“The main thing is for the patient to know that he did not deserve this pain. Hospice - also applies to palliative care? Many patients who are faced with serious illnesses do not know that, in addition to treating medicine, there is also palliative care. About what is

I am a general practitioner, gastroenterologist, doctor of the highest category.
16 years of experience with the most diverse contingent of gastroenterological and therapeutic patients, as well as with patients at the junction of several specialties.

Part 1

In the branch where I work, everything is very strict with sales. Did not fulfill the plan for the first time - a fine and a minimum salary. Did not perform the second time - fired. In any paid medical institutions there is a plan, the average bill for the patient. If the doctor does not cope with this check and does not fulfill the monthly plan, then he is reprimanded, fined, or even fired altogether if this is repeated several times.

The financial plan must be fulfilled! Each medical Center calculates this amount specifically, how much on average per month in terms of revenue should go to the doctor. For motivation, so as not to insert pistons to doctors and tell every day how important it is to make a profit for the branch and recoup their crazy expenses, they make them a minimum salary and a good interest rate from each patient, that is, from those services that the doctor sells.

This system has almost nothing to do with any Euroset or Svyaznoy, where the technology is exactly the same. Sellers have an average salary and a direct motivation to sell as much as possible in order to earn a percentage of sales, then they get an interesting salary. Medicine has become a "sales mobile phones”, where the patient’s health is not in the first place, but the number of services provided.

Part 2

Today I had a patient with complaints of pain in the lower abdomen and in inguinal region. He described the following symptoms: discomfort when walking, pain in the groin area after lifting weights, a feeling of heaviness in the lower abdomen. After describing the symptoms, there were clear suspicions of inguinal hernia. And after examination and palpation, it became quite obvious. When the patient was standing, he had an inconspicuous swelling that changed in size, disappearing in the supine position.

This is a simple situation that does not require additional examination. It was possible to calmly diagnose him and send him to a surgeon for planned operation. But in our clinic (as well as in any paid one) it is impossible to do this. Hernia repair operations are not performed in our clinic, and sending him to the hospital means losing a client and getting a reprimand/fine from management for not meeting the average check for each patient.

Therefore, I began to drive him along our standard scheme sales: general blood tests, urine, feces, ultrasound abdominal cavity. He also sent me to a urologist in a neighboring office, where he, most likely, will pass an analysis for the secret of the prostate and pay for the consultation itself. The approximate total cost of all the listed services is 35-40 thousand rubles.

I have been working in this clinic for 6 years. The above situation is a normal working day. And even after all this time, I still have occasional remorse. They are already weak and almost invisible, but there are still memories of the thoughts and hopes with which I went to study at the medical institute in order to help people and treat them, as Hippocrates bequeathed. There were no thoughts about any deception and divorce for the average check then.

But as the head of the clinic where I work says: “Hippocrates is not relevant now, and he died a long time ago, but my family and children are alive and want to eat.”

Part 3

This is one of the first comments I received on a previous post. The comment is quite fair, I perfectly understand the feelings of this woman, and I sympathize with her. The situation she described occurs fairly regularly. For each patient, I receive a whole stack of tests and examination results. As a rule, I send all these tests to be taken in two appointments, so that the patient does not immediately shy away from the impressive cost and does not suspect the excess of the prescribed examinations.

First, it is usually not necessary to take such a number of tests. But you already know perfectly well about the plan, the norm and the check for each patient.

Secondly, you, most likely, cannot even imagine how your analyzes are made and how your analyzes are faked in laboratories.

There are several options:

Clinics that save on tests

You were prescribed a lot of tests, and you paid the appropriate amount for them, but the study best case conduct only the most basic, or not at all. Why is this happening? Most likely, the clinic you came to is not doing well, so they save on tests. Accordingly, an unreliable picture of your examination is obtained, and, as a result, inadequate treatment. As a result, health not only does not improve, but is likely to worsen, which will provoke the appearance of other sores. But this is not bad, because now you will go to this clinic for a long time and regularly. But this is not done in all clinics, but only in those where sales are bad, and the clinic does not even pay off.

Clinics that do not miss the opportunity to make money even on a healthy patient

Analyzes are prescribed to you according to the standard scheme, but their results are faked. "Discover" what you don't really have. And this, by the way, is not the worst, because only a minor “disease” is found here, which can be “cured” by dripping a few droppers and drinking a course of medicine. The patient, most likely, will not feel the difference, but then he will pass the tests again, which will show that he is “cured”.

