Doctor pdo. Family doctor

General doctor

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

General practitioner (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) performs outpatient appointments and home visits, provides emergency care, conducts a complex of prevention, diagnostic and rehabilitation measures, and assists in solving medical and social problems of the family.

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

The procedure for carrying out the activities of a general practitioner (family doctor) is established by the federal executive authority in the field of health care, executive authorities of the subjects Russian Federation. ( Art.59. "Fundamentals of legislation on the protection of the health of citizens, as amended. Federal Law of 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 families served, provide primary medical care, and treat patients independently. on their age and type of disease.

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

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

One of the most important functions of a general practitioner is the early detection of latent forms of the disease, the dynamic monitoring of the health 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: single practice and group practice.

solitary 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 polyclinic. 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 the GP.

Rights of a General Practitioner:

Supervision of the work of subordinate employees;

On the basis of the terms of the agreement (contract) acquisition, possession and disposal of real estate;

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

Receipt of payment for medical services not covered by the terms of the contract on the basis of an additional agreement;

The use of medical institutions to improve their skills on the terms of an agreement with payment, both at the expense of the employer and at their 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 medical and social assistance to the population in accordance with the received certificate;

Sanitary and educational work (propaganda of a healthy lifestyle);

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

Dynamic observation;

Providing urgent assistance in urgent and acute conditions;

Timely consultation and hospitalization in the prescribed manner;

Medical and rehabilitation work in accordance with the qualification characteristics;

Conducting an examination of temporary disability in accordance with the Instruction "On the procedure for issuing sick leave certificates and referral to the ITU";

Organization of medical, social and household assistance, together with social protection agencies and mercy services, for lonely, elderly, disabled, chronically ill;

Providing advice to the family 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 of family life;

Maintaining approved forms of accounting and reporting documentation.

The general practitioner is responsible within their rights:

For an independent decision;

For illegal actions or omissions that caused damage to the health or death of the patient, in the manner prescribed by law.

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

Know the basics of public health legislation, 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, association of doctors, etc.) ;

Know and follow the principles of medical ethics and medical deontology;

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

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

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

When providing urgent (emergency) medical care, a general practitioner should be able to independently diagnose and provide emergency (emergency) care at the prehospital stage in 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 should be able to independently perform all types of injections; carrying out intradermal tests; determination of the blood group; carrying out and interpretation of an ECG; spirometry; manipulations for emergency care (intracardiac drug administration, artificial respiration, aspiration methods, chest compressions); surgical manipulations (biopsy, punctures, probing, anesthesia, primary treatment of wounds, burn surface, dressing, 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.; to carry out anti-epidemic and health-improving 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; to 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 social security authorities and mercy services, to organize assistance to the lonely, the elderly, the disabled and the chronically ill, incl. care, placement in boarding schools, etc.

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

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

What is the scope of this specialist?

Examination and counseling of all family members in all areas of medicine. Involvement of narrowly qualified specialists for consultations occurs only in exceptional cases.
At the first appointment, the general practitioner gets acquainted with the patient's complete medical history, 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 the family doctor

• to observe and prevent oncological pathologies;
• help prevent weight problems;
• monitoring of pregnant women and much more.

When to contact a general practitioner?

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

• Unreasonable weight loss. If you've 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 an occasion for joy. The cause of dramatic weight loss may be stomach cancer or (in women) ovarian cancer;
• A sharp decrease in the sensitivity of the skin, fuzzy speech, ringing in the ears, an unnaturally twisted mouth when trying to smile, and bouts of weakness - all this harbingers of a stroke. In most cases, when timely assistance is provided, it can be avoided and severe consequences for the brain can be prevented;
• black chair color. Perhaps one of the most serious symptoms. The reason for this process is most likely gastrointestinal diseases - an ulcer,. Another reason for black bowel movements is internal bleeding, which is very dangerous in itself. If a black stool occurs, it is necessary to urgently consult a doctor to identify and prevent the disease;
• Sudden, intense that you have not experienced before. This is rare, but it can still be a sign of an aneurysm or cerebral hemorrhage, so it is not permissible to delay visiting a doctor in this case;
• Severe pain in the neck, passing to the head and accompanied by fever. Such symptoms can occur as a result of the development of bacterial meningitis, therefore, if they occur, a visit to the doctor should be as soon as possible in order to prevent the disease in a timely manner, bacterial meningitis is treated with antibiotics at an early stage.

