There is no orthopedist at the clinic, what should I do? Is it possible to make an appointment with a doctor or make a call to a home other than your place of registration? Check your insurance policy

Not everyone has the money to visit a paid one. What to do if the specialist you need in a public clinic has closed appointments and you don’t know when he will continue working? Get ready to write letters. Preferably in two copies. And be patient.

You will have to act on the principle: in order to be treated, you need to be in good health... First, contact the chief doctor (or his deputy) with a request to refer you to such a specialist at the nearest public clinic. If your verbal appeal has no effect, write a statement in two copies addressed to the head physician of the clinic. The first copy is for him, on the second copy, which you keep for yourself, be sure to get his note: signature, date, “I have read the application.”

Try to explain as convincingly as possible why you need to consult a specialist, and not a local therapist. Unfortunately, there are no clear rules regulating the recruitment of specialists who should see patients at the district clinic. But there is a standard agreement between it and the insurance company that issued you the compulsory medical insurance policy (compulsory health insurance). And in the contract there is a fifth clause that will save you: “If it is impossible to provide medical and preventive care of the agreed type, ... The institution (that is, your clinic) is obliged at your own expense provide the insured with such care in another medical institution or by involving an appropriate specialist." Do not forget to refer to this point in your application!

The chief doctor who has studied your “petition” has three options. 1. Persuade you to be treated by the local police officer. 2. Offer you hospitalization in a specialized hospital department. 3. Refer you to a nearby district clinic where the specialist you need can see you.

In practice, as a rule, referrals to another clinic are not refused. But you must remember that a referral is one thing, but a real appointment with a specialist is completely different. While you, with the treasured referral paper in your hands, are storming the next healthcare facility, time is passing. In another clinic there is also an appointment, a queue, a specialist may get sick, go on vacation, equipment may break down, have to undergo a preventive examination, etc. In short, you will need time. If time is of the essence, wait. If the matter is urgent, contact centralized inter-district diagnostic centers and clinics.

...To a written application, the chief physician is obliged to give a written response. Let's say he insists on the first option that is most convenient for him, but unacceptable to you, rejecting the second and third. In a word, you were refused.

Then, adding a new application to the refusal paper, contact two organizations at once. This is your insurance company, which by law must ensure the quality of medical care provided to citizens. And the regional (district, city) health department that controls the work of your clinic. I wish you success! Try not to lose any remaining optimism. And health.

Grigorieva Alexandra

Yulia Sharapova

A situation that is probably familiar to everyone: you come to the district clinic with heart pain, and they tell you: the cardiologist will only be available next week, and the appointment is on Wednesday from 8 a.m. on a first-come, first-served basis. Or another example. A neurologist sees you and says: take some pills and get an X-ray of your spine, preferably also an MRI, of course, but that’s paid for. Meanwhile, many of our readers have probably heard that according to their compulsory medical insurance policy they have the right not only to go to their own clinic, but also to consult with doctors from other medical organizations (for example, in a clinic at a regional clinical hospital), as well as undergo a number of complex and expensive research in the same regional diagnostic center. Let's figure out who is entitled to what free diagnostics and treatment. With the help of Yulia SHARAPOVA, Lead Advisor to the Department of Health Services for Adults, we are answering the most popular questions.

1. Where is it written which disease is treated and how?

Let's first figure out how money circulates in public medicine. We receive a number of services free of charge under the compulsory health insurance policy (CHI). But then the cost of these services to medical institutions is compensated by the Compulsory Medical Insurance Fund, which, in turn, receives funds from budgets of different levels, as well as contributions from our employers.

However, the fund compensates for the cost only of medical care that was provided in accordance with the program of state guarantees of free medical care to citizens based on the standards of medical care approved by the Ministry of Health. Standards of medical care are average indicators of the frequency of use of medical interventions for various diseases. Standards for each disease can be found on the Internet, for example in electronic legislative databases. That is, what is included in the standard specifically for your illness, you have the right to receive for free, everything else is paid. But again, we must keep in mind that there are standards for providing care in a clinic, and there are in a hospital; in addition, a number of standards stipulate that some type of examination or treatment is not indicated for all patients with a given disease, but, for example , every third. And who exactly this “third” will be is decided by the doctor, based on medical indications.

