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General doctor - description, doctor's advice

1. Organization of primary medical care on the principle of a general practitioner (family doctor).Forms of organization in general medical practice.

General doctor ( family doctor) - a doctor who has undergone special multidisciplinary training in providing primary health care to family members, regardless of their gender and age.

A specialist who has mastered the training program in accordance with the requirement of a qualification characteristic and has received a certificate is appointed to the position of a GP. A general practitioner (GP) provides outpatient appointments and home visits, providing emergency care, carrying out a complex of prevention, treatment, diagnostic and rehabilitation measures, assistance in solving medical and social problems of the family.

On a contractual basis, GPs (GPs) can be assigned hospital beds. He also organizes hospital at home, day hospital.

The procedure for carrying out the activities of a general practitioner (family doctor) is established by the federal executive body in the field of health care and executive bodies of the constituent entities of the Russian Federation. ( Art.59. “Fundamentals of legislation on protecting the health of citizens, ed. Federal Law dated August 22, 2004 No. 122-FZ).

A general practitioner must have knowledge both in the field of medicine and in other related specialties - psychology, sociology, social medicine, health economics, prevention, etc. His main task is to protect the health of the families he serves, provide primary health care, and treat patients independently depending on their age and type of disease.

The main function of a general practitioner is to provide multidisciplinary outpatient care to the population in accordance with the requirements of the qualification characteristics and the received certificate.

A general practitioner must have a basic therapeutic education, but since the scope of his activities is significantly expanding, he must have knowledge in related specialties and possess practical skills to implement various diagnostic and treatment methods currently performed by narrow specialists in outpatient clinics.

One of essential functions general practitioner is early detection latent forms of the disease, the implementation of dynamic monitoring of the health status of patients with the necessary medical and recreational activities and the involvement of specialists from various medical institutions for this purpose.

An important section of the activity of a general practitioner is the examination of temporary disability, rational employment, and if there are signs of permanent disability, timely referral to the ITU.

In the activities of a general practitioner, a significant role should be given to disease prevention, the organization of medical and social assistance to the lonely, the elderly, the disabled, the chronically ill (together with the social protection authorities, charitable organizations, and mercy services). General practitioners should know the current legislation on social protection of these contingents.

Among the main functions of a general practitioner, it is also necessary to note the provision of advice to the family on feeding, raising children, immunoprophylaxis, family planning, ethics and mental hygiene of family life.

An integral part of the work of a family doctor is the maintenance of approved accounting and reporting documentation.

Forms of organization of general medical practice: Solo practice and group practice.

Solo practice it is advisable to use mainly in rural areas.

Group practice the most expedient form should be considered in cities (guidelines developed by NPO Medsotsekonominform and approved by the Ministry of Health of the Russian Federation). It makes it possible to more rationally organize the work of a doctor and more fully meet the needs of the population in medical care. In this case, general practitioners work in a territorial clinic. They receive patients, use the services of consultants - specialists, treatment and diagnostic rooms of the polyclinic (laboratory, x-ray, functional diagnostics rooms, physiotherapy rooms, etc.).

In order to make medical care more accessible to the population in certain areas, it is possible for polyclinics to organize separate offices for general practitioners. It should be considered preferable if the physician resides within the service area.

A general practitioner may be a private practitioner and serve the attached population under an agreement with a medical institution.

2. Rights, duties and responsibilities of GPs.

Rights of a general practitioner:

Monitoring the work of employees subordinate to him;

Based on the terms of the agreement (contract), the acquisition, ownership and disposal of real estate;

Concluding contracts for the provision of medical services within the framework of compulsory and voluntary health insurance programs with any organizations, enterprises, institutions, insurance companies in the prescribed manner;

Receiving payment for medical services not provided for by the terms of the contract, on the basis of an additional agreement;

Use of medical institutions to improve one’s qualifications under the terms of a contract with payment, both at the expense of the employer and at one’s own expense;

Conducting an examination of the quality of medical care provided to the patient by other specialists.