Clinics that detect a severe or terminal illness in a patient

Most likely, these are clinics with lazy and stupid management with post-Soviet thinking, who only hearsay about management, marketing and internal sales. They save on everything, doctors are paid a modest salary. These are greedy leaders who have only one clinic, because they will never expand to the network scale because of their greed and stupidity. Therefore, in order to somehow stay afloat, and at the same time earn a living with caviar, they are engaged in outright fraud. The atmosphere in such clinics is depressing, the doctors are evil, and this is seen with the naked eye.

And the last option

These are clinics that do not fake anything, but thanks to competent management and marketing, they manipulate the patient so that he passes a large number of analyses, additional analyzes and surveys. The patient is diagnosed only after the plan has been fulfilled, and then an adequate treatment regimen is prescribed.

This is the clinic I work in. And I will tell you that this option is not the worst. Moreover, today, even the best in Russia. Yes, the patient will spend 3-5-10 times more than necessary, but he will definitely know a reliable picture of his situation.

A few words about free medicine

In the comments, they wrote to me a lot that once in paid clinics this is how they cash in on patients, therefore, it is better to go to a free district clinic. But tell me, what is better for you, to be cured, albeit for a lot of money, or not to be cured at all, because “for free” will everyone give a damn about you? In the next world, money is no longer needed.

Part 4

Time is short now. I write the most memorable situations for last week- I will describe everything in more detail later. The other day we had an extraordinary meeting.

The authorities were extremely dissatisfied with the falling income of our branch - everyone was reprimanded and threatened with dismissals.
Main complaint: “All you do at work is drink tea and don’t treat patients properly”
This is despite the fact that I alone bring in twenty working days a month to the cashier from 3.5 million rubles.

They set the task: “To bite into any patient and if the described symptoms even remotely resemble complex diseases, then intimidate patients and prescribe local procedures and additional examinations"

Our ultrasound specialist, frightened that she would be fired, pregnant healthy girl she said that she had premature oligohydramnios, the placenta was all in cysts, that everything
very bad, it is urgent to put droppers and conduct full examination otherwise she might lose the baby.

A pharmaceutical company that promotes its “miracle drugs” through us has released a new remedy for gastrointestinal diseases. As a result, several patients have already complained of diarrhea and bleeding.

The urologist, when taking material for PCR, provoked bleeding from the urethra. The patient stained the doctor's white coat with blood and, frightened, began to fuss, spattering the floor of the office with drops of blood. When the doctor opened the door a crack and went to call the cleaner, the patients who were waiting for their turn, when they found out what had happened, got up and left. Something tells me that our urologist will be fired.

For those who were interested in what salaries are in our clinic and how sales are stimulated, I’ll tell you. We have a minimum salary - an average of 10-15 thousand rubles. Everything else is interest. From the reception of a patient, the doctor receives 20%, six months ago it was 15%. For a referral to another specialist, 5%, six months ago it was 3%. For referral for testing 8%, six months ago it was 5%.

If you are studying in medical schools and want to get a decent salary, I recommend studying to become non-therapeutic doctors. You will receive even more money. Those who know how to count have already guessed why. And for those who do not understand, another time I will write in more detail.

Conclusions:

A funny moment that many of you probably noticed, but do not know the ins and outs. If you have noticed, in Moscow in many medical centers at the reception there are “boards of honor” with photographs the best doctors months, and I guess what patients think about it. But in fact, these are the doctors who brought the most money to the cashier this month. It's like employee of the month at a furniture store.

Many sores that cause patients to come to clinics can be cured after one or two consultations, based on basic general analyzes. This is enough to determine the picture and prescribe an adequate treatment regimen. But it’s completely unprofitable to treat like that, and if you try, you will get a hat from the management.

By the way, the patient does not even need to be intimidated when he comes with his problem. It is enough just to strengthen his already existing fears with all sorts of hints and shaking his head. And the most stable patients are those who carefully study their symptoms on the Internet. They read all sorts of horrors and agree to any various examinations.

It is unprofitable to treat the patient, it is advantageous to relieve the symptoms and delay until the last. And if the patient managed to earn dysbacteriosis from taking an infinite number of drugs, then this is not bad. The patient becomes very sad and obediently goes to the appointment and is ready for all procedures and additional examinations.