2. Is it true that under the compulsory medical insurance policy you can get an MRI for free?

Yes, and in the Voronezh region, patients from clinics are usually sent for magnetic resonance imaging to the regional diagnostic center or regional clinical hospital No. 1. All city and district clinics are allocated referrals for this (or, as they are popularly called, quotas). However, this study is not suitable for everyone according to the standards. For example, in the standard treatment of degenerative diseases of the spine (osteochondrosis), MRI is indicated for 90% of patients, but only if they are in a hospital. And with rheumatoid arthritis, only every tenth patient is sent for an MRI of the joint. The same applies to other complex procedures. For example, in case of arterial hypertension, duplex scanning of the brachiocephalic arteries (examination of large vessels responsible for the blood supply to the brain) is required for 8 out of 10 patients. By the way, the waiting time for these procedures by law is from 2 to 4 weeks. The regional health department admits that there are not enough MRI and CT diagnostic equipment in the diagnostic center and in the regional hospital, and the issue of purchasing additional equipment is being considered.

3. In a commercial clinic they told me that I have indications for an MRI, and in the district they offered me pills. Who is right?

If a patient doubts the qualifications and correctness of his doctor’s decisions, he can file a complaint with the chief physician, demand to be assigned to another doctor, and also, for example, initiate a meeting of a medical commission or council at the clinic. Of course, not all patients have the strength and nerves to do this, but this is the only legal way. And there is one more important point: pay attention to whether the doctor wrote down all the recommended examinations on your card. In this case, he must ensure that, in accordance with the standard of care, you receive it free of charge.

4. I urgently need to see a cardiologist, but he is on vacation and generally works part-time at the clinic. So what should we do, wait?

No, if a patient requires consultation with a specialist, Voronezh clinics have a system for making appointments with doctors at a diagnostic center or a clinic at a regional clinical hospital. These institutions do not have an assigned population; they are specifically designed to help residents of the entire city and region. According to regional health care specialists, district clinics receive a lot of referrals for such consultations. Therefore, the local physician refers the patient to the same cardiologist from the regional clinic. But again, pay attention if his consultation is included in the standard for your illness.

Also, such consultations are prescribed in cases where a specialist with a rare profile is needed (for example, a hematologist) or in difficult cases. Moreover, you can receive a referral for such a consultation even if you provided the therapist with studies (ultrasound, tests) from a private clinic. Last year, about 57 thousand people passed through the clinic at the regional hospital, where they provide consultations in 38 specialties. For children, such consultations are carried out in clinics at the regional children's hospital, also by referral.

5. I cannot undergo a fluorogram or ultrasound at the clinic because the machine is broken. Should I be sent to another facility or should I now wait for it to be fixed?

Fluorogram and ultrasound are routine types of medical care. According to the law, the waiting period is 2 weeks. If the device cannot be repaired by this time, you should be told where this research can be done for free. For example, often several clinics are combined into one medical institution, and you may be referred to another.

6. Can I take all blood tests for my disease for free?

No, not all laboratory tests are included in the compulsory medical insurance standards, but most of them are present. Of course, clinics usually do not have such equipped laboratories. Therefore, in Voronezh, complex tests are done centrally, when you donate blood in your clinic, and then they are brought to the laboratory of the regional diagnostic center. At the same time, some of the tests that are not within the scope of the standards of medical care may indeed be offered to be carried out in private medical centers. As our interlocutor explains, sometimes standards lag behind the development of science and do not have time to include new types of research, although they are recommended for a given diagnosis. Therefore, even from the hospital, they are sometimes sent to a private medical center to undergo tests that turn out to be outside the standards, for example, for rare autoimmune diseases.

7. Will the time ever come when, like in the West, I will be able to take my insurance policy to any medical center, whether public or private, and they will provide me with free help?

