General practitioner or therapist. Family doctor

Today, one of the most sought-after professions in medicine is a general practitioner. Who is this, almost every resident of the countryside knows. The fact is that it is in the villages that doctors of this specialty most often work.

General Practitioner: who is he?

The main difference between doctors of this specialty and others is that they have basic knowledge in each of the sections of medicine. However, they do not require specialized medical care.

They should be able to solve relatively simple health problems and engage in the prevention of therapeutic, surgical and gynecological diseases in both adults and children.

Why are general practitioners prevalent in rural areas?

It is in the villages that one can most often meet such a specialist as a general practitioner. Who is this, all the villagers know. It is in this area that general practitioners have received the greatest distribution due to the economic inefficiency of building full-fledged medical institutions in each settlement and ensuring work in it for a large number of doctors. From this point of view, it would be much more expedient to create small outpatient clinics, in which a general practitioner (family doctor), a nurse and a nurse will work. Such a set of employees will allow the outpatient clinic to provide full-fledged medical care to residents of the region attached to it.

For a remote from large centers, a general practitioner becomes a real salvation. Who is this, all the inhabitants of the agrarian regions know, because it is to him that they go in the first place. He is able to perform the simplest manipulations of the surgical and gynecological profile, he is familiar with therapeutic pathologies of both adults and children.

How is the general practitioner trained?

This specialist, after graduating from a higher medical institution, must undergo an internship on the basis of one or more clinics. He needs to acquire the skills of a therapeutic, surgical, pediatric, as well as gynecological profile. As a result of such training, he becomes a specialist with general skills in the diagnosis and treatment of diseases in any medical field.

How is the work of a general practitioner structured?

Prevention, diagnosis and treatment are all the main areas within which a general practitioner conducts his professional activities. Its work is built primarily on identifying the risks of developing certain serious diseases among the population living in the area under its control, as well as systematic activities aimed at counteracting their formation.

What does it take to be a specialist?

The office of a general practitioner should be equipped with a number of tools that help to carry out the initial diagnosis. We are talking about a phonendoscope, a tonometer, a glucometer, thermometers, spatulas, laryngoscopes, otoscopes, rhinoscopes, ophthalmic and gynecological equipment. In addition, the general practitioner's outpatient clinic should have the simplest surgical instruments.

Ideally, the outpatient clinic can be equipped with a mini-laboratory. It greatly simplifies the work of a general practitioner. Those specialists in this field who do not try to equip their outpatient clinic have to constantly refer patients to district medical institutions for simple laboratory tests (complete blood count, general urinalysis, biochemical blood test, and others).

What services does a general practitioner provide to the population?

The work of this specialist is of great importance for the entire population served. Thanks to him, medical care becomes noticeably closer to people. The simplest surgical manipulations are carried out in outpatient clinics. In addition, all conditions for injection (including in the form of droppers) administration of drugs are created here. There is necessarily a small bed fund here, which allows placing patients in that is, the patient can go to the doctor and, if he deems it necessary, be treated without going to the hospital.

In large outpatient clinics, in addition to an ordinary specialist, a general dentist may also work.

In the event that a person becomes very ill, and he cannot visit a doctor on his own, he has the opportunity to call him at home. At the same time, most often a specialist of this profile serves such calls in the afternoon, and an appointment in an outpatient clinic leads to him.

Economic feasibility of outpatient clinics

Such institutions and the position of "general practitioner" (who we are, we have already found out) were introduced not only to bring medical care closer to the population of rural areas. The fact is that it is beneficial from an economic point of view. Firstly, there is no need to send a separate therapist, gynecologist, surgeon, ophthalmologist, otorhinolaryngologist and others here. All relatively simple problems will be handled by a general practitioner. Those who make more serious complaints, or whose health condition causes concern in this doctor, are sent to higher level healthcare institutions.

