How GP stands for in medicine. General medical practice (family medicine)

IN Lately V sick leaves in the column “position of the attending physician” you can see the abbreviation GP.

The question arises, what does this abbreviation mean?

According to Nomenclature of positions medical workers , there is a specialty of doctor called doctor general practice or family doctor.

Let's try to figure out what kind of specialty this is.

The difference between a general practitioner and a therapist

General practitioner, traditionally also called family doctor, provides medical care on an outpatient basis. That is, in the clinic, the so-called primary care, where the sick person goes. The main difference between a general practitioner and a therapist is volume of performed practical work , because he has the right to carry out a whole range of manipulations.

The therapist uses only such tools as a tonometer and a phonendoscope, but a family doctor has the right to perform otoscopy, laryngoscopy and rhinoscopy. Simply put, he has skills that allow him to examine the ears, nasopharynx, and even the fundus of the eye.

The doctor has the ability to conduct diagnostic minimum in some narrow medical specialties. Also, a general practitioner has the right to interpret an electrocardiogram, and in small towns he is charged with treating wounds and applying plaster casts, in the absence of appropriate specialists.

What education does a general practitioner receive?

Basic education for a general practitioner is training in medical school, in which the graduate is certified as a general practitioner or pediatrician. Then you need to complete a residency in the field of “therapy”, “pediatrics” or “ internal illnesses”, maybe even do an internship.

If a general practitioner has been educated for a long time, then he has the right to obtain the specialty “General medical practice(Family medicine) to carry out advanced training, having undergone retraining.

At this stage in Russia there are approximately the same number of general practitioners as there are therapists. Thanks to retraining programs, therapists retrain and get positions family doctors or general practitioners, it depends on the place where they plan to work. The number of such doctors is constantly growing.

What is the job of a family doctor?

A general practitioner is assigned a smaller area than a therapist, because he has more responsibilities in relation to each patient. Usually about 1800 patients, but it all depends settlement where the doctor practices.

For example, in Moscow a family doctor deals only with adult patients, while children are supervised by a pediatrician, while the observation system and call system are similar to those used by a local physician. When a family doctor goes on vacation, another doctor comes in to replace him and is given responsibility for the entire area. The duration of vacations for general practitioners and therapists is the same.

However, the family doctor and internist do not visit sick people The doctor on duty responds to calls. In some cases, when there is a need for a visit, the family doctor visits the patient outside of working hours.

What to do if the general practitioner was unable to make a diagnosis?

The higher the professionalism of a general practitioner, the greater the capabilities he has and the less he needs advice from other specialists. But when they arise highly professional questions, the family doctor refers the patient to the appropriate specialist or to a separate medical institution that provides specialized care.

As an example, consider the option when the patient suffers arterial hypertension (hypertension). This disease is within the competence of internists, family doctors and cardiologists. There are no indications to redirect the patient to a cardiologist, since a qualified general practitioner is able to examine such a patient and prescribe him treatment.

But if the patient is diagnosed with ischemic disease heart,” then he may need the intervention of a surgeon; naturally, in this case, the family doctor will refer the patient to a specialized specialist.

Also, when a family doctor believes that he cannot cope with the situation and the treatment he prescribes does not give the desired effect, he has the right to ask for help from another specialist, that is to get a consultation. General practitioners often use this opportunity.

Of course, in regulatory documents the level of competence is prescribed family doctor. At the same time, these documents are constantly being revised, taking into account precedents arising in practice. The standards developed in this way determine what types of examinations and manipulations the doctor will have the right to perform.

Photo: Lina Shafeeva/Shutterstock

In the capital, general practitioners will receive a monthly additional payment of 20 thousand rubles, another 10 thousand rubles will be awarded to doctors for accompanying patients with chronic diseases. This is targeted funding, which will be provided to clinics in the form of grants, said the head of the Moscow Department of Health, Alexey Khripun. What are they going to pay extra for general practitioners, how do they differ from local therapists and in what conditions will they work? David Melik-Guseinov, director of the Research Institute of Healthcare Organization and Medical Management in Moscow, told Mednovosti.

David Melik-Guseinov. Photo: nastroenie.TV

David Valerievich, what is the meaning of twenty thousand “grants”?

— Additional payments are being introduced in order to motivate doctors to obtain the “general practitioner” specialization, which becomes more financially attractive. Moscow has long ago set a course for our primary care to have specialists with deeper knowledge and competencies who could treat many diseases in different profiles, and not just refer the patient to specialized specialists.

Don't primary care physicians provide treatment? And how is a general practitioner fundamentally different from a therapist?