Surely some of you have had occasions when you long time were treated in some kind of medical center, but there was no improvement at all, and then at some point you lost patience or financial problems began and you quit this business. Then - once, and health straightened out by itself. Many sores get better either on their own or with minimal intervention.

And it may also be a discovery for someone, but most of the drugs that we (doctors) prescribe, we ourselves do not take even with similar diseases.

A good doctor must be very tactful. The ability to talk to patients is the main skill you will need to develop.

Steps

Part 1

1. Before you say something, think about what exactly you want to say. Once you know exactly what to say, think about the best way to express yourself before the patient enters your office.

   • You do not need to write down everything you say, but if you have general idea about what to say, it will be easier for you to remember all the necessary details. It will also give you the opportunity to think about how best to express yourself.

2. Listen carefully. Ask patients questions about their problems. Pay close attention to the reactions of patients and respond to them in the same way.

   • Pay attention to both verbal and non-verbal responses.
   • Repeat the patient's answers. This will help you understand the situation better while you reassure your patients that her or his problems are solvable.

3. Consider the needs of the patient as a whole. The patient is more than just medical case. You must look at him as a person with his own unique fears, beliefs and circumstances.

   • Respect all of your patient's beliefs, even if you do not agree with them.
   • Encourage patients to ask questions.

4. Speak to the patient in an accessible language. If possible, avoid medical terminology Do not speak professional language with patients. Speak slowly and clearly to avoid unnecessary confusion.

   • Divide important information about a condition or treatment into small parts. Make sure the patient understands one part before moving on to the next.
   • Provide technical information only if asked. Too much complex information can make many patients feel discouraged.
   • Some say that reading comprehension is stuck at the 6th grade level. Try replacing the words you would use to describe the situation to another doctor with words that a sixth grader would understand.

5. Build your discussions on past experiences. When describing the meaning of specific actions, try to use words that were understood by your previous patients.

   • If the patient has recently been discharged, explain that neglect of the prescribed treatment may lead to re-hospitalization.
   • If a family member or friend of the patient had the same illness, speak of good and bad ways caring for a loved one.

6. Explain everything to the patient carefully and accurately. The information you provide about his illness, condition, and treatment must be complete and accurate.

   • Explain the essence of the diagnosis in an accessible language.
   • Describe the course of treatment and the expected result. If there is alternative methods treatment, explain their essence too.

7. Make sure you are understood. After you have said everything the patient needs to know, ask him to repeat what you said. This will help you make sure the patient understands you.

   • Clear up any misunderstandings right away.
   • You can also provide sources additional information if the patient is eager to learn more.

   Part 2

   Meeting new patients

   1. Introduce yourself. When you first meet with a patient, you should introduce yourself and explain that, as a doctor, your the main task take the best care of the patient.

      • Let the patient know that you are sensitive to their concerns and beliefs and will try to take them into account when choosing a treatment.
      • Reassure the patient that he can discuss everything without fear of judgment and ridicule.
      • Present yourself as an ally of the patient. It helps to set a good relationship between doctor and patient.

   2. Break the ice with a short conversation. A short conversation creates a relaxed friendly atmosphere in which your patient will feel more comfortable. You can also accomplish this by ending the conversation on a light-hearted note.

      • A short conversation can be helpful when meeting a patient for the first time and in cases where you need to communicate with him in the future.
      • Distracted topics of conversation can be the weather, the economy, the latest medical news, or current events.
      • If you think that you will establish a long-term professional relationship with the patient, you can also move on to personal topics. Tell about your family and ask about the patient's family. Discuss your patient's career, education, likes and dislikes.

   3. Double review the patient's medical history. You should have your patient's medical history on the table in advance, in a conversation you can clarify doubtful points.

      • Ask for clarification of any points in the medical history that are incomprehensible to you.
      • Review the medical history of your patient's family members and find out if they have any family members with diseases related to the diagnosis.
      • Before prescribing any medications, ask the patient if they are allergic to them.

   4. Ask about the patient's values ​​and ideas. Ask if the patient has any beliefs that you should take into account from the start. Regardless of the answer, you must assess the patient's values ​​and goals as you work.

      • Ask questions to make sure the patient believes you. When working with terminally ill patients, ask what is worth living for? From the answer, you will understand what the patient is ready for in order to prolong life.
      • Keep asking questions until you have a complete understanding of the patient's point of view.

   Part 3

   Use of non-verbal communications

   Part 4

   Discussing difficult issues

   1. Discuss difficult topics before a crisis hits. You should discuss some of the difficult questions that may arise once a diagnosis is made or if there is concern that the condition may worsen.