List of required tests

A list of tests will be provided to you after the initial examination by a general practitioner.

Most often, you need to take tests:

• general analysis of blood and urine;
• 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 ordered, depending on what pathology is suspected in the patient.

Types of diagnostics that a general practitioner can perform?

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

VIDEO

It is important to take care not only about the health of your body, but also about healthy relationships between generations.

• Don't forget to be active.
  Spend at least one day on the weekend for an active holiday with your family: in winter, go sledding, skiing, skating, play snowballs and make snowmen; in summer - play ball, swim, rollerblade, play catch-up; in spring and autumn, you can arrange bike rides, clean up the garden. And if you take a light snack with you to nature, you will get a full-fledged picnic after a good physical activity. Joint walks and training strengthen mutual understanding between all family members;
• Play sports with your kids.
  Find a gym (or yoga/aerobics center) where you can work out in the same room as your kids. If your child is still small for such activities, you can simply arrange long walks or ride a bicycle with him, jump on a trampoline or jump rope. If you don’t have children yet, then there are joint classes for couples, and even for owners and their dogs - “dog yoga”;
• Change your family lifestyle.
  You can start with small changes in the common TV room, which is usually perceived by family members as a corner of laziness. Together with the household, make a schedule for watching TV with a time limit for everyone, limit the time that children spend at the computer. Distribute free time so that most of it family members are on the move. Find a joint activity that you will do together at least once a day;
• Turn household chores into an outdoor game.
  Instead of boring apartment cleaning, arrange competitions in the speed of cleanliness or races with brooms and vacuum cleaners; replace washing dishes with washing off the golden sand that is hidden under the last dirty plate. Do all the chores around the house to the music, dance, sing with the children, let them feel that they are doing an important and at the same time fun thing;
• Pay attention to your diet.
  There is some relationship between what a person eats and his lifestyle. Families whose diet is balanced and healthy have more healthy habits, such as daily exercise and general activity during the day. Proper nutrition provides maximum energy and minimum extra calories. Adjust your family's meal plan to be as healthy as possible.

GENERAL

MEDICAL PRACTICE
(FAMILY MEDICINE)
(educational manual)

Stavropol

UDC 614.255.004.14 (07)

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

Compiled by:

MD, Professor Valentina Nikolaevna Muravieva - Rector of SSMU, Head of the Department of Health Organization, Economics and Social Work,

MD Frantseva Victoria Olegovna - Head of the Department of Health Management and Economics, Vice-Rector for Additional Professional Education and Medical Work,

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

PhD Klimenko Tamara Vasshievna - Associate Professor of the Department of General Medical Practice,

PhD Maksimenko Lyudmila Leonidovna - Associate Professor of the Department of Health Organization, Economics and Social Work,

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

Reviewers:

Head of the Department of Public Health and Healthcare, SSMU, Professor ON THE. Shibkoe; chief physician of the City Clinical Polyclinic No. 1 of the city of Stavropol, Ph.D. V.V. Brusnev.

About 28 General practice (family medicine). Teaching aid. Stavropol: Publishing house of StGMU; 2014. -36 p.

The training manual presents the definition and objectives of the specialty "General Medical Practice / Family Medicine", models for organizing general medical practice, as well as the functional responsibilities of general practitioners, describes the official requirements for the amount of medical care that general practitioners must provide in order to ensure its highest quality and economic efficiency. The study guide allows students to better prepare for practical classes and acquire deeper knowledge about the financing of general medical practice, the system of payment for a lump, and the criteria for evaluating the performance of a general practitioner. The materials of the manual can be used by students to master the subject in preparation for practical exercises and exams.

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

© Stavropol State

GENERAL 1

MEDICAL PRACTICE

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

Organization of general medical practice 12

1. Models of organization of general medical practice 12

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

3.Structure and equipment of the department and the 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 a general practitioner (family doctor) and the social protection service 15

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

8.Functions of a nurse of a general practitioner 19

Financing of general medical (family) practice 21

1. Funding options for general practice 22

2. Rational payment systems for doctors

Criteria for evaluating effectiveness

Normative documents regulating

Basic concepts used in this manual 30

Literature 33

Introduction

When we find out that our new acquaintance is a doctor by profession, we are always interested: what is the doctor's specialty? And when we hear in response: a general practitioner, we are perplexed, what kind of doctor is this, and whom does he treat, that he knows what he can, whether it is bad or good. At the same time, over the past 20 years, general medical practice has taken its place in Russia, has become a common practice, at least with the use of the name - family medicine. Is it introduced into our medical culture? Where did its origins come from? These questions are answered by the history of medicine, in which the practice of a family doctor is rooted in deep and not very antiquity.