Here we are talking about the so-called public-private partnership (PPP), when part of the services is purchased from a commercial structure that is part of the compulsory medical insurance system at the expense of the Compulsory Medical Insurance Fund and they are provided to the population free of charge. Discussions about the need to develop PPP have been going on for a long time at the highest levels of government. But so far there are few examples. In our city, these are hemodialysis centers at hospitals, opened in collaboration with the Nephrological Expert Council and Fresenius Nephrocare, a public-private partnership with the Interregional Medical Center for Early Diagnosis and Treatment of Oncological Diseases - the oncology clinic sends patients there to undergo several high-tech procedures. The third project is sanitary evacuation using an An-2 aircraft and a Eurocopter-135 helicopter with a resuscitation module. Also, as part of the PPP, in vitro fertilization is being carried out in the region. Representatives of private clinics explain that the development of PPP is hampered primarily by the low tariffs of the Compulsory Medical Insurance Fund for the provision of certain types of assistance - they simply do not compensate for the real costs of the clinics.

8. Who is entitled to free spa treatment?

There are few such categories of citizens. These are working people who have suffered a stroke, heart attack or heart surgery in a hospital. But not all, and also if there are indications - that is, when the patient does not need to undergo further treatment in a clinic or in another hospital. Also, women with complicated pregnancies, after certain operations of the gastrointestinal tract and patients with diabetes can receive vouchers to the sanatorium.

Long queues, insults towards patients, high levels of waiting, indifference of doctors, uncomfortable conditions of stay in a medical institution, shortage of doctors - these are the main problems of clinics that patients face every day.

Many people are dissatisfied with the quality of medical care they receive in public clinics. Some even try to correct the situation: they quarrel with the honey. staff, other patients, but no use.

Where can I complain about the clinic so that the quality of service improves?

Patients can contact higher-level organizations regarding any problems that seem serious to them and require outside intervention.

You can complain about the actions of the medical staff of the clinic, for example, on issues such as:

refusal of a specialist to provide assistance;
provision of medical care is not complete;
incorrectly prescribed treatment, as a result of which the patient’s condition worsened even more;
disclosure of medical confidentiality;
misdiagnosis;
provision of inadequate care, which led the patient to physical or mental injury;
unethical, unprofessional behavior of the clinic staff - rudeness, rudeness, callousness, etc.;
the doctor’s demand for money for an appointment, for prescribed treatment, etc.;
lack of vaccine;
inability to obtain an appointment ticket and much more.

If you have complaints about the quality of service in a medical institution, then you have the right to complain to the following authorities:

Head doctor of the clinic– if the patient’s complaint is related to the action or inaction of a specific doctor or other medical employee.
To the Ministry of Health(local department) – if the head physician does not accept a complaint from the patient or ignores it. You can write a complaint to the Ministry of Health about anything: long queues, poor quality service, inattention and rude attitude of the staff of a medical institution, etc.
To the local authorities(city administration) - if the clinic does not have the necessary medications that should be given to a certain category of patients free of charge, if the doctor refuses to write a prescription for free medications, etc.
To the insurance company which issued the health insurance policy - if the doctor refuses to prescribe medications to the patient that are included in the list of free medications specified in the health insurance policy; if the doctor did not tell the patient that he was entitled to the medicine free of charge.
To Roszdravnadzor– if the patient’s legal rights were violated; if the clinic staff violates the rules of medical care; if the patient is not satisfied with the result of treatment, etc. That is, the applicant can apply to this authority if his rights as a consumer of medical services have been violated, as well as if there is a threat to his life or health.

To the prosecutor's office– if the patient is faced with extortion of funds from staff; the doctor caused harm to the patient’s health by misdiagnosing him or prescribing the wrong treatment.
To the police– if the appeal is related to extortion, threats, insults from medical personnel, as well as if the doctor intentionally caused harm to the patient’s health.
To court– if the patient has suffered serious harm; if the patient has recorded a violation of medical ethics; if the doctor unlawfully charges the patient a fee for providing free care, etc.

If you have complaints about the quality of service at the clinic, you can leave a written complaint on the Ministry of Health website.

To do this you need:

Log in to the website www.rosminzdrav.ru.
Select the subsection “Public reception” – “Form for sending an appeal”.
Fill out the form by entering your last name, first name, patronymic, and the text of the complaint in the appropriate fields. Attention! The text of the document should not exceed 2 thousand characters. The application must indicate the address of the clinic, as well as specific facts with which the patient was dissatisfied.
If necessary, you can attach documents that serve as evidence of the patient’s innocence - photo, audio materials, a scanned copy of an extract, a doctor’s prescription, etc.
Be sure to select from the list the region from which the application is being submitted.
Check the box next to the desired option for receiving a response to the complaint: by mail or email.
Place a checkmark at the end indicating that the client has been familiarized with the procedure for receiving and appeals from citizens, and then click on the “Send appeal” button.