      • This can apply to anything from radical treatments to lifelong patient care.
      • The ideal place to discuss complex issues is your office, not the hospital. Patients tend to make wise decisions in a relaxed environment.

   2. Take time to discuss important decisions. Some issues may require immediate resolution, but patients usually have several days or weeks to think.

      • Insist on the importance of making a decision, but let the patient maximum amount time to think.
      • People often regret decisions made in a hurry. Try to minimize your regrets and the regrets of your patients.

Science to heal.

The abbreviation MONIKI is known far beyond the borders of Moscow and the Moscow region. Today, the Moscow Regional Research Clinical Institute named after. M.F. Vladimirsky is the largest health research institute in the country and one of the few places where medical science closely intertwined with practice. Such legendary figures as Pyotr Herzen, Nikolai Semashko, Nikolai Blokhin, Alexander Vishnevsky, Leonid Roshal and many others worked within the walls of this institution with a 240-year history.

Director of the institute, cardiologist, endovascular surgeon, professor Philip Nikolayevich PALEEV told the MK observer about what new methods of treatment and diagnostics have become available to residents of the Moscow region today.

Philip Nikolayevich, one can say that your specialty is now fashionable ...

A year and a half ago, X-ray endovascular surgery in our country was singled out as a separate specialty, which made it possible for radiologists, surgeons, and other doctors to master this profession. Now it's very promising direction- all vascular centers of the country are based on minimally invasive surgery. And abroad, every cardiologist seeks to specialize in this area: such doctors are able not only to put stents, but to make a choice - whether the patient needs it or not. In our country, until recently, only surgeons or radiologists were engaged in the installation of stents, which is not entirely correct ...

There was a scandal in America, they said that every third stent is installed there without evidence.

Not entirely true - in fact, the Wall Street Journal published data that 20% of such transactions were carried out without reason. This caused a resonance among the professional community, the doctors conducted their own investigation and found out that stents are indeed installed without indications, but these are about 5-7%.

We are still far from this ... There are queues for stenting.

But we must be prepared for such a turn of events. To give an interesting example: in the 1970s in Los Angeles whole month surgeons were on strike, they only carried out emergency operations, but did not do the planned ones. As a result, the death rate in the city decreased by 30%! So the correct choice of treatment is very important aspect. And this problem is also before us. Patients periodically complain about doctors, seek expertise: was the doctor right? Of course, there are standards, protocols, but the doctor's clinical thinking is also important. And, perhaps, choosing this or that method of treatment, the doctor was right, even if the patient is not satisfied with the result. We purposefully work to improve the professionalism of doctors. Recently, a delegation of the German Medical Chamber visited the Moscow Region, its representatives, together with representatives of the regional Medical Chamber, discussed issues of professional expertise of care - one that would allow not to accuse or defend the doctor, but to determine exactly whether a professional mistake was made.

And who should be involved in such expertise?

Usually lawyers, specialists in the field of medicine, experts participate in this. And it is very important that every doctor be able to conduct an examination of the cases of his colleagues and be critical not only of his own, but also of someone else's work.

Does this already exist?

We are already actively working with patients. The Medical Chamber of the Moscow Region has created a scheme for working with citizens' appeals.

Among the complaints of patients, there are constructive, but there are not, and it is important to interpret them correctly. Now, on behalf of the Governor of the Moscow Region, in the Moscow region, including at our institute, a survey is being conducted - collecting feedback on the work of medical institutions. There are thanks and suggestions, but we most attention we work with complaints - they contribute to development, as they expose shortcomings and weaknesses in the system. We conduct internal monitoring on a quarterly basis - we study public opinion, daily we accept applications to the open electronic reception of the director. We saw many approaches during the visit of a delegation of 12 chief doctors of the region's hospitals in October 2014 to an Israeli clinic.

What else useful did you see there?

In addition to dealing with complaints and internal monitoring of the hospital, we were impressed by the resource management system of the operating unit, the work of which is used as efficiently as possible. The same with the bed fund - everything is verified, calculated, nothing is idle. This helps to manage the queue for surgery, for hospitalization. We also liked the system of long-term relationships with patients. Today, our health care is on the path of reducing the length of stay of patients in hospitals, but this should not be done at the expense of the quality of medical care. As physicians, we know that a long hospital stay is harmful, and the risk of nosocomial infections increases. However, it is very important that the patient does not feel abandoned - therefore, a remote contact system has been introduced in Israel, which allows you to be constantly in touch with the patient. Through various communication channels: e-mail, SMS, through a personal account - he is reminded of taking medications, undergoing examinations, taking tests, etc. We have also introduced such a system. At our department of doctors general practice system developed personal account, where all data on the patient's condition, the treatment he has undergone, necessary analyzes etc. Treatment is not only a stay in a hospital, but also preparation for it, and recovery after.