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

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

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

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

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

During the initial appointment, the doctor carefully examines the patient's medical history and conducts a thorough diagnosis. After that, he works to reduce or eliminate the risk of developing pathologies to which the patient is prone.

What diseases does a General Practitioner deal with?

Oncological pathology, atherosclerosis, metabolic syndrome, obliterating diseases of the vessels of the lower extremities, overweight.

When to contact your General Practitioner:

The first symptoms are discomfort, a feeling of fatigue, inconvenience, a feeling that in some place you are pulling, pressing. The cause of frequent and seemingly causeless headaches can be blocks in the cervical vertebrae, with which vascular spasms are closely associated, causing a violation of the outflow of blood from the head. All this leads to headaches, dizziness, flashing "flies" before the eyes. And we are accustomed to attribute all this to age, fatigue, lack of sleep. The reasons for the weakening of attention, absent-mindedness, forgetfulness are eighty percent the result of problems in our cervical region.

Below are 5 symptoms that should not be ignored.

1. You suddenly lost weight. Your diet has not changed, but you have noticeably lost weight. Any woman can only dream of 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 numbness of the limbs are all signs of an impending stroke. If the necessary treatment is provided in time, 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 as an ulcer or cancer of the stomach or intestines. The black color of the stool becomes the result of internal bleeding, which in itself can be very dangerous. The sooner you manage to identify its cause and stop it, the more likely you are to prolong your life.

4. Severe headache, passing into the neck, as well as high fever. These symptoms may be caused by a serious condition such as meningitis. If you have a very high temperature and severe pain prevents you from reaching your chin to your chest, then you should immediately consult a doctor. You may have bacterial meningitis, which is treated with special antibiotics.

5. Sharp excruciating headache. If you have never experienced a headache of this magnitude before, then do not hesitate to consult a doctor. Such pain can serve as a signal of hemorrhage in the brain. Although aneurysm is quite rare, the possibility cannot be ruled out.

When and what tests should be done:

General blood analysis;
- General urine analysis;
- Analysis of feces for eggs of worms;
- Blood test for HIV and Wasserman reaction;
- Analysis of ejaculate;
- Hormonal studies;
- Blood tests (Screening for 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, coagulation blood test);
- Taking material for research from the urogenital tract;
- Sowing on microflora and sensitivity to antibiotics;
- Sowing on Candida and sensitivity to antimycotic drugs;
- Sowing on 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 the ovarian cyst (ovarian punctate).

What are the main types of diagnostics usually performed 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 weekend for an active holiday with the whole family: swimming in summer, sledding or hiking in winter, cycling in spring and autumn. The day will pass without ailments if you take a light breakfast with you and treat yourself to some healthy food after a good workout.

2. Work out together

Find a sports club in your area that offers yoga and aerobics classes with the kids. If your child is too young for these activities, find activities that help you and your child burn calories, have your child do yoga with you or take long walks. If you don't have kids yet, then find where yoga classes are held with a partner or even "dog yoga", yes - this is yoga for you and your dog.

3. Redo the common room in your apartment

Very often common rooms are the "lazy center" in the house: a comfortable sofa, a game console, a DVD shelf and nothing to encourage sports or physical activity. There are ways to add subtle reminders to a room without redoing the entire room or taking up a lot of space with gym equipment. Set a weekly limit on TV viewing and limit the amount of time you're "inactive" to keep your whole family moving.

4. Make chores fun

Instead of dividing the chores around the house among family members, turn it into a game that everyone can play. Compete who will clean the house faster, and next time try to improve your result. Turn on some music while doing the laundry so that the children who help fold and put things away will sing and dance. At your leisure, run a little, go rollerblading, or jump rope.

5. Review your diet

This tip isn't just about physical activity, but it's still worth mentioning: Families that eat healthy tend to engage in healthy habits like being physically active.

If you want to lose weight after childbirth or just want to eat well, get the whole family involved and you will be successful sooner. Take the children to the agricultural market, let them choose their own fruits and vegetables, and involve the children in the cooking process. They will enjoy "their" food more and wash the dishes.