- The fact is that in last years existence Soviet Union and later, various narrow specialties began to multiply among us, and the general practitioner gradually turned into a kind of dispatcher, because he simply did not have full-fledged clinical work left. At the same time, in the West, the institute of so-called general practice (GP) specialists was developing - general practitioners, who relieved the specialized link of patients who could well be helped in primary care. And they seriously worked on the qualifications of such doctors. Moreover, at the same time, a motivation system for general practitioners was built. For example, in France, if such a doctor refers more than 30% of the patients who come to him to specialists, then he is considered insufficiently competent and should undergo additional training.

In Russia, the majority of patients of narrow specialists are people who could have been helped at the first stage by a therapist. Therefore, Moscow is the first of the subjects Russian Federation placed an emphasis on ensuring that people with a real suspicion of a diagnosis come to narrow specialists, and that most of the issues are resolved at their level by a general practitioner.

But that's what good therapists do. I know a lot of local doctors who, for example, in just one family monitor the elderly who have had a heart attack, treat the middle generation for hypertension and radiculitis, and insure the young against pneumonia during the flu season.

— If this is a competent therapist who has enough knowledge (for example, to read a cardiogram) and skills to perform some basic manipulations, then by and large he does not need to study additionally. Just get a general practitioner certificate. The problem is that such wonderful doctors you are talking about are worth their weight in gold.

Today at Sechenov University there is a department (so far it is the only one in Russia) that trains general practitioners and where you can go through the certification procedure, having received a document allowing you to practice specifically general practice, and not just issues related to job descriptions therapist. This can be done now, or later, when the five-year certificate of a general practitioner expires.

It is clear that tomorrow it is impossible to make general practitioners out of all therapists. This is not a quick process, because the currently functioning system cannot be left for some time without doctors at all. But the fact that primary care requires a general practitioner is obvious to everyone. Therapists themselves say that they are losing clinical skills and turning into dispatchers. Therefore, I think a year or two will pass, and in Moscow almost only general practitioners will work at outpatient primary appointments.

What will change in the work of a local doctor after receiving a new certificate?

— He will remain in the same clinic and will work with the same patients. But he will have additional motivation. Today, unfortunately, all doctors, both good and not so good, are hostages of a system in which the therapist is not responsible for anything. But often the patient has some kind of combined pathology, for example, coronary heart disease and diabetes, and he needs to be managed by both a cardiologist and an endocrinologist. Who will bind their assignments? Who will care for this patient? Today, medicine loses patients precisely at the intersection of specialties: between cardiology and endocrinology, between surgery and gastroenterology or urology. The patient must be managed by one doctor. And this doctor should be a general practitioner.

You talked about a set of manipulations that a general practitioner will do, but this also requires additional equipment.

— Of course, additional equipment will appear in the general practitioner’s office. For example, for some simple procedures that ENT doctors now do. The whole point is to remove most of the questions already at the first visit to the doctor. This means that he must be able, at his own level, to carry out the simplest, but important for the patient, therapeutic and diagnostic manipulations.

Will such a doctor have any additional powers? For example, the right to independently write prescriptions for painkillers without a decision from the Higher Quality Committee and an additional signature and seal of the manager. department?

— This is more complicated: if we are talking about drugs dispensed according to the subject-quantitative accounting system, then this does not depend on the general practitioner. These are national rules that Moscow as a region is forced to obey. But in the future, these general rules will be softened, and I hope that any doctor, no matter what specialty, will have the right to prescribe these drugs on their own.

Will the standard appointment time with a general practitioner be longer?

- Yes, of course, more. But again, it is important to understand that the intake time is a conditional standard, a tool for measuring volume medical care, so that officials understand how long an appointment lasts on average. And if the doctor needs to spend more time on a patient, he can under no circumstances interrupt the appointment and send him on his way.

The second monetary increase, which was announced by the head of the department, concerns the dispensary management of chronic patients. But there are such patients at every doctor’s office.

— Of course, there are chronic patients in every area. But not all local police officers actually keep their own chronicles. How long these patients will live depends on how the therapist works with them today, and how the general practitioner will work tomorrow. If you contact them more often, if you consult them competently and do not fuss with various specialists, these patients will live much longer.

We studied the experience of reference countries in terms of mortality from non-communicable diseases. For example, in Finland, men with diabetes live 20 years longer than in Russia. It turned out that neither medicine nor propaganda healthy image Our lives are no different, but it is the medical approach that is different. These patients are in constant contact with the general practitioner, provide him with self-monitoring diaries, and resolve issues related to the correction of therapy at a basic level. If the doctor sees that the patient already needs a competent endocrinologist in order to better compensate him, then he is referred to an endocrinologist.