Prospects for the development of the profession in the future

Currently, a general practitioner (this is who was described above) is not the most common, but at the same time a very necessary profession. This specialist is in demand in rural areas. At the same time, such a doctor saves the state significant funds, because it is not necessary to maintain a large health care institution in every locality, in which a large number of doctors work. With many problems, the general practitioner will cope on his own. If the intervention of narrow specialists is required to combat a particular pathology, then the patient will be referred to a medical center of the appropriate profile.

In the future, a general practitioner can be re-registered as a so-called family doctor. This specialist is a doctor who provides medical care to several families. He knows each of his patients very well. A small number of them allows him to delve into the problems of all wards as deeply as possible. Family doctors are a very effective way to preserve the health of the population, but the activity of such specialists is possible only in a fairly developed economy. The fact is that the salary of such an employee will consist of deductions from his immediate patients. So the family doctor, if we talk about the widespread activities of such specialists, so far remains the prospect of the future. In many European countries, the institute of family doctors has existed for quite a long time and has proven its effectiveness. At the same time, the basis of the activity of such specialists is precisely the prevention and early diagnosis of any diseases.

In addition, the profession of a general practitioner is also promising. Now mobile complexes are being created that allow to significantly expand the capabilities of this doctor in the field of diagnosing certain diseases. We are talking about the so-called specialized cars of a general practitioner. The structure of such a complex includes a small laboratory, as well as a set for the most important instrumental research.

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 constituent entities of the 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 significantly expanding, he must have knowledge in related specialties, possess practical skills to implement various diagnostic and treatment methods currently performed by narrow specialists of outpatient clinics.

One of the most important functions of a general practitioner is the early detection of latent forms of the disease, 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: 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;

Therapeutic 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 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.; 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; 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.

When contacting a polyclinic or any other institution, you will first be referred to a general family specialist.

This type of specialization is somewhat different from therapeutic. General practitioner studying development of diseases in more detail, and is able to independently diagnose and treat the patient.

Quite often, clients self-diagnose themselves, and when visiting an institution, they already know the coupon to which specialist they need to get. However, in most cases, the client cannot accurately determine the pathology.

The point here is not only the lack of medical education, but also the lack of real practice. Disease - a serious phenomenon, it is not worth delaying with him. Therefore, in order to correctly determine the initial diagnosis and choose the right specialist, you still have to visit a family physician.

In his student years, the future doctor explores general development of various diseases. A specialist can conduct a consultation regardless of the gender and age of the applicant, which is why he is called a family consultation.

Speaking about the functions of work, they accommodate a different approach. The doctor can examine and conduct a course of therapy on his own, or he can refer to narrower specialists. Despite the fact that his duties include a comprehensive examination, treatment is carried out only for a certain number of violations.

Referral to a family specialist during the screening. In this case, the survey includes only weighing, examination, questions about the presence of certain ailments.

In what situations visit a specialist?

Despite the fact that the physician is trained in all types of pathologies, it is not always necessary to contact him. For example, if in case of bruises, fractures and other types of injuries, you should immediately visit a traumatologist, without wasting time in vain.

Although the specialist is considered general, the circle of his practice is not so wide. Let's start with main obligations medica:

• regular checking of the patient for the presence of oncology;
• determination of the normal weight for the patient and its correction;
• prevention of all types of atherosclerosis (special attention is paid to visitors of mature age);
• systematic examination of women during pregnancy, as well as their consultation;
• the appointment of a therapeutic course in the pathology of the veins and vessels of the extremities.

If we talk about when it is worth visiting a specialist, then there are almost no exceptions. Many doctors advise to take a closer look at the processes of your own body. It is inattention and irresponsibility that exacerbate the situation.

When a patient turns to a doctor because of the inability to endure headaches or pains of internal organs, the problem must be solved already. urgently. Unfortunately, the vast majority of clients are sure that in this way they save the family budget, however, a neglected disease is much more expensive and more difficult to eliminate.

It is worth contacting a doctor when pain in any area of ​​the body, not excluding headaches, which are already considered to be the norm. You should come to the doctor if you feel frequent, unreasonable fatigue, internal heaviness.

In addition, you should pay attention to memory problems, the occurrence of absent-mindedness, or the rapid appearance of fatigue.