Your clinic is like a whole town...

Yes, our multidisciplinary medical center is built by analogy with the university clinics of the world. We have a large clinical base (1105 beds of all profiles, except for obstetrics, gynecology and psychiatry), research departments and a faculty for the improvement of doctors (24 departments and 9 beds). A sort of conglomerate of science, education and medical base allows you to close the process. Therefore, today MONIKI is a key institution in the Moscow region. Extremely difficult, complex patients come here both in terms of diagnosis and in terms of medical process. Several specialized centers. For example, center multiple sclerosis supervising all patients with this pathology in the region; the leading hepatology center in Russia - the volume of research here exceeds the total volume of research throughout the country; center pulmonary hypertension, Center for Diabetes Pump Therapy, Center for Minimally Invasive and Video Endoscopic Surgery, Center for Osteoporosis. On our territory, perinatal screening of babies from all over the region is carried out on genetic diseases. More than 270 thousand patients pass through the institute every year, hospital treatment receives more than 26 thousand people. Operational activity is 18 thousand operations per year. Plus 6,000 emergency trips of specialists to the regions of the region.

In other words, your beds are not idle?

Yes you! The institute works even with excess of the norm of work of a bed in a year. In addition, not ordinary patients who are successfully treated in district hospitals, and the most difficult, who need high-tech medical care.

How are things with the process of education of doctors?

Every year, about 7.5 thousand doctors of the Moscow region receive training in all major specialties within the walls of MONIKI. The call of the times: two new courses have recently opened - plastic surgery and pediatric surgery. Two years ago, we opened a simulation center where they conduct trainings on providing emergency, obstetric and gynecological care, where a simulator works to hone skills in performing laparoscopic operations - this is a whole operating room, where the entire team trains at the same time: a surgeon, an assistant surgeon and an anesthesiologist. The simulator for X-ray endovascular operations is in particular demand. In recent years, vascular centers have been actively built in the Moscow Region. Today there are already seven of them, two more will be opened by the end of the year, and this is a lot - the population of the region is not as large as Moscow, although we have long distances. We can be proud of our centers. For example, the vascular center in Dolgoprudny not only provides treatment acute infarction myocardium, but also emergency operations on cerebral arteries. And the center is run by a very talented surgeon who moved to this center from MONIKI. Not so long ago, he performed an operation on a difficult patient - within three hours, a blood clot was removed from her brain vessel, which prevented the development of a stroke. Such interventions are extremely rare today: it requires not only equipment, but also a highly qualified doctor.

Is there enough high-tech equipment today?

Fortunately, a lot of high-quality equipment was delivered to us under the modernization program. And it doesn't stay with us! We have recently implemented new system evaluation of treatment for the completed case. That is, the quality of treatment is assessed not on the basis of how many times the patient visited the doctor, but on how effective the examinations and treatment turned out to be. As a result, we detect 40% of tumors on early stages, which can significantly improve efficiency and reduce treatment costs. And the system we have introduced medical care patients with chronic viral hepatitis allowed for the first time in Russia to provide mass diagnostics and treatment of patients within the framework of the CHI program. More than 500 patients with rheumatic diseases receive innovative therapy with genetically engineered biological preparations at MONIKI.

Are there domestic innovations in the treatment of oncological diseases?

30% of our patients are diagnosed with cancer each year. And we use a personalized approach to treatment. Our specialists together with Pushchinskiy scientific center RAS developed a selection method drug therapy based on patient cell culture. This is a know-how for which a patent has been received. The method of photopheresis is developing very actively in oncology - we received a presidential grant for the development of this technique, - our domestic developments allow us to treat the most complicated diseases skin, blood, nervous diseases even reduce rejection in organ transplants. We had a case of severe skin lymphoma - and photopheresis gave a fantastic result. In Russia, we are the only ones who own this technique in full.

What other scientific developments can you boast of?

