home Calculators General doctor. How does a general practitioner differ from a family doctor?

General doctor. How does a general practitioner differ from a family doctor?

In the municipal health care of the city of Ulyanovsk, the formation of a general practitioner institute began in 2005.
A general service has been created family practice, which is primarily aimed at improving the primary medical care. Deputies of the city parliament fully support the initiative of the municipal government. The State Revenue Service receives many requests from citizens in which they ask for comment on this innovation. At one of the last meetings of the Committee on Social Policy and local government The issue of general practitioners' offices was considered comprehensively.
Commented on what the responsibilities of a general practitioner are: chief physician City clinic No. 5, UGD deputy Vladimir Levanov.
— Tell us, who are general practitioners and what are their responsibilities?
— A general practitioner is a generalist who has the skills of a specialist, which allows him to treat and examine patients with the most common diseases. He not only treats patients, but also delves into their psychological problems, is responsible for the ongoing therapeutic and preventive measures.
Prevention is the prevention of emerging health problems. By observing older family members, the doctor has the opportunity to prevent or reduce the risk of developing the disease in the younger generation.
— In your opinion, where are general practitioner offices most in demand?
— Today, the most pressing issue is the provision of medical services in remote areas of the city, where there is the greatest need for doctors. This happens due to a lack of specialists.
If general practice offices open in areas remote from the city center, the problem will be solved. A general practitioner is able to provide qualified medical care not only in the therapeutic profile, but also in narrow specialties. However, without modern diagnostic equipment, the functioning of general practitioners’ offices in rural areas difficult. Therefore, such departments are formed on the basis of clinics to improve the population’s access to quality medical care. Special attention This issue is given attention in the Ministry of Health of the Ulyanovsk Region, in the Committee on Social Policy and Local Government of the Ulyanovsk City Duma.
— How does a local therapist differ from a general practitioner? Why is it that in a clinic where there are specialized specialists, the appointment is conducted by a general practitioner?
— If you have health problems, of course, you will go with them to your local therapist, or better yet, to your general practitioner.
To his level vocational training very high demands are made. It is the general practitioner, thanks to his multidisciplinary knowledge, who is able to make a preliminary diagnosis. What research should be carried out first, to which specialist and when to refer the patient - these are issues within his competence. A general practitioner sees the big picture. His responsibilities include not only general examination, but also carrying out narrow-profile examinations, which makes it easier to carry out comprehensive examinations by one specialist, including when registering with the Bureau of Medical and Social Expertise.
General practitioners have the opportunity not only to examine the patient, but also to perform a number of medical procedures: selection of glasses, rinsing ear canal, measurement intraocular pressure, ECG. He gives full consultation in treatment. All this reduces the patient’s time in a medical facility and increases the availability of medical care.
A general practitioner can be a therapist with solid experience and long-term work experience, which allows him not only to get closer to the essence of the disease, but also to learn to “feel” the patient.
— How many general practitioners’ offices fully serve patients today?
— In 2005, the first department of general practitioners was opened in city clinic No. 5, which successfully receives patients to this day.
Today in Ulyanovsk there are 8 departments of general practitioners. For the local population, for the convenience and accessibility of older people on December 1 at the base day hospital Polyclinic No. 5 opens a new additional office of a general practitioner. Another 17 are planned to open in the city in 2012.
Thus, at the end of 2014 there will be 41 offices medical practice, including 76 doctors and 107 nurses, which will serve 161 thousand people.
You can ask all questions you have about the work of general practitioners’ offices on the website

Zhanna Valentinovna Dorosh, Candidate of Medical Sciences, Associate Professor of the Department of Therapy and Family Medicine of the Russian National Research Medical University named after. N.I. Pirogova, chief physician of the 2nd clinical department of the Medicine clinic.

What does a family doctor do? How is he different from a therapist?

A family doctor or general practitioner provides medical care outpatient stage. This is a clinic, the primary link that a person who seeks medical help encounters. The main difference between a family doctor and a therapist is the amount of what he can do with his hands. Manipulation is within his competence.

If the therapist has two weapons - a phonendoscope and a tonometer, then the general practitioner has otoscopy, rhinoscopy, and laryngoscopy. That is, he can look at the ear, throat, nose, and can look at the fundus of the eye. He carries out some diagnostic minimum for narrow specialists. He can register and decipher an electrocardiogram, maybe, if we are talking about the outback, and not major cities, do primary processing wounds, apply plaster.