An online complaint filed against a clinic with the Ministry of Health is registered by the responsible employee within 3 days, after which it is sent to the required department of the Ministry or to the authority that directly deals with the issue raised in the appeal.

The applicant may not receive a response to the email or postal address from the Ministry of Health if he indicated incomplete information about himself in the application or entered inaccurate information about himself.

Anonymous complaints filed by a citizen against the clinic are not accepted by any authority.

In order to properly file a complaint, you must consider the following:

The complaint must be written in a formal style, without unnecessary emotions, curses.
The text needs clearly describe the problem, do not deviate from the essence of the complaint.
If the complaint is submitted in writing, then you need to write it in two copies so that one remains with the applicant. On its copy, the responsible official must indicate the date of acceptance of the application, the incoming number, as well as indicate his position, surname and signature.
When filing a complaint, it is recommended to refer to the articles of law that regulate issues in the field of healthcare.

If you want to complain about a clinic on the website of the Ministry of Health, then the patient is asked to fill out a complaint form. But how to write a complaint if the applicant decides to submit it in writing?

The document must reflect the following information:

addressee's name;
information about the addressee: full name, residential address, contact phone number, address for feedback;
The text of the complaint must contain information about the clinic where the person is complaining: the name and number of the medical institution, as well as its address. If the complaint concerns a specific doctor or medical employee, then you need to indicate his last name, first name and patronymic. After the descriptive part, the applicant must put forward his demands, for example, to hold officials accountable, conduct an inspection, etc.;
a list of documents that are attached to the complaint;
date of drawing up the appeal, signature, surname and initials of the applicant.

If you want the work of a medical institution to be improved, then you have the right to file a complaint.

This can be done in several ways:

Submit an application on the website of the Ministry of Health, the prosecutor's office, and the city administration.
Write a written complaint and bring it personally to the head physician, the Ministry of Health and other authorities, or send the document by registered mail with notification.
Complain about the clinic by calling the hotline. Since 2011, a hotline was created to analyze the work of clinics and hospitals. Any person who is faced with arbitrariness in the clinic, disrespectful attitude of medical staff, and so on, can call the number 8-800-700-8-800 and leave a complaint.

Sample complaint submitted to the Department of Health

So that you do not have unnecessary questions regarding the registration of a complaint, we suggest that you familiarize yourself with an example of a complaint that was submitted in writing to the Ministry of Health:

To the Ministry of Health in the Volgograd region

st. Raboche-Krestyanskaya, 16, Volgograd, 400001

from Lyudmila Petrovna Izmailova, living at:

Volgograd, st. Lenina, 56-A, 400025.

tel. 8-903-656-88–89

On April 12, 2018, I went to clinic No. 2 at the address: Volgograd, Metallurgov Ave., 16 for medical help. At an appointment with general practitioner S.E. Abdulova, she allowed herself to loudly voice my diagnosis in the presence of other patients who were in the office at that moment. In addition, the specialist violated medical ethics: she scolded me for late contact with her. She did not pay attention to my requests to stop the discussion.

On April 13, 2018, I wrote a complaint to the head physician of clinic No. 2 regarding his employee’s violation of ethics in relation to patients. I didn't receive an answer.

I believe that the actions of doctor S.E. Abdulova do not comply with the provisions described in Art. 13 Federal Law “On the Fundamentals of Health Protection” regarding medical confidentiality. In my opinion, therapist S.E. Abdulova showed a disrespectful attitude towards me, and also violated the law “On the Fundamentals of Health Protection in the Russian Federation.”

In connection with the above,

Understand the situation and bring the therapist S.E. Abdulova to justice in accordance with the law.

Applications:

a disc with a recording of a conversation with doctor S. E. Abdulova dated April 12, 2018;

copy of the complaint addressed to the head physician of the clinic dated April 13, 2018.

05/25/2018 signature of Izmailov L.P.

Where to write if the clinic refuses to provide medical care?