In 2014 alone, our employees obtained 17 Russian patents. For example, our neurologists, together with scientists from the Severny Biopharmaceutical Cluster, have developed a device to restore activity after a stroke. The robot detects the slightest muscle movements, due to which the connections between the cerebral cortex and the motor muscles are restored, which allows the patient to stand on his feet much faster. And together with Skolkovo, we have developed T-shirts with implanted electrodes that allow daily monitoring cardiac activity. This is much more convenient than Holter monitors, which must be worn on a belt. In addition, we have developed a lot of copyright operations. Our center of minimally invasive surgery is famous for them. For example, they recently performed a laparoscopic operation for a tumor of the stomach, during which the stomach was actually re-created from the esophagus and intestine. Such operations were performed before - but only in an open way. We did everything through punctures, and on the second day the patient was able to eat on his own, and on the fifth he was discharged. We have launched a program of hybrid operations, and recently, during a master class, the legendary Renat Akchurin taught our surgeons how to perform them.

It is known that in the cities and villages of the Moscow region it is not always possible to get qualified assistance. Do your specialists provide any local consultations?

Yes, of course, we often go to hospitals, consult doctors in difficult cases. There are at least 8,000 such trips per year. In addition, we have a good base for the professional growth of young doctors and scientists, annually we defend 10-12 dissertations, they have the opportunity to be published in our peer-reviewed journal Almanac clinical medicine". In general, the road is open to young doctors of the region today. And I believe that together we can make medicine in the Moscow region the best in the country.

Many patients who are faced with serious illnesses do not know that, in addition to treating medicine, there is also palliative care. The correspondent of Amur.info learned about what palliative care is and how it works in the Amur Region from the head physician of the Amur Regional Oncology Center Svetlana Leontyeva.

- What palliative care?

Palliative care is the provision of care to patients with incurable diseases. Improving their quality of life, selecting adequate pain medication and helping relatives learn how to care for severe patients.

Who gets palliative care? Dying patients? Or is it therapy for many years?

Such assistance is provided to all patients who, for one reason or another due to the disease, need outside care, need to relieve pain. These are not only cancer patients, but any patients: those who have had a stroke, after an accident, and other serious illnesses.

- How long has palliative care been available in the Amur Region?

Palliative care was first introduced into Russian legislation in 2012. B 323 federal law articles have appeared on the organization of palliative care, so this is a young discipline in health care.

The basic principle palliative medicine- to prevent the suffering of terminally ill patients and their loved ones?

Yes, that's the main thing.

- How much this assistance is in demand among us, are there any figures?

Today, this is a very popular medical care; in our region, more than a thousand people annually apply for palliative care.

- Are there any criteria by which they determine who exactly is entitled to palliative care?

Yes, of course, this is all spelled out in the regulations of the Ministry of Health of the Russian Federation, which determine the procedures for providing palliative care to children and adults.

- Can we somehow indicate who exactly is supposed to help?

To all those in need without exception. The patient goes to the district physician at the place of residence, and the therapist determines how much specific assistance is needed. The order of the Ministry of Health No. 187 clearly states who is entitled to palliative care. It:

Patients with various forms malignant neoplasms;

Patients with organ failure in the stage of decompensation, if it is impossible to achieve remission of the disease or stabilize the patient's condition;

Patients with chronic progressive diseases of a therapeutic profile in the terminal stage of development;

Patients with severe irreversible consequences violations cerebral circulation in need of symptomatic treatment and in the provision of medical care;

Patients with severe irreversible consequences of injuries requiring symptomatic therapy and in the provision of medical care;

Patients with degenerative diseases nervous system on the late stages the development of the disease;

Patients with various forms of dementia, including Alzheimer's disease, in the terminal stage of the disease.

Where does palliative care take place?

It can be outpatient or inpatient care. The polyclinics have rooms where outpatient palliative care is organized. In the Amur Region, such rooms are organized in city polyclinics No. 1, 2, 3 and 4. Outpatient palliative care is also provided in primary oncology rooms. Inpatient medical care for seriously ill patients is provided in the Blagoveshchensk city clinical hospital, In the Svobodnenskaya hospital, in the Belogorsk hospital (Tomichi village).

Are these beds full all the time?

Almost yes. The beds in the Blagoveshchensk hospital are especially in demand. There are also three children's beds at the Amur Regional Clinical Hospital.

- Hospice - also applies to palliative care?

Yes, it does, but in our region, unfortunately, there are no hospices and no houses nursing care. We only have palliative care beds deployed on the basis of inpatient departments. And there are nursing beds, which are also deployed at the base of medical facilities.

