General practice surgeon. The patients approved the experiment. Therapist and general practitioner - the difference

Today, one of the most sought-after professions in medicine is a general practitioner. Who is this, almost every resident knows countryside. 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 are not required to provide specialized medical care.

They should be able to solve relatively simple health problems and engage in the prevention of diseases of therapeutic, surgical and gynecological profile 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. General practitioners received the greatest distribution in this area due to the economic inefficiency of building full-fledged medical and preventive institutions in each locality and providing 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) will work, nurse and a nurse. 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, he 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 in which it conducts its professional activity general doctor. Its work is built primarily on the identification of the population living in the area under its control, the risks of developing certain serious illnesses, as well as systematic activities aimed at counteracting their formation.

What does it take to be a specialist?

The GP's office should be equipped with a range of tools to help primary 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 of the specialists in this field who do not try to equip their outpatient clinic have to constantly refer patients to district medical institutions for the simplest laboratory research (general analysis blood, urinalysis, biochemical analysis blood, etc.).

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. Relatively with everyone simple problems 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 healthcare institution in every locality, in which a large number of doctors. 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 medical Center corresponding 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 - very effective method to preserve the health of the population, however, the activity of such specialists is possible only in a sufficiently developed economy. The fact is that wage such an employee will consist of deductions from his direct 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 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.

Very soon, district therapists, after appropriate training, will turn into general practitioners (GPs), or, as they are also called, family doctors.

What can Muscovites expect from new reform and how the work of medical personnel will change now.

How is a general practitioner different from a general practitioner?

By the way, the opportunity to call a GP at home in Moscow has not yet been provided. However, the local therapist now leads only outpatient appointment. Home care is provided by other doctors, and for them, with the advent of family doctors, nothing will change (as well as for pediatricians, who are essentially children's general practitioners).

What should a family doctor know and be able to do?

The order of the Ministry of Health defines a GP as a specialist who is broadly oriented in the main medical specialties and able to provide care for the most common diseases and emergencies.

According to the order of the Moscow Department of Health of February 2017, the offices of general practitioners should be equipped with a tourniquet to stop bleeding, a manual apparatus for artificial ventilation lungs, surgical scissors, ophthalmoscopes (for checking vision), rhinoscopes (for examining the nasal cavity), a table for blood sampling and intravenous infusions, Esmarch circles.

Judging by the equipment of the doctors of the new profile, they should be universal specialists, be able to give an enema and take blood, and simple surgical intervention to carry out, and even resuscitation.

How many specialists have been retrained?

In Russia, an experiment in the training of general practitioners began in 1987, but the emergence of these specialists was hampered by problems with determining their legal status.

Only in 1992, a corresponding position appeared in the nomenclature of specialties. By 2000, about a thousand GPs had been trained in the country, by 2005 - almost four thousand.

What is the retraining program based on?

In Moscow, a pilot retraining project was launched back in 2014. As journalists were told in the capital's health department, the main goal of the project was to train a general practitioner as soon as possible.

In 2014, 113 specialists were trained. In 2015, their number exceeded one thousand, but the need for metropolitan polyclinics is more than 4.5 thousand general practitioners.

How long will it take to see a doctor?

As a result of the innovation, it is supposed to reduce the queues for appointments with specialists and increase the duration of appointments with a general practitioner. The time for reception will increase to 15-20 minutes. In addition, a nurse is provided to help such a doctor.

At the office of a general practitioner, there should be a manipulation room (for mini-operations) and a procedural one. Perhaps, due to organizational difficulties, GPs and district police officers will work in parallel for some time.

Will retrained therapists be able to replace specialized specialists?

The question arises: will the quality of medical care be worsened with the advent of doctors of universal specialties? There is a fear that former therapists will not be able to replace specialized specialists to the extent that they are counted on. The Moscow Health Department does not share these fears.

If general practitioners in the capital have yet to prove their worth, then in rural areas this practice should be effectively implemented. In areas where medical assistance narrow specialization not always available family doctors will be in demand first.

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Changes in the healthcare sector continue: this spring, general practitioners, as well as doctors who see older patients with multiple chronic diseases, began to work in the capital's polyclinics.

Unload but not replace

General practitioners began to conduct appointments in the capital's clinics from April this year. To begin with, as doctors on duty: you can get an appointment with them without an appointment. The level of their training is higher than that of general practitioners. The competence of general practitioners is diagnostics, treatment, prevention, rehabilitation of patients, organizational arrangements, solving psychological problems, etc.

In Soviet times, we followed the European path and began to produce narrow specialists. This is not entirely correct. A general practitioner is, in fact, a therapist who at the same time can look at the nose, throat, eyes. The treatment of children remains a separate item. In addition, a pediatrician is a general practitioner, only for children, - explained the deputy. Mayor of Moscow for social development Leonid Pechatnikov.

One doctor's treatment

In the Northern District, one of the first clinics where general practitioners began to receive appointments was the polyclinic of the State Clinical Hospital named after. Veresaeva, located on Lobnenskaya street.