General practitioner or therapist. Who are general practitioners and what will they be paid for?

When we find out that our new acquaintance is a doctor by profession, we always ask: what specialty is the doctor? And when we hear in response: doctor general practice, - we are perplexed, what kind of doctor is this, and who does he treat, what does he know, what can he do, whether it is good or bad. At the same time, the general medical practice In the last 20 years, it has taken its place in Russia and has become a widespread practice, at least using the name - family medicine. Is it imported into our medical culture? Where did its origins come from? These questions are answered by the history of medicine, in which the practice of a family doctor has its roots in deep and not so ancient times.

In fact, the ancestors modern medicine, like real Russian medical researchers who laid the foundations of Russian medical science and practice - S.P. Botkin, G.A. Zakharyin, N.I. Pirogov, were a prototype of a general practitioner. This is a doctor who sees the patient completely, and not in parts, who is able to assess the degree of involvement of each organ and part of the human body and identify the leading problem or problems. The relevance of this approach to the treatment process explains the widespread and high demand for general medical practice throughout the world. However, general medical practice, widespread in pre-revolutionary Russia in the form of the institute of zemstvo doctor, which continued in the first decades of the USSR, was lost by the 1970s. And if back in 1950, any graduate of a medical school could work as both a therapist and a surgeon and conduct an examination of ENT organs and eyes, later the concept of specialization won, which, on the one hand, improved the quality of care in certain areas, but contributed, on the other hand, to The loss of the doctor's vision of the patient as a whole gave rise to "specialists in the little toe on the left foot."

Over the last century, medicine has been filled with a colossal amount of information and is updated daily. “One doctor cannot know everything equally well,” you say. Absolutely spot on. But the doctor is now a large number of sources of information that do not replace knowledge and experience, but provide the opportunity to be a highly informed specialist. At the same time, without a good basic vocational training and the experience of daily medical practice, it is impossible to understand the flow of information about new medicines and treatment methods. In addition, communication between specialists, colleagues of various specialties, joint management of a patient, sometimes with a diverse and complex pathology, is the basis of the daily activities of a general practitioner. Such a doctor does not work like a dispatcher and does not “refer” his patient to another specialist, but bears full responsibility for him. Such a doctor strongly recommends returning to him after consulting a specialist or reporting the results of examinations, as this is required healing process. Such a doctor is not afraid to admit that he doubts his diagnosis, that he wants to get more information, additional consultation. With the rapid development of medical science, this quality of a doctor gives an advantage to the patient.

Due to the fact that the tradition of general medical practice in Russia was interrupted and resumed only in the 1990s, the class of general practitioners is very heterogeneous in origin and possession of practical skills. Many doctors acquired this specialty after being retrained as therapists, surgeons, pediatricians, and gynecologists. And this leaves an imprint on their daily work. However, every year the number of doctors who have completed residency at the departments of family medicine/general practice is growing, which provides an optimal balance of knowledge and skills. But in practice, one can still see that there are doctors who are ready and able to deal with patients of all ages, from diapers to old age. There are general practitioners who, in parallel with their main activities, specialize more deeply in some field (for example, in surgery or pediatrics, or certain areas of internal medicine - gastroenterology, cardiology, etc.). The level of qualification of a doctor certainly depends on his experience. Many general practitioners easily and highly professionally cope with most of the problems of their patients, such as: acute moderate viral otitis, manifestations of congestive heart failure, chronic gastritis or purulent inflammation finger - panaritium. All these and many other conditions do not require a highly specialized approach; they can be successfully treated by the same person - your attending physician. And he will also determine the indications for consultation with highly specialized colleagues: if the diagnosis is unclear, the disease takes an unusual course, or a problem is identified that requires highly specialized high-tech help.

Thus, a general practitioner is your attending physician who treats and prevents diseases in all family members: parents, their children, elderly family members, advises during pregnancy and breastfeeding. Such a doctor inevitably knows your personal characteristics, drug tolerance, and family history. Will provide assistance in most common medical situations and optimally determine the time when it is worth contacting a specialist.

Not long ago it became known that a training program for family doctors will be launched in Moscow in 2015. Within the framework of this program, it is planned to train 2.3 thousand doctors - mainly from among local therapists. How does a traditional primary care physician differ from a family doctor? Let's understand this difficult medical issue.

The head of Moscow healthcare, Leonid Pechatnikov, quite correctly defined this difference as follows: “a family doctor is a competent therapist who has the skills of a number of specialized specialists.” The latter primarily means ENT, ophthalmologist, and gynecologist.

Although, of course, a general practitioner needs to know the basics of surgery, neurology, and many other specialties, not to mention “narrow therapeutic” ones - cardiology, pulmonology, gastroenterology, nephrology, and so on.

There has already been a discussion around this initiative. Supporters of the innovation believe that the innovation will improve the quality of treatment.

Regarding this opinion, we can say quite confidently that it is absolutely unfounded. “General practitioner” is, in terms of medical science, a return somewhere like the beginning of the 19th century in best case scenario. Because by the middle of this century, even therapy began to rapidly divide into subsections, specializing in which scientists moved science forward much faster than before.

Another thing is that within the framework of a “market economy,” say, a small town - no matter where it was located - whether in Europe or Russia - could not support an entire clinic of specialized specialists. Therefore, local doctors had to be jacks of all trades.

In Russia, a real revolution in this area came only after the revolution, when the People's Commissar of Health of the USSR Semashko organized a system of public outpatient care that is still unique even for most developed Western countries. When any patient could turn directly to eye doctor, gynecologist, surgeon and so on.