- What methods of palliative care are available?

It is important to provide a person with decent care (feed, wash, make a bed), improve his quality of life. Even if we teach him elementary methods self-care, this will already be a big plus. Here, both psychological and medical, and social aspects are connected.

Does palliative care cost patients money?

No, all assistance is provided free of charge.

- Tell us about those people who are undergoing palliative treatment in our region.

In the Amur Region, palliative care beds are mostly filled with cancer patients. These are the patients who need special care who need painkillers. It is desirable for the relatives of these patients to learn how to care for them, because the patient is not always ready to die after being in the hospital. We are often talking about years of living at home with the appropriate help of loved ones. It all depends on how emotionally the patient is ready to provide such assistance and how much his relatives are ready to help him.

That is, a person receiving palliative care will not necessarily die soon, he, depending on the disease, can live for several years?

I was studying at the Central Hospice in Moscow. There we were introduced to a patient who had lived for three years in a hospice, he was periodically discharged home, he received adequate care. This is a young guy after a serious accident, he does not speak well, but he understands everything. He has been taught basic techniques for caring for himself after his injury and is periodically admitted to hospice.

- Do all palliative care patients have enough painkillers?

Yes, of course, all patients who need it are anesthetized. Pain therapy is prescribed according to a three-level system: for starters, these are non-steroidal anti-inflammatory drugs. Further, if the pain increases, other medicines are given. And the last one is narcotic painkillers. Now transdermal patches are showing themselves very well, they are well suited to emaciated patients, for whom any injection is already painful.

Stories are widely known when in different regions of Russia, cancer patients took their own lives, unable to bear the suffering ...

We, on the territory of the Amur Region, have not registered such cases. All patients who seek palliative care receive necessary medicines. The main thing that sick people should know is that they should not endure pain, they should seek help, advice, so that their relatives are taught proper care- because it prolongs life. People with serious illnesses feel much better at home if they are helped by loved ones. Familiar environment, pets, they really need attention.

- What skills are taught to patients?

Depends on the state. It is safe to roll over, sit down, drink, transfer to a wheelchair on your own. After all, health workers are also not constantly in the hospital ward and do not watch the patients inseparably.

Let's remind where and to whom patients with serious illnesses should apply for palliative care.

Go to your doctor and he will tell you.

Anastasia Bolotina

• Petta

  1 year ago

  The line to the hospital is huge. Some are waiting

• Lützow

  1 year ago

  Stories are widely known when in different regions of Russia, cancer patients took their own lives, unable to bear the suffering ...

  We, on the territory of the Amur Region, have not registered such cases.

  Dear head physician of the regional oncological dispensary!

  I personally know 2 (two) such tragic cases.

  One of them happened not so long ago, in one of the district centers of the Amur Region. The police know about him - the woman took her own life because of the inability to endure unbearable pain who tormented her with oncology of the stomach.

  Another similar case (God forgive me) threatens to be now in the village. Volkovo, Blagoveshchensky district

  Woman suffering from cancer genitourinary system. No matter how much she and her relatives turn to doctors, according to her, the ambulance sends her back without helping.

  Referring to you, her relatives advise her to contact the doctors, but she says that they don’t accept her at the oncology dispensary, they send her home, local Volkov doctors either don’t stamp the prescription and don’t accept it in pharmacies, then they can’t find a vein on her arm and leave the therapist is on vacation...

Over the past two years, authorities have issued a record number of documents simplifying discharge narcotic analgesics. And now, as the Ministry of Health assures, there are no difficulties in obtaining painkillers. In fact, if a breakthrough of pain happens "unscheduled", and even worse - on the weekend, there is a wall between the patient and the saving ampoule of morphine. The problems of those suffering from severe pain non-cancer patients are not solved at all.

“Yesterday was hell. All attempts to get help ended in nothing ... We manage with noshpa, baralgin, sedatives, which we constantly tease. Maybe we are doing something wrong. But in our glorious city for almost two days we did not find medical assistance. Only an ambulance with baralgin,” film director Lyubov Arkus wrote on his Facebook page, whose mother, who is in the terminal stage of her illness, began to experience terrible pain from Saturday evening. And such stories, unfortunately, are not uncommon.

Why despite all efforts recent years, such stories still happen and how to avoid them, MedNovosti talks with Olga Goldman, director of the Yasnoe Morno charity service for cancer patients.