What education should a family doctor receive?

For a family doctor there is a basic education - medical school or a university where everyone who graduates receives a diploma, no matter whether it is a general practitioner or a pediatrician. After this there must be either a residency in internal medicine or therapy, or pediatrics, or internship, if the education was received some time ago. Then the doctor can undergo initial retraining in the specialty “General Medical Practice (Family Medicine).” Another option is to go immediately after completing basic education at the institute to a residency in this specialty.

How many family doctors are there in Russia?

If we talk about how many family doctors there are in Russia now, this figure will be close to the number of general practitioners. There is a retraining program in which therapists who provide primary care outpatient care in Moscow and the surrounding regions, they are now being retrained and transferred to the positions of general practitioners and family doctors, depending on where they will work. This figure is constantly changing, the number of such specialists is growing.

How does a family doctor work?

The area assigned to the general practitioner is somewhat smaller than the area of the therapist. Depending on where the family doctor works, this is no more than 1800 attached. If we are talking about Moscow, then here the doctor does not see children, they remain under the supervision of pediatricians, so only adults are assigned to the general practitioner. The observation system remains the same as that of a local therapist. If the doctor is on vacation, then his place is taken by a part-time doctor who, during the vacation of your immediate supervisor, is responsible for what happens in his area.

The duration of leave for a family doctor is the same as for a general practitioner. The system for calling a family doctor to your home is also no different from the system for a local therapist. Home visits are carried out by the doctor on duty, not a therapist or general practitioner, who works on site and, if there is no operational need for this, he may not attend the call. If there is a need to visit a patient at home, then he can go on call during non-working hours after the end of the appointment.

What to do if your family doctor cannot make a diagnosis or you need to consult a specialist doctor?

This is a matter of competence of the general practitioner. You should always understand that the higher the level of professionalism of a family doctor, the less he will need consultations from other specialists. And only if highly professional questions arise, the patient will be referred to medical institution which provides specialized assistance.

For example, if a patient arterial hypertension or hypertonic disease, then these nosological units can be treated by both cardiologists and therapists. There are practically no indications for a patient to be referred to a cardiologist with such a diagnosis. Good Family doctor can carry out this level of examination and manipulation.

If the patient has, then at some stage when he needs surgical intervention, of course, the general practitioner will send the patient to see a specialist. If the family doctor feels that he cannot cope with the clinical situation, then the treatment he provides is ineffective, he can ask for help from a specialist and send the patient for consultation. This right remains, and general practitioners exercise it.

If a family doctor looks at the fundus of the eye and sees pathology there, he is obliged to send the patient to a specialist. If a doctor sees a pathology during otoscopy, he is obliged to assess how critical it is for the patient. He will leave some patients under his supervision in accordance with his competence, and send some to a specialist.

The level of competence of a general practitioner is prescribed regulatory documents. These documents are in a state of constant development and are being discussed. They are directly related to what a doctor can do with his hands and see with his eyes.

This doctor is also called a family doctor. Essentially, this is the same local therapist, but with a wider range of knowledge and capabilities.

He diagnoses and treats patients with surgical and neurological problems regardless of their gender and age.

(see also Family doctor)

What is the responsibility of a General Practitioner?

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

During the 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, with which vascular spasms are closely associated, causing disruption of the 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 of TORCH - infections, serological blood tests, and Antibodies to the 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 rest with the whole family: in summer - swimming, in winter - sledding or hiking, in spring and autumn - cycling. The day will pass without illness if you take with you light breakfast 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.