There are also other reasons to visit patient:

• fast weight loss, if dietary nutrition and physical activity were not connected. For young women, this is often a cause for joy, but rapid weight loss is a well-known symptom of stomach or ovarian cancer. The latter pathology applies only to the fair sex;
• dark stool color is a common prerequisite for stool testing. the presence of an ulcer or oncology of the stomach. You can't joke with this kind of pathology. Another reason for discoloration is internal bleeding, which also carries no small danger;
• in mature and elderly years, pay attention to common symptoms of a stroke. Here it is important to inform the patient's age. Harbingers are: ringing in the ears, deterioration in skin sensitivity, difficulty in speech, unnatural curvature when trying to smile, sudden onset of weakness;
• do not delay visiting a family doctor in case of a sudden occurrence severe headaches. This is a classic sign of an aneurysm or a blood enrichment disorder;
• Another common reason for referrals is bacterial meningitis. Its well-known symptom is pain in the neck, which is accompanied by headache and fever. At the initial stage, the disease can be eliminated with the use of antibiotics, but with a protracted disease, it is not so easy to prevent cerebral edema.

In the municipal health care of the city of Ulyanovsk, the formation of the institute of a general practitioner began in 2005.
A service of general family practice has been created, which, first of all, is aimed at improving primary health care. Deputies of the city parliament fully support the initiative of the municipal government. The UGD receives a lot of appeals from citizens in which they ask for a comment on this innovation. At one of the last meetings of the Committee for Social Policy and Local Self-Government, the issue of general practitioners' offices was considered comprehensively.
Vladimir Levanov, head physician of the City Polyclinic No. 5, deputy of the State Revenue Office, commented on what is the responsibility of a general practitioner.
- Tell us who are general practitioners and what is their responsibility?
- A general practitioner is a general practitioner who has the skills of a narrow 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 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 the general practitioner’s offices most in demand?
“Today, the most acute issue is the provision of medical services in remote areas of the city, where there is the greatest need for doctors. This is due to the lack of specialists.
If general practice offices open in areas far from the city center, the problem will be solved. A general practitioner is able to provide qualified medical care not only in a therapeutic profile, but also in narrow specialties. However, without modern diagnostic equipment, the functioning of general practitioners' offices in rural areas is difficult. Therefore, such departments are formed on the basis of polyclinics to improve the accessibility of the population to receive quality medical care. Particular attention is paid to this issue in the Ministry of Health of the Ulyanovsk Region, in the Committee on Social Policy and Local Self-Government of the Ulyanovsk City Duma.
What is the difference between a primary care physician and a general practitioner? Why is a general practitioner in a polyclinic where there are narrow specialists?
- If you have health problems, of course, you will go with them to the local therapist, and better - to the general practitioner.
Very high demands are placed on the level of his professional training. It is the general practitioner who, thanks to the multidisciplinary knowledge, is able to make a preliminary diagnosis. What studies should be carried out first of all, to which specialist and when to refer the patient - these are questions that are within his competence. The general practitioner sees the big picture. His duties include not only a general examination, but also conducting narrow-profile examinations, which facilitates the conduct of comprehensive examinations by one specialist, including when registering at 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 manipulations: fitting glasses, washing the ear canal, measuring intraocular pressure, ECG. He provides comprehensive treatment advice. All this reduces the time spent by the patient in a medical institution and increases the availability of medical care.
A general practitioner can become a therapist who has a solid experience, a long 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 offices of general practitioners today fully serve patients?
- In 2005, the first department of general practitioners was opened in the city polyclinic No. 5, which successfully admits patients to this day.
Today in Ulyanovsk there are 8 departments of general practitioners. For the local population, for the convenience and accessibility of the elderly, on December 1, a new additional office of a general practitioner will be opened on the basis of the day hospital of polyclinic No. 5. The city plans to open 17 more in 2012.
Thus, by the end of 2014, there will be 41 medical practice rooms, including 76 doctors and 107 nurses, who will serve 161,000 people.
All questions that you have about the work of general practitioners' offices, you can ask on the website

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 accepts 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.