Although even now in the “blessed West” only his “family doctor” is available to the patient. And this doctor decides whether to treat the patient himself (which happens in 95 percent of cases) or send him to a “specialized” specialist.

Moreover, you have to wait a very long time to receive the latter. In Israel, for example, waiting lists to see a neurologist reach 100 days. And in England, a third of cancer patients die only because they have to wait up to 8 months for consultation with a qualified oncologist and surgery - by the end of which the tumor reaches the stage where intervention can only slightly delay the fatal outcome.

The training of doctors itself implies that they study the first three courses of theoretical disciplines at medical institutes, then begin studying clinical subjects. The same surgery, therapy, eye diseases, etc. Note that training in “narrow” specialties goes from the 4th to the 6th year.

But even after this, having received a diploma young specialist They still weren’t allowed to see the sick! At least until this year - when graduates were allowed to immediately work in hospitals in “broad” specialties - therapy, pediatrics. And ENT doctors, ophthalmologists, surgeons, both before and now, are still required to undergo at least two years of postgraduate training.

Meanwhile, a “general practitioner,” according to the plan of health care organizers, will have to have knowledge not even in one, but in several “narrow” specialties after just six months of specialization courses. It is clear that such knowledge will be very superficial, and such a “specialist” himself will be comparable in skill level to an ordinary paramedic. In any case, precisely in “narrow specializations” - knowledge of therapy, of course, no one can take away from such a doctor.

Of course, he will be able to do a considerable part of the work of his fellow specialists. But by no means as qualified as they are. After all, a “general practitioner” will still have less experience than a “specialty” doctor.

For example, if for many years you treat only vision, then you begin to recognize many diseases “with eyes closed"And if an ex-therapist, promoted to a “family doctor,” sees one conjunctivitis well, if in a day, and not once a month, it’s no wonder someday uveitis or iridocyclitis will be missed under his “mask”, without immediately starting serious treatment fraught with loss of vision.

In general, in modern world There are no longer “just engineers” or even “just teachers.” With the exception of teachers primary classes- already from the 4th grade, children are taught by “subject specialists” specializing in physics, chemistry, biology, etc. Although, it would seem, these are only schoolchildren, not students.

The only place where the Institute of Family Doctors can help is in situations where access to “narrow” specialists is difficult. Either in rural areas, due to the ever-present shortage of personnel, or because of the same shortage - but in urban clinics. Then, as they say, “without fish there is cancer,” it is better to get a prescription for glasses or wash out the “plug” in your ear from a “general practitioner” than to wait several days for an appointment with an ophthalmologist or ENT specialist. Or even go to see them at another clinic.

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 a doctor called a general practitioner 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 medicine,” and perhaps even undergo an internship.

If a general practitioner received his education a long time ago, he has the right to obtain the specialty “General Medical Practice ( Family medicine) 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 of a family doctor is prescribed. 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.

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.

Very soon, local therapists, after appropriate training, will turn into general practitioners (GPs), or, as they are also called, family doctors.

What Muscovites can expect from the new reform and how the work of medical personnel will now change.

How is a general practitioner different from a regular therapist?

By the way, the opportunity to call a GP to your home in Moscow is not yet provided. However, the local therapist now only provides outpatient visits. Home care is provided by other doctors, and nothing will change for them with the advent of family doctors (as well as for pediatricians, who are essentially pediatric general practitioners).

What should a family doctor know and be able to do?

The order of the Ministry of Health defines a GP as a specialist broadly oriented in the main medical specialties and able to provide assistance for the most common diseases and emergencies.

According to the instructions of the Moscow Department of Health from February 2017, the offices of general practitioners must be equipped with a tourniquet to stop bleeding, manual device For artificial ventilation lungs, surgical scissors, ophthalmoscopes (for checking vision), rhinoscopes (for examining the nasal cavity), a table for drawing blood and intravenous infusions, Esmarch circles.

Judging by the equipment, doctors of the new profile must be universal specialists, be able to give an enema and draw blood, and simple surgical intervention carry out, and even resuscitation.

How many specialists have been retrained?

In Russia, an experiment in training general practitioners began back in 1987, but the emergence of these specialists was hampered by problems with determining their legal status.

Only in 1992 did a corresponding position appear in the list of specialties. By 2000, about a thousand GPs were trained in the country, by 2005 - almost four thousand.

What is the retraining program based on?

In Moscow, a pilot retraining project was launched back in 2014. As the capital's health department told reporters, the main goal of the project was to train a general practitioner in the shortest possible time.

In 2014, 113 specialists were trained. In 2015, their number exceeded a thousand, but the capital’s clinics need more than 4.5 thousand general practitioners.

How long will it take to see a doctor now?

As a result of the innovation, it is expected to reduce queues for appointments with specialists and increase the duration of appointments with a general practitioner. The appointment time will increase to 15-20 minutes. In addition, a nurse is provided to assist such a doctor.

A general practitioner's office should have a manipulation room (for mini-operations) and a procedure room. Perhaps, due to organizational difficulties, GPs and district police officers will work in parallel for some time.

Will retrained therapists be able to replace specialized specialists?

The question arises: will the quality of care worsen with the advent of doctors of universal specialties? medical care? There is a fear that former therapists will not be able to replace specialized specialists to the extent that they are counted on. The Moscow Department of Health does not share such concerns.

If in the capital general practitioners have yet to prove their worth, then in rural areas this practice must be effectively implemented. In areas where medical assistance narrow specialization not always available family doctors will be in first demand.

Subscribe to the "site" channels in T amTam or join in