The doctor did not accept me without an appointment. View full version

There are often cases when citizens who wished to see a doctor without having a coupon with them heard a categorical refusal and, forever disappointed in the moral code of this specialist, harbored and fed sincere resentment in their souls. But let's figure out in what cases the doctor is obliged to accept a patient without a coupon, and in what cases he may not do this. The situation is clarified by the Deputy Chairman of the Lida District Executive Committee, Viktor Pranyuk.

– Are there any clear rules governing the admission of citizens to the clinic without a coupon? Is the doctor obliged to accept such patients or not?

– If people complain of acute pain, they can go to either a general practitioner or a specialist doctor.

- That is, if a person has any emergency situation- Do you have to accept it?

- Certainly. You must tell the receptionist, and the doctor must accept you without any conversation. This could be, for example, trauma, bleeding, or acute toothache or any other urgent situations, you must be accepted. In other, non-emergency cases, clinic doctors are not required to accept patients without a coupon. I also want to say that if a person is worried about something vague and “hurts somewhere here or somewhere there”, it is better to contact doctors of broad specialization: therapists or surgeons, for women - a gynecologist. And then they will either solve your problem and prescribe treatment, or refer you to to the right specialist. This way it will be faster and more correct.

It is necessary to clearly understand and comprehend the essence of the dialogue presented above. If you have an emergency situation that cannot be delayed (bleeding, injury, acute pain), any doctor in the clinic is obliged to see you. If you refer to the fact that “something somewhere is bothering you”, do not be offended or angry if the doctor refuses to see you without a coupon, because he acts in accordance with the rules. From the point of view of a simple layman-patient, each of us will judge differently about the correctness or incorrectness of such settings regulating the work of clinics. However, the law is the law, and as long as it is such, we, whether we like it or not, are obliged to take it into account.

13.05.2009, 21:02

To get an appointment with a doctor, you need to make an appointment; to make an appointment, you need to come on Tuesday at 17-00. To be sure, come at 14-00 and get in line for an appointment, fight with all the old people, and maybe you’ll be able to make an appointment with a doctor at the most inconvenient time, in about a couple of weeks.
I found out all this later...
The doctor refused to see me. Because I came without an appointment. I asked to accept, I'm really worried about the eyes in this moment. There are babies at home. Suddenly the disease is contagious. I asked her to recommend drops for me, well, there is probably something universal, which, unfortunately, I know nothing about (I only know Visine).
She ran into nothing. She yelled at me and kicked me out of the office.
Questions:
1. Is this a violation of the Hippocratic Oath?
2. Is there any punishment for this behavior?

Article 124???

13.05.2009, 21:06

1. This is not a violation of oath G (by the way, the doctor did not give it)
2. There is no punishment for such behavior - the doctor works within the framework of the administrative model prescribed from above.

Article 124 is applicable, at a minimum, “if this has negligently caused moderate severity harm to the patient's health"

For urgent cases, there are emergency services.

13.05.2009, 21:16

The doctor has truly terrible behavior. He kicked you out, and not the one who came a couple of weeks before, got into a fight, made an appointment... And then didn’t get an appointment because of you. I think he's the next one to create a "is this breaking someone's oath?" topic here. The doctor will not create it, he will receive punishment in any way, either from you or from that patient.

13.05.2009, 21:21

OK. Your position is clear.
BUT will you even agree that our system is stupid (scoop!)?
Why can't I just come and get a consultation?
(The answer will be: because it is free medical care.)

13.05.2009, 21:25

Any consultation takes a certain amount of time. If you get in, it means someone else won't get in. It is not clear how this can not be understood.

13.05.2009, 21:27

This is not my position - this is the position of the law - you asked a question in the legal section.
The answer is because a doctor, for a set salary, must work a set number of hours and see a set number of patients. Having received a set salary for this.
Since you refused to be included in the designated number of patients, you are denied admission.
The doctor also has children, a family, etc.

You can
- get an appointment number and turn up at the appointed time,
- get advice more comfortably by contacting the non-state healthcare sector,
- seek emergency services in case of a health threatening situation,
- appeal to the UN and the League of Nations.

You can not,
- expect that for the sake of your case the healthcare system throughout Russia will be changed,
- count on a long flood here.

13.05.2009, 21:28

Well, if you tried to get to a specialist in non-Soviet Norway, then I assure you, it would take... uh... well, two months, at least.
Despite the fact that there are taxes of 35-55% of wages and conditionally free healthcare.

You can come and get a consultation - but this requires an appointment. If the situation is urgent, there is an ambulance and a hospital on duty. If you want comfort, a time convenient for you and free slippers, there are paid appointments.
That is, you have a choice. Everything is logical.

I myself do not go or take my child to the free dental clinic. They do good work there (one night I contacted acute pain). But it’s inconvenient for me to get up early, take numbers and leave work.
Not long ago my mother filed for disability. I went for numbers in the same way.