Responsibilities of a general practitioner:

Providing primary health care to the population in accordance with the received certificate;

Sanitary education work (propaganda healthy image life);

Preventive work (timely detection of early and latent forms of diseases, risk groups);

Dynamic observation;

Rendering urgent help in emergency and acute conditions;

Timely consultation and hospitalization in accordance with the established procedure;

Medical and rehabilitation work in accordance with qualification characteristics;

Conducting an examination of temporary disability in accordance with the Instruction “On the procedure for issuing certificates of incapacity for work and referral to medical examination”;

Organization of medical, social and household assistance together with social protection authorities and charity services for the lonely, elderly, disabled, and chronically ill;

Providing advisory assistance to families on issues of immunoprophylaxis, feeding, raising children, preparing them for preschool institutions, school, career guidance, family planning, ethics, psychology, hygiene, social and medical-sexual aspects family life;

Maintaining approved forms of accounting and reporting documentation.

The general practitioner is responsible within the limits of your rights:

For an independent decision;

For illegal actions or inactions that resulted in damage to the health or death of the patient, in accordance with the procedure established by law.

3. Qualification requirements for a general practitioner. The general practitioner must:

Know the basics of legislation on protecting public health, the structure and basic principles of healthcare, rights, duties, responsibilities, be able to plan and analyze your work, know the principles of cooperation with other specialists and services (social service, insurance company, doctors’ association, etc.) ;

Know and comply with the principles of medical ethics and medical deontology;

Master the following types activities and corresponding personal tasks: prevention, diagnosis, treatment of the most common diseases and rehabilitation of patients; provision of emergency and emergency medical care; performing medical procedures; organizational work.

When carrying out prevention, diagnosis, treatment of diseases and rehabilitation of patients , the general practitioner must be able to independently examine and evaluate physical examination data of patients; draw up a plan for laboratory and instrumental examinations; master the principles and methods of prevention and treatment of the most common diseases and rehabilitation of patients; timely organize further examination, consultation and hospitalization, etc.

A general practitioner monitors a patient for the following diseases : internal diseases, surgical diseases, diseases of the female genital organs, infectious diseases, tuberculosis, diseases nervous system, mental illness, skin and venereal diseases, diseases of the upper respiratory tract, eye diseases, allergic pathology.

When providing emergency (emergency) medical care, a general practitioner should be able to independently diagnose and provide emergency (emergency) care at the prehospital stage with the following emergency conditions: shock, fainting, collapse, coma, acute respiratory, heart failure, laryngeal edema, false croup, status asthmaticus, hypertensive crisis, bleeding, appendicitis, drowning, fractures, etc.

When performing medical procedures, a general practitioner must be able to perform all types of injections independently; carrying out intradermal tests; determination of blood group; conducting and ECG interpretation; spirometry; manipulations for emergency care (intracardiac administration of drugs, artificial respiration, aspiration methods, indirect massage hearts); surgical manipulations (biopsy, punctures, probing, anesthesia, primary treatment of wounds, burn surfaces, bandaging, immobilization, opening of abscesses, etc. in all specialties).

When carrying out organizational work , the general practitioner must know the demographic and medical and social characteristics of the attached contingent. Promote a healthy lifestyle, conduct hygiene education, anti-alcohol propaganda, etc.; give recommendations on feeding, hardening, preparing children for preschool institutions, career guidance, etc.; provide counseling on family planning, ethics, medical and sexual aspects of family life, etc.; carry out anti-epidemic and therapeutic measures; carry out work to identify early and latent forms of diseases and risk factors; to organize the whole complex of diagnostic, health-improving and rehabilitation measures; diagnose pregnancy and monitor the course of pregnancy, treat extragenital diseases, identify contraindications to pregnancy, refer to termination of pregnancy, know the management of the postpartum period.

Together with authorities social security and mercy services, to organize assistance to the lonely, the elderly, the disabled and the chronically ill, incl. for care, placement in boarding homes, etc.

Conduct an examination of temporary disability, refer to the ITU, transfer to light work; be able to analyze the health of the attached contingent, correctly maintain accounting and reporting documentation.

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?