We are now talking about the fact that a chronic patient with multiple pathologies should be monitored by one doctor. At the same time, today Moscow local doctors sit for 8 hours at an appointment, and they send visiting teams to the seriously ill patients who cannot leave their homes, and each time they are different.

— The division of labor, in which some doctors conduct outpatient visits, and the other part visits patients at home, justifies itself. When a therapist sits at an appointment for half a day, and then runs around the site for the same amount of time, it’s hard work. Now the workload has become more uniform, and the efficiency of work, both on reception and on the road, has increased significantly. This efficiency is expressed in quantity correct diagnoses, reducing complications that patients experience, and so on.

But if we're talking about about a patient who cannot leave his house, and a new team comes to him every time, of course, this is wrong. For this purpose, an institute of doctors is being created who will patronize their chronic patients. The division of time here may be different. Relatively speaking, at three quarters of the rate, a doctor can conduct appointments at the site, and for another quarter he can deal with dispensary patients, including visiting them at home.

Will the innovations somehow affect hospitals? Doctors therapeutic departments Will they also have to obtain general practitioner certificates?

— These doctors remain therapists. If they want to become a general practitioner, no one will restrict them from doing so. But in general, if there are any transformations in hospitals, they will be at the second stage. This is not being discussed yet, because there are fewer questions about the competence of therapists working in hospitals. They are multidisciplinary, they receive more severe patients, and therefore their level of knowledge differs from their colleagues from the outpatient department. Today, the main problem is concentrated in primary care, and changes will take place here first.

The qualifications of a general practitioner give him the right to advise all family members in any field of medicine, involving specialists for consultations and coordination of treatment only in exceptional cases.

During initial appointment The doctor carefully studies the patient’s medical history and conducts a thorough diagnosis. After this, he works to reduce or eliminate the risk of developing pathologies to which the patient is prone.

What diseases does a General Practitioner treat?

Oncological pathology, atherosclerosis, metabolic syndrome, obliterating vascular diseases lower limbs, overweight.

When to contact a General Practitioner:

The first symptoms are discomfort, a feeling of fatigue, inconvenience, a feeling that there is a tugging or pressure in some place. The cause of frequent and seemingly causeless headaches may be blocks in cervical vertebrae, which are closely associated with vascular spasms, causing disturbance outflow of blood from the head. All this leads to headaches, dizziness, and “spots” flashing before the eyes. And we are used to chalking it all up to age, fatigue, and lack of sleep. The reasons for weakening attention, absent-mindedness, forgetfulness - eighty percent are the result of problems in our cervical spine.

Below are 5 symptoms that should not be ignored.

1. You have unexpectedly lost weight. Your diet hasn't changed, but you've lost a lot of weight. Any woman can only dream about this. However, if you notice such changes, then do not rush to rejoice - they may be a harbinger of some forms of stomach cancer (or ovarian cancer in women).

2. Slurred speech, paralysis, weakness, ringing in the ears and stiffness of the limbs are all signs of an impending stroke. If you provide it on time necessary treatment, then a stroke can be avoided and, as a result, serious brain damage can be prevented.

3. Black chair. This symptom is one of the most serious. It can serve as a signal of such dangerous diseases, such as ulcers or cancer of the stomach or intestines. The stool becomes black as a result internal bleeding, which in itself can be very dangerous. The faster you can identify its cause and stop it, the greater your chances of extending your life.

4. Severe headache extending to the neck, as well as heat. These symptoms may be caused by: serious illness like meningitis. If you have a very high fever and strong pain prevents you from reaching your chin to your chest, you should consult a doctor immediately. You may have bacterial meningitis, which is treated with special antibiotics.

5. Sharp, painful headache. If you've never experienced before headache such strength, then, without hesitation, consult a doctor. Such pain can serve as a signal of a cerebral hemorrhage. Although aneurysm is quite rare, its possibility cannot be ruled out.

When and what tests should be done:

General blood analysis;
- General urine analysis;
- Analysis of stool for worm eggs;
- Blood testing for HIV and Wasserman reaction;
- Analysis of ejaculate;
- Hormonal studies;
- Blood tests (Screening TORCH - infections, serological test blood, aAntibodies to hepatitis C virus (anti-HCV), general analysis blood with ESR, hematological blood test, blood group, Rh factor, antibodies to Rh factor, biochemical research blood, tumor markers, coagulological blood test);
- Collection of material for research from the urogenital tract;
- Culture for microflora and sensitivity to antibiotics;
- Candida culture and sensitivity to antifungal drugs;
- Culture for U Urealyticum and M hominis with determination of titer and sensitivity to antibiotics;
- Biopsy from the cervix with histological examination;
- Aspiration of the endometrium with histological examination;
- Bacterioscopy of discharge from the female genital organs;
- Cytological examination contents of an ovarian cyst (ovarian punctate).