My patients can see them for free and without a queue - both teeth (their own dentist) and childbirth (the head attends them). obstetric department, free), and disability - I gave my passport to the doctor - and all that.

Man faced with Russian system health care, often feels complete helplessness. Indifference, bureaucratic delays, crazy lines outside offices... It’s not easy for a healthy person to cope with all this, let alone for a sick person. In such situations, the phrase “patients' rights” seems like a mockery. However, these rights still exist in our country, and some of them can be fought for.

Related materials:

Article 16 says the same thing. Federal Law"About mandatory health insurance in the Russian Federation”, guaranteeing the right of the insured person to choose a doctor and choose a medical organization.

We are talking specifically about free medical care - according to compulsory medical insurance, a citizen is assigned to one specific clinic and hospital at his place of residence. If these institutions, or the specific doctor to whom you are assigned, do not suit you, you have every right to change them. This is done like this:

if you want to change your attending physician, contact the doctor you want to be treated by. According to the law, the addition of new patients is allowed only with the consent of the doctor himself. As a rule, doctors are interested in increasing the number of patients - because this is reflected in their salary. They rarely refuse - only when they have too many patients. If the doctor agrees to take you “under his wing,” write an application addressed to the head physician medical institution, in which it is advisable to indicate the reason for changing the doctor and, necessarily, the consent of the doctor you have chosen.
if you want to change medical institution, you first need to call the insurance company that issued your compulsory medical insurance policy and find out if it has an agreement with the municipal or state medical institution where you want to be treated. If not, you can either change your insurance company or choose another medical institution from those with which your insurance company has contracts for receiving and servicing patients.

After this, you can independently write an application addressed to the chief physician of the selected hospital. However, in practice, especially if we're talking about about the clinic, your attempt to register at the “wrong address” may encounter active resistance from the administration of the selected medical institution. Therefore, it is better to act immediately through the insurance company. Ask your insurers to help you fill out the necessary application and contact the head physician of the relevant clinic.

Point 5. Relief of pain associated with disease and (or medical intervention, accessible ways and means.

When severe pain When conventional painkillers do not help, the doctor has the right to prescribe narcotic painkillers. The mechanism of their appointment is regulated methodological instructions Ministry of Health of the Russian Federation “Procedure and timing of prescribing narcotic analgesics.” This document reads: " Pain intensity is divided into 4 levels great importance for practical healthcare, since the indications for prescribing potent narcotic drugs(morphine preparations, buprenorphine, piritramide, promedol, satel, fentanyl preparations, etc.) should be prescribed only for severe and very severe (3-4 points) acute pain syndrome (APS) or chronic pain syndrome (CPS)».

In theory, this means the following: the doctor must determine the strength pain syndrome and, if necessary, prescribe effective pain relief.

In practice, there is no clear system for the severity of pain - this is too subjective a feeling. The question of when to start using narcotic analgesics is not clearly stated in any law. This is at the discretion of the doctor. And the fight against the spread of drugs has led to the fact that in order to prescribe narcotic analgesics, a doctor needs to obtain permission from higher authorities, fill out a bunch of papers, and report for each ampoule. Not only does the process of obtaining permission and registration take a lot of time, during which the patient continues to suffer from pain, but most doctors simply do not want to deal with this. Therefore, most often - with the exception of completely indisputable cases - the doctor “does not consider” the patient’s pain to be strong enough, and in response to a request for adequate pain relief, the patient’s relatives may well hear the menacing: “What do you want - for your grandfather to become a drug addict? We’ll give him some analginic now, it’ll go away in a week.”

In this situation, you can contact your insurance company for help or write a complaint to the hospital's chief physician or health department. However, practice shows that the chances in this case are negligible.

Clause 6. Keeping confidential information about the fact of applying for medical care, about the state of health, diagnosis and other information obtained during his examination and treatment.

Only the patient can decide whether to tell their family about the diagnosis, no matter how terrible it may be. Exceptions:

threat public safety, for example, when a patient is found to have a serious infectious disease. In this case, doctors are obliged to find everyone with whom the patient had contact and examine them;
information about the health status of minors, which doctors are required to disclose to parents or guardians;
necessity urgent intervention when the patient is unconscious. In this case, doctors may ask the patient’s close relatives for consent to intervene.

Clause 7. Informed voluntary consent to medical intervention.

If the patient is unconscious and there are no close relatives nearby, the issue of urgent medical intervention is decided by a council, and if it is impossible to gather it, by the attending or duty doctor, who is subsequently obliged to notify the management of the medical institution about this.

If the question of intervention is decided on children under the age of 15, then the decision on intervention is made by his parents and also the decision on incompetent patients is made by their proxies.

Clause 8. Waiver medical intervention.

You may refuse any treatment, test, procedure, medication or surgery prescribed to you by your doctor. In this case you should be in clear language explained possible consequences. If, despite this, you do not consent to medical manipulation, the doctor has no right to insist. Exceptions:

examination and hospitalization of citizens suffering from severe mental disorders;
compulsory examination and treatment of persons who have committed socially dangerous acts;
refusal of parents or guardians to treat their child or ward - if it comes to saving his life. In this case, the hospital has the right to provide medical care and subsequently go to court to protect the interests of incapacitated citizens.