The difference in the actions of district police officers and GPs can be shown using examples from existing work experience. A woman came to the appointment complaining of a lump in her breast. Upon palpation, a round, painless formation is determined. In this case, the district police officer will send you to a surgeon or gynecologist, while the GP will immediately send the patient for a mammogram, and if a tumor is detected, to an oncologist. Another situation is a man complaining of headaches, ringing in the ears, unsteadiness of gait, deterioration of hearing and memory. The therapist passes it on to the neurologist. The family doctor himself refers the patient to duplex scanning arteries and for tests. The study determines a critical narrowing of the internal carotid artery, responsible for the blood supply to the brain. A man goes for a consultation vascular surgeon to resolve the issue of surgery. After consultation and passing all the tests, the GP sends him for hospitalization.

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 dated February 2017, the offices of general practitioners must be equipped with a tourniquet to stop bleeding, a 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?

The retraining program consists of educational modules on internal medicine, neurology, ENT diseases, surgery, skin and infectious diseases. Training, which involves both full-time and distance learning, is divided into theory and practice. The regular program is designed for 864 hours (study period is six months), but there is also a shortened one - 504 hours (about four months).

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 now take to see a doctor?

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: won’t the quality of medical care worsen with the advent of doctors with universal specialties? 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 the help of highly specialized doctors is not always available, family doctors will be in first demand.

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The Ministry of Health informs: in Belarus in 2020 there will be no local therapists in clinics; they will be completely replaced by general practitioners. And medical officials will most likely keep their word. In 2017, about 40% of local doctors retrained as general practitioners (GPs). It is expected that in the capital in 2018, 60% of local therapists will become GPs, in 2019 - 75%, in 2020 - 100%. The question arises: why is this necessary? A correspondent from the Minsk-Novosti agency was looking for an answer.

- General medical practice is a modern organization of local medical service,- said the chief therapist of the Ministry of Health of the Republic of Belarus Alexander Verbovikov. - In this connection, in city clinics the existing therapeutic departments will be renamed into general medical practice departments. This won't just be a sign change. This means retrofitting doctors’ offices and bags with modern electronic tonometers and thermometers, portable electrocardiographs and other medical equipment. Each doctor will have a computer installed at his or her workplace, connected to the clinic’s database.(in the capital, almost all workplaces of local therapists are equipped with computers, in the regions - not yet. - Note auto). In computer - full information about the patient with his hospitalizations, prescribed treatment, medications taken. There are also the results of laboratory, instrumental, ultrasound, and radiographic studies.

GP has basic skills in ENT diseases

Three years ago, only six general practitioners worked in Minsk - at outpatient clinic No. 1 in Sukharevo, the villages of Sokol and Sosny. Now in the 39th city clinic there is a department of general medical practice of the Belarusian State medical university. This is where the capital's local therapists undergo retraining.

A GP is a generalist doctor with basic knowledge in neurology, endocrinology, cardiology, surgery, and otorhinolaryngology. This doctor's bag contains a portable electrocardiograph, a neurological hammer, a glucometer, a portable otoscope, and an electronic tonometer.

- In Rus' there was a zemstvo doctor who knew how to do everything,- added Lyudmila Lugovets, head of the primary health care department of the Health Committee of the Minsk City Executive Committee. - Both as a neurologist could look at the patient, and as a cardiologist. What now? The patient complains to the doctor that his back hurts, he refers him to a neurologist, so he can sort it out.

They started expanding the powers of local therapists in the capital two years ago: they organized a series of seminars, practical classes, tests in neurology, endocrinology. Due to which patients with diabetes mellitus, for example, were completely transferred to local therapists. With basic knowledge of neurology, these doctors are also quite capable of providing advice and assistance. medical care patients. Only diagnostically complex patients are referred to neurologists and endocrinologists.

- We analyzed the work of general practitioners in the capital - the patients are very satisfied,- noted L. Lugovets. - During one visit, a person receives advice from several specialists in one person. If the case is complex, you need additional examination or an examination of a specialist colleague, the doctor will write a referral. And doctors like to work in a new way, their self-esteem has increased.

Marina Dreyling: everything you need for work is at hand

...Marina Dreyling, a general practitioner at the 39th city clinical clinic, explained that she personally is interested in working.

“I don’t remember any patients complaining.” For us, local service doctors, this fact is especially important. There are no queues for me,- she said.

As for the workload, according to the standards in the city, one GP is assigned 1,700 patients, and in rural areas - 1,300. On average, one person is given 15 minutes to see each other.