What are the main types of diagnostics usually carried out by a General Practitioner:

ECG, ultrasound, EEG, EchoEG, EchoCG, X-ray, colposcopy, fluorography, organ radiography chest, MRI, CT, mammography.

It is important to take care not only of your own cardiovascular health, but also about the health of future generations.

1. Plan an active holiday

Set aside one day on the weekend for active recreation with the whole family: in the summer - swimming, in the winter - sledding or walking, in the spring and autumn - cycling. The day will pass without any discomfort if you take a light breakfast with you and pamper yourself a little healthy food after a good workout.

2. Exercise together

Find a sports club in your area that offers yoga and aerobics classes for children. If your child is too young for such activities, find activities that will help you and your child burn calories, such as having your child do yoga with you or go on long walks. If you don’t have kids yet, then find where they offer yoga classes with a partner or even “dog yoga”, yes - this is yoga for you and your dog.

3. Remodel the family room in your apartment

Very often, family rooms are the “laziness center” of the home: a comfy sofa, a games console, a shelf of DVDs, and nothing to encourage exercise or physical activity. There are ways to add subtle reminders to your room without remodeling the entire room or taking up space with exercise equipment. Set a weekly limit on TV viewing and limit “inactivity” time to get your whole family moving.

4. Make chores fun

Instead of dividing up chores among family members, turn them into games for everyone to play. Compete to see who can clean the house faster, and next time try to improve your result. While doing laundry, play music to encourage children to sing and dance as they help fold and put away clothes. In your spare time, run a little, rollerblade or jump rope.

5. Review your diet

This advice isn't just about physical activity, but it's still worth mentioning: families who eat healthy foods tend to healthy habits, such as physical activity.

If you want to lose weight after giving birth or just want to eat well, get the whole family involved and you'll be more likely to succeed. Take the kids to a farmer's market, let them choose their own fruits and vegetables, and get the kids involved in the cooking process. They will enjoy “their” food more and wash the dishes.

One of the fundamental principles of the functioning of the health care system is the optimization of primary health care. Typically, people in need of medical care turn to local doctors for help. In most cases, a local doctor involves several specialists to diagnose and treat a patient. Sometimes visiting specialized specialists is not justified.

Thus, visiting a local therapist leads to loss large quantity time. Ultimately, the local doctor turns into a dispatcher for the distribution of patients to specialized specialists, which leads to the loss of his functional responsibilities. At the same time, there is practically no preventive work and medical examination. Experience in foreign countries has shown that 50% of patients who visit a local doctor are referred to specialists. But with the introduction of the position of general practitioner, 80% of patients begin and complete diagnosis and treatment in outpatient clinics. In modern healthcare, this is the main support for the development of out-of-hospital care to the population.

Despite the fact that the position of general practitioner was introduced recently, this principle of providing medical care in Russia was known even before the middle of the last century. At that time they were called “zemstvo doctors.” The general practitioner decides much big problems than a local doctor can do. Functional responsibilities General practitioners are multifaceted: diagnosis, treatment, prevention, rehabilitation of patients, organizational measures, etc.

"IN Soviet time we followed the European path and began to produce highly specialized specialists. This is not entirely correct. A general practitioner is, in fact, a therapist who at the same time can look at the nose, throat, eyes... We hope that they will soon replace local therapists. But we are not destroying pediatrics - it is a heritage Russian medicine, so the treatment of children remains a separate item. Besides, a pediatrician is a general practitioner, only for children,” explained Pechatnikov.

How does this change benefit the patient? The fact that a general practitioner, after completing the appropriate training and assigning this qualification, will be able to carry out, for example, an examination of the fundus of the eye and take cardiogram readings in one step. Of course, those patients who require deeper specialized research, will be redirected to highly specialized specialists.

In 2016, at the State Budgetary Healthcare Institution “GP No. 69 DZM”, they were trained in vocational training“General Practitioner” 20 therapists, this year it is planned to train 10 more doctors, as well as all newly hired therapists. All GP offices are equipped with new equipment, including the purchase of otorhinolaryngophthalmoscopes, which will allow doctors to carry out full inspection patient. The appointment time has also been increased to 20 minutes, this will allow a full examination, assessment of the patient’s condition, and recommendations to be made without haste.

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