But this can only be done when it comes to saving the life of a child or an incapacitated person. Therefore, if the pediatrician at the clinic threatens you with legal action if you refuse, you can safely tell him that the need for vaccination is not related to saving a life.

Sometimes in clinics patients are forced to agree to some kind of examination, the “plan” of which was issued by a department or ministry. This happens especially often to pregnant women. It often comes to the point of outright intimidation when a doctor antenatal clinic refuses to issue an exchange card without all the required tests and scares me with a “dirty maternity hospital” - this is what doctors call institutions where they admit women in labor who do not have documents, have not been examined, or are sick with contagious diseases. In fact, not all examinations are required in mandatory. For an exchange card, it is enough to submit the required minimum on time, especially for infections, and everything else is voluntary. But the guidelines require doctors to examine patients according to full list, and the doctor, in turn, puts pressure on the patient so as not to be reprimanded. In order not to worry about this, find out in advance at the selected maternity hospital which examinations are required, and you can safely refuse all the others. The antenatal clinic has no right not to issue you an exchange card. By the way, if the doctor behaves incorrectly, you should go to the appointment with your husband or another close man - and the larger the man, the more polite the doctor behaves.

So, if you don't want a particular medical procedure, you need to sign a document called an "informed refusal" that your doctor files with your chart and details everything you refuse.

Clause 11. Compensation for damage in the event of harm to his health during the provision of medical care.

According to Article 1064 Civil Code RF, " harm caused to the person or property of a citizen, as well as harm caused to property legal entity, is subject to compensation in full by the person who caused the harm».

Compensation for harm is compensation to the victim for funds spent on restoring impaired health in connection with the provision of poor-quality medical care, as well as compensation for lost profits. In addition, the court may also award compensation for moral damages.

However, harm is recognized only as damage to the patient’s health due to the negligence of a doctor. That is, saying in simple words if the doctor prescribed incorrect treatment- this is harm, and if you did everything correctly, but it did not help, then this is fate. Human body- too much complex design, and it is often impossible to give a clear answer to the question “who is to blame?”

Therefore, you can complain and go to court. And it’s even necessary - the more such ships there are, the greater the chances that this dead system will ever move. At the moment, in our country, the degree of guilt of a doctor is determined by medical examination. Does the concept of “guild solidarity” mean anything to you?

In fact, it is possible to win a personal injury claim only in completely undisputed cases. For example, if the patient did not have hepatitis C before admission to the hospital, but it appeared at the time of discharge. Or if you forgot a napkin in your stomach during surgery.

Point 14. Direct acquaintance with medical documentation, reflecting the state of his health, and obtaining advice on it from other specialists.

The patient has every right to demand to review and make a copy of his medical card. Medical institutions often resist making copies, citing internal instructions- this is contrary to the legislation of the Russian Federation.

If the attending physician refuses to explain to you why you are being treated this way and not otherwise, or explains, but in such a way that a person without higher education can understand him medical education is impossible - you have the right to contact the head of the department, the chief of medicine, the chief physician of the clinic or hospital.

Patient rights: how to protect yourself

Theoretically, with a complaint about the quality of treatment and behavior medical personnel hospitals or clinics you can contact:

To the management of this medical institution.
To an insurance company, which is obliged not only to organize medical care for you, but also to control its quality. The insurance phone number is indicated on your compulsory medical insurance policy. In the event of your complaint, the insurance company is obliged to conduct an examination of the quality of medical care, arrange for you a consultation with an independent specialist, and give you a referral to another hospital or clinic.
If the insurance company tries to hush up your complaint and does not help you in any way, contact the territorial Compulsory Medical Insurance Fund or the Department of Health.
If these actions do not bring results, you can contact the appropriate professional medical associations or .

In practice, everything should be done a little differently. It’s sad, but your main weapon is a strong scandal. Polite, quiet patients in hospitals are not treated worse, they are simply not noticed. They don’t like scandalous people, but they are afraid of them. In the end, there are not many people who can stand up for themselves - so it’s easier for doctors to meet them than to later deal with the consequences of numerous complaints. It is especially effective to call the insurance company with a complaint directly in the presence of the attending physician or the head of the department. As a rule, after this the situation changes dramatically for the better.

Don’t be afraid to complain - now the healthcare system undergoes periodic scheduled purges, and doctors are very afraid of them.

If you don’t know how or can’t make a scandal yourself, involve your relatives. In general, relatives, especially loud, meticulous ones, constantly asking the doctor about your health, are a real strength. Especially if the patient is seriously ill and helpless.

However, when starting a scandal, think carefully: is the doctor really not fulfilling his duties? Or did it just seem that way to you? Don't nitpick over little things - this will just have the opposite effect. But if we are talking about serious things, don’t be afraid to stand up for yourself!