For information

From January 24, 2018, outpatient clinic No. 1 in Sukharevo was reorganized into the general medical practice department of the 10th city clinic.

Photo by Sergei Sheleg

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 look into 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 means primarily an ENT, an ophthalmologist, a gynecologist.

Although, of course, a general practitioner needs to know the basics of surgery, neurology, and many other specialties, not to mention the "narrow therapeutic" - 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.

Concerning this opinion it is possible to tell rather confidently - it is absolutely unreasonable. "General practitioner" is in the plan medical science return somewhere like the beginning of the 19th century in best case scenario. Because already by the middle of this century, even therapy began to be rapidly divided into subsections, specializing in which scientists moved science forward much faster than before.

Another thing is that within the framework of the "market economy", say, a small town - no matter where it is located - whether in Europe, in Russia - could not feed an entire polyclinic of narrow specialists. Therefore, local doctors had to be jacks of all trades.

In Russia real revolution in this area came only after the revolution, when the People's Commissar of Health of the USSR Semashko organized, as before, unique even for most developed Western countries system of public outpatient care. 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 at medical institutes. theoretical disciplines, then the study of clinical subjects begins. 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.

A general practitioner is also known as a family doctor. His responsibilities can be compared to those of a therapist, but his range of actions and knowledge is much wider.
His areas of expertise include the diagnosis and treatment of surgical and neurological diseases in patients of all ages and genders.

What is the competence of this specialist?

Examination and consultation of all family members in all areas of medicine. The involvement of specialists with narrow qualifications for consultations occurs only in exceptional cases.
At the first appointment, the general practitioner gets acquainted with full history the patient’s disease, studies it, conducts a thorough diagnosis, and based on the results of these actions, begins work to prevent and prevent pathologies to which the patient is prone.

Responsibilities of a family doctor

monitor and prevent cancer pathologies;
help prevent weight problems;
observation of pregnant women and much more.

When to contact a general practitioner?

It is worth contacting if you feel constant fatigue, discomfort, heaviness in internal organs and pain in any part of the body. For example, habitual headaches, which many are accustomed to consider normal and attribute to fatigue, age and lack of sleep, can be a signal for the development of serious illnesses, such as meningitis or. Absent-mindedness, inattention, fatigue, memory impairment are often consequences of problems in the cervical spine;
The following symptoms should not be ignored:

Unreasonable weight loss. If you suddenly and inexplicably lost weight - without changing your diet or exercising yourself - then it's time to sound the alarm, despite the fact that for many people losing weight is a cause for celebration. The cause of sudden weight loss may be stomach cancer or (in women) ovarian cancer;
A sharp decrease in sensitivity skin, unclear speech, ringing in the ears, an unnaturally curved mouth when trying to smile and attacks of weakness - all this warning signs of stroke. In most cases, when providing timely assistance it can be avoided and prevented severe consequences for the brain;
Black color of the chair. Perhaps one of the most serious symptoms. The reason for this process is most likely gastrointestinal diseases– ulcer, . Another reason for black bowel movements is internal bleeding, which is very dangerous in itself. If black stool occurs, you must immediately consult a doctor to identify and prevent the disease;
Sudden, intense that you have not experienced before. This is rare, but it can still serve as a sign of an aneurysm or cerebral hemorrhage, so delaying visiting a doctor in this case is unacceptable;
Severe pain in the neck, moving to the head and accompanied by fever. Such symptoms can arise as a result of the development of bacterial meningitis, therefore, if they occur, contacting a doctor should be as soon as possible in order to promptly prevent the disease, bacterial meningitis on early stage treated with antibiotics.

List of required tests

A list of analyzes will be provided to you after initial examination general practitioner.

Most often, you need to take tests:

general blood and urine analysis;
feces to detect the presence of helminths;
ejaculate for spermogram;
analysis on hormonal research;
blood for the study of antibodies to the hepatitis C virus;
taking material from the urogenital tract for research;

Other tests may also be prescribed, depending on what pathology is suspected in the patient.

Types of diagnostics that a general practitioner can perform?

Fluorography;
Electrocardiogram;
Ultrasonography;
Electroencephalography;
echocardiography;
echoencephaloscopy;
X-ray;
Mammography;
Colposcopy;
Magnetic resonance imaging;
.

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