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State budgetary educational institution
higher professional education
"Stavropol State Medical University"
Ministry of Health of the Russian Federation

GENERAL

MEDICAL PRACTICE
(FAMILY MEDICINE)
(educational manual)

Stavropol

UDC 614.255.004.14 (07)

BBK51.1 (2Ros),2ya73 0 28

Compiled by:

Doctor of Medical Sciences, Professor Valentina Nikolaevna Muravyova - Rector of St. State Medical University, Head of the Department of Healthcare Organization, Economics and Social Work,

Doctor of Medical Sciences Frantseva Victoria Olegovna - Head of the Department of Health Management and Economics, Vice-Rector for Additional Studies vocational education and medical work,

Doctor of Medical Sciences Bayda Alexander Petrovich - Head of the Department of General Medical Practice,

Ph.D. Klimenko Tamara Vashyevna - Associate Professor, Department of General Medical Practice,

Ph.D. Maksimenko Lyudmila Leonidovna - Associate Professor of the Department of Healthcare Organization, Economics and Social Work,

Livanova Natalya Lvovna - Senior Lecturer at the Department of Healthcare Organization, Economics and Social Work.

Reviewers:

head of department public health and health care of St. State Medical University, professor ON THE. Shibkoe; Chief physician of the State Budgetary Healthcare Institution “City Clinical Clinic No. 1” of the city of Stavropol, Ph.D. V.V. Brusneva.

O 28 General medical practice (family medicine). Educational and methodological manual. Stavropol: St. State Medical University Publishing House; 2014. -36 p.

The educational manual presents the definition and objectives of the specialty “General Medical Practice / Family Medicine”, models for organizing general medical practice, as well as functional responsibilities general practitioners are described official requirements to the volume of medical care that general practitioners should provide in order to ensure it to the maximum High Quality and economic efficiency. The teaching aid allows students to better prepare for practical classes and gain greater knowledge about the financing of general practice, the breastfeeding system and the criteria for assessing the performance of a general practitioner. The materials in the manual can be used by students to master the subject in preparation for practical classes and exams.

UDC 614.255.004.14 (07) BBK 51.1 (2Ros),2ya73 0 28

Medical University, 2014

GENERAL 1

MEDICAL PRACTICE

(FAMILY MEDICINE)
(educational manual) 1
Main characteristics of general medical practice
(family medicine) 7

1.Definition of the specialty “General Medical Practice (Family Medicine)”, its goals and objectives 7

Organization of general medical practice 12

1. Models of organizing general medical practice 12

2. Standards for the size of the population attached to general medical practice ( family medicine) 13

3.Structure and equipment of the department and center of general medical (family) practice 13

4.Functions of a general practitioner (family doctor) 14

5. Interaction of general practitioners with doctors of “narrow” specialties 15

6. Interaction between the general practitioner (family doctor) and the service social protection 15

7.Work of a general practitioner (family doctor) with a population of 18

8.Functions nurse general practitioner 19

Financing of general medical (family) practice 21

1. Financing options for general medical practice 22

2. Rational payment systems for doctors

general practitioners (family doctors) 23

Performance evaluation criteria

activities of a general practitioner
(family doctor) 24

Regulatory documents regulating

activities of a general practitioner (family doctor) 29

Basic concepts used in this manual 30

Literature 33

Introduction

The World Health Organization (WHO) is considering primary health care(PHC) as one of the leading tools for achieving a health for all strategy. Carrying out main function healthcare system and being its central link, primary health care is an integral part of the entire process of socio-economic development of society.

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.

What diseases does a General Practitioner treat?

Oncological pathology, atherosclerosis, metabolic syndrome, obliterating vascular diseases of the lower extremities, excess weight.

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 can be blocks in the cervical vertebrae, with which vascular spasms are closely associated, causing a disruption in the 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.

2. Slurred speech, paralysis, weakness, ringing in the ears and stiffness of the limbs are all signs of an impending stroke. If the necessary treatment is provided promptly, 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 dangerous diseases such as ulcers or stomach or intestinal cancer. Stools become black in color as a result of 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 high fever. These symptoms may be caused by a serious illness such as meningitis. If you have a very high fever and severe 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 have never experienced a headache of this magnitude before, do not hesitate to 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 blood test, Antibodies to hepatitis C virus (anti-HCV), complete blood count with ESR, hematological blood test, blood group, Rh factor, antibodies to Rh factor, biochemical blood test , 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 of the 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, chest X-ray, MRI, CT, mammography.

It is important to take care not only of your cardiovascular health, but also of 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. You will have a stress-free day if you take a light breakfast with you and treat yourself to some healthy food after a good workout.

2. Exercise together

3. Remodel the family room in your apartment

4. Make chores fun

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 engage in healthy habits, such as physical activity.