First you need to write a written complaint addressed to the chief doctor of the clinic. If the complaint remains unanswered, then you need to go further - write to the Ministry of Health.

If a citizen is assigned to a specific clinic, then he has the right to receive medical care. If a doctor refuses to provide assistance, he may face criminal liability under Art. 125 of the Criminal Code of Russia.

This article clearly states that leaving a person without medical care, which has cast doubt on his state of health, entails liability for the guilty person in the form of a fine or correctional or forced labor.

Below is an example of filing a complaint regarding a clinic doctor’s refusal to provide medical care to a patient:

To the chief physician of state clinic No. 2

Volgograd

Vinogradova O. P.

from Izmailov Stanislav Mikhailovich,

living at the address: Volgograd, st. Starorusskaya, 16,

index 400025.

tel. 8-903-112-47–78

On March 5, 2018, I went to clinic No. 2 in Volgograd. I wanted to see a cardiologist about complaints of heart pain. The doctor's office is located on the 3rd floor. The elevator in the clinic did not work, so I called the doctor’s office and asked Yuri Leonidovich Romanov to come down to me, since I am disabled in a wheelchair. To which the doctor replied that he did not intend to go down, because he had many patients.

I consider the actions of cardiologist Yuri Leonidovich Romanov illegal, such as those that fall under Art. 125 of the Criminal Code of Russia, namely, “Leaving in danger.” The doctor violated my right to receive medical care, and refusal to provide assistance is unacceptable according to Art. 11 of the Law “On the Fundamentals of Health Protection”.

I ask you to look into this situation and hold cardiologist Yu. L. Romanov accountable in accordance with the law.

Applications:

disc with a voice recording of a conversation with Dr. Yu. L. Romanov dated 03/05/2018

03/10/2018 signature Izmailov S. M.

Many parents are concerned that there are no vaccines in city clinics, and according to the vaccination calendar, the child must be vaccinated.

So, if information was received that vaccines were purchased, but in fact there are none in the clinic, the citizen must file a complaint with the local government health department.

This is a local issue, so you need to go to the local government administration to complain about this issue.

Is it possible to write a collective complaint against the clinic?

If, for example, patients are dissatisfied with the service at the clinic (according to the schedule, the doctor was supposed to be on site, but in fact he was not, and people sat in line), then they can write a collective complaint.

This norm is spelled out in Federal Law No. 59-FZ “On the procedure for considering citizens’ appeals.” In paragraph 1 of Art. 2 clearly states that citizens have the right to apply personally, as well as send collective appeals to government bodies.

If a person is assigned to the clinic to which he is applying, and the doctor refuses to see him, he must contact the chief physician.

It is advisable to videotape the refusal to provide medical assistance or record the conversation on a voice recorder.

In paragraph 6 of Art. 4 of the Law “On the Fundamentals of Health Protection” clearly states that every citizen must receive affordable and high-quality medical care.

Paragraph 7 of the same article states that a doctor’s refusal to provide medical care is unacceptable.

Therefore, if you have complaints against the clinic’s employees, you have every right to file a complaint with the appropriate authority: the Ministry of Health, local authorities, the insurance company where the policy was issued, the prosecutor’s office or the court, depending on the reason for your appeal.

You can now make an appointment with a doctor online. With the advent of services for self-registration with a doctor, it would seem that it’s time to forget about endless queues and frayed nerves.

But in reality, things don’t always go as smoothly as we would like. Sometimes this is due to the patient’s ignorance of their rights or the organization of an appointment by self-registration.

Self-registration

Just as a theater begins with a coat rack, so a medical institution begins with a reception desk.

Moreover, it doesn’t matter whether you have an appointment or want to see a doctor without an appointment - you will still have to stand in line at the reception desk. This is necessary to issue a coupon and take an outpatient card.

In some clinics there are notices that citizens who have pre-registered are being served out of turn. But in practice, we have to deal with people’s reluctance to let anyone go ahead of them. And the registrars themselves do not interfere in the process.

Things are better in those hospitals where a separate admission window has been created for people who come by self-registration. But even here it is easy to meet a large number of people, because there are quite a lot of people who use the opportunity to register independently. Therefore, it is worth arriving at the medical facility in advance so as not to stand in line at the moment when they are waiting for you at the doctor’s office.