Olga Goldman. Photo: svoboda.org

Clumsy system

Olga Emilyevna, it turns out that all the assurances of officials that the problem of the availability of pain relief has been solved are empty words?

— No, it's not. You see, formally everything that was required has already been done: all the necessary laws have been adopted, orders have been issued. Expiry date of drug prescription medicinal product extended from five days to 15, any district doctor can prescribe it. The dosage of the drugs was doubled. When discharged from the hospital, the doctor may hand over to the patient with chronic pain a supply of painkillers for five days. " Ambulance» received the right to use drugs in the relief of pain in palliative patients. And palliative care itself has entered the MHI and is developing very quickly.

But in reality it doesn't work.

- The problem is that our routing system inside medicine is very lame. The patient finds himself alone with these problems - he must rush around the Internet, through funds, look for information that he must receive in his polyclinic at the place of residence. When it leaves close person, this is the hardest thing that can be. And if it is also accompanied by hellish pain, relatives are often in a state of shock and cannot act adequately. Therefore, the attending physician should go half a step ahead: not wait until the situation becomes critical, but warn relatives that such a development of events is possible, and everything must be foreseen in advance.

At a minimum, a patient in the terminal stage should be registered with the palliative care service and inform his relatives about the opportunities that are available in their city. What opportunities this family will take advantage of, for a fee or for free, is no longer important. But the system should work in such a way that the initiative comes from the attending physician even before the crisis develops. And to establish such a system is the task of healthcare organizers in each region.

The salvation of the drowning is the work of the drowning themselves

It looks like it will take a very long time to get it fixed.

— Of course, the sluggishness, slowness, which is inherent in any state organization, is not good for a person with pain. Therefore, you need to understand what the risks are and try to minimize them. Of course, it is impossible to spread straw everywhere, but it is still not emergency situation when you need to work in emergency mode. For example, now you can get a prescription for pain relief within half an hour, but only if you receive this prescription not for the first time, when you need to fill out the documentation and complete other formalities. Especially not on weekends. Therefore, if a person becomes worse, it is necessary, without waiting for the development of a pain syndrome, to register, attach to a hospice or an outreach palliative service.

Many people are not ready to send their loved ones to hospice.

— Unfortunately, there are many prejudices associated with hospice care. Often people think that if they send their relative to a hospice, then they will betray him. But hospice is just medical institution where the patient is given a dose of painkillers, his relatives are taught how to care, that is, they improve the quality of his life. And from where you can always take it home. But it is still important to face the truth and understand that if you make it to the end, it will be very painful for everyone.

Can pain be avoided altogether?

The breakthrough of pain (intensification of the pain syndrome) does not occur spontaneously, but when there is already chronic persistent pain. When a person takes pain medication different kind, but at some point they cease to suffice. And this means that you need to change the dose or form of the medicine, for example, switch from injections to patches or vice versa. The problem is that if a person constantly endures pain, it is more difficult to remove it: his body, his brain gets used to this pain background, changes begin to occur already in the brain. Therefore, it is so important that the patient does not experience pain. The doctor must assess how severe the pain syndrome is and decide on pain relief - this is a medical decision.

“We don’t have a culture of patient trust”

strong constant pain experienced not only by cancer patients.

- This is very a big problem. There are a lot of such patients, in addition, in Russia great amount problems with bedridden patients who can never be cured. And unlike cancer patients who face it late in life, they may need palliative care for many years. For non-cancer patients who have been living on painkillers for years, it is very important to choose the right medicine so that the quality of life does not suffer, but at the same time that there is no side effects, addictive. This is a separate, very highly specialized question.

According to world statistics, 80% of people who use palliative care are not cancer patients. In our country, the system of helping people with chronic pain, if it is not oncological, is practically absent. Russian hospices now serve only cancer patients. But in some places there are geriatric centers, palliative departments, so-called social beds in hospitals. And about this, too, you need to inform relatives, who are very difficult in such a situation.

And how can such patients get strong painkillers?

- By law, any patient with pain syndrome- if necessary, he should be prescribed a drug, regardless of the diagnosis and whether he is being treated in a hospital, or is at home or in a hospice. The first thing to do is to tell your local doctor about this pain, who should monitor this pain. Unfortunately, we do not have a culture of patient trust. But, nevertheless, if a person is brushed aside, declaring, “you don’t have pain,” you don’t have to stop, you have to insist on your own.