial bodies of the Federal Service for Supervision of Health and Social Development (Roszdravnadzor). All phone numbers and addresses on the site http://www.roszdravnadzor.ru /.
Portal "Eternal youth" www.vechnayamolodost.ru14.01.2009