It doesn’t hurt to inquire by phone the day before visiting the hospital about possible changes in the schedule. It often happens that the doctor gets sick or goes on vacation. Agree, it’s a shame to get to the clinic (especially if it’s not a short distance for a person) and find out that there is no appointment.

The examination itself by the doctor is no different from the usual one, which is carried out on a first-come, first-served basis.

What do you need to book a ticket yourself?

To register yourself, you need:

Outpatient card. If the hospital where you plan to make an appointment does not have your card, i.e. If you have never visited it in person, then self-registration will be impossible.
Individual personal account insurance number (SNILS). Often used to complete registration in self-registration services.
Compulsory health insurance policy.
Passport details or birth certificate.

What else you should definitely read:

➤ How to transfer back to the state pension fund?
➤ How to fill out tax reporting online!

Who has the right to see a doctor without an appointment or queue?

Some patient conditions require healthcare providers to conduct an appointment at the time of treatment.

These conditions include:

Acute pain of any location (ear, back, head, etc.);
High temperature (implied to be at least 38 degrees);
Loss of consciousness, bleeding - in a word, conditions that require an emergency response from doctors.

If, in case of obvious symptoms of deterioration in the patient’s well-being (fainting, for example), medical personnel are ready to provide assistance and conduct an examination, then if there is pain or a temperature not exceeding 38.5, clinic staff simply refuse to admit you. Be aware: this violates your rights!

Secondly, in absolutely any clinic there is a so-called on-duty therapist. It is he who must accept the patient in case of refusal to be examined by a specialist (otolaryngologist, neurologist, etc.).

For information on how exactly you can sign up through the State Services portal, watch the video instructions below:

We get to the office, bypassing hours-long queues

How to get to a doctor without an appointment? Unfortunately, a ticket with the treasured hour and minutes indicated on it does not guarantee timely passage of the specialist.

And if a delay in reception within 15 minutes is acceptable, then waiting in a general queue for several hours is not! So how can you avoid getting into such a situation?

Arrive 30 minutes before your scheduled time. In half an hour, you can calmly stand in line (if there is one) at the registration desk for your card and find the right office. If you don’t make it in time, you will most likely have to go to the appointment on a first-come, first-served basis!
Near the doctor's office, find out about the appointment at the appointed time and the presence of people with coupons for an earlier time. If there are any, then you will have to wait for a specialist to pass them (unless, of course, we are talking about those who are more than 15 minutes late)
In many hospitals, real crowds of people gather at the offices of doctors who do not organize entry on call. Only some of them are recorded for time.

If you want to make an appointment with a doctor at a specified time and get there on time, you probably won’t succeed; this process is still far from perfect. Therefore, be prepared for the old difficulties of making your way to the coveted doctor’s office in those medical institutions where this moment is left to chance. Have a good and relaxing visit to the doctor!

How to get to the doctor if you haven’t made an appointment in advance

“Good afternoon, please explain how I can get to the doctor. This morning I woke up with a strong cough and runny nose, but no fever. I called the reception desk of my clinic to make an appointment with a therapist, and they told me that the next available time was only in three days. But I need help now. Are there really no options? If you get sick without making an appointment with a doctor in advance, will you not get an appointment? Sincerely, resident of Krasnoyarsk Anna Grigorievna Stepanenko.”

Indeed, today in Krasnoyarsk clinics, local therapists are seen by appointment. But this does not mean that if a person falls ill “without warning,” he will not see a doctor.

— Primary medical care in municipal clinics is provided in accordance with the state guarantee program. It can be either planned - by appointment, or emergency - directly on the day of the patient’s visit,” says Oksana Sokolova, chief therapist of Krasnoyarsk. — To provide emergency care, pre-medical offices have been opened in almost all branches of the adult network’s clinics.

To get into it, you need to contact the reception directly; no pre-registration is required. “The reception in the pre-medical office is conducted by a paramedic,” explains Oksana Igorevna. — He examines the applicant and decides on the further management of the patient: he gives directions for tests, and in some cases prescribes drug therapy. If the patient needs to be examined by a doctor on the day of treatment, the paramedic will refer him to the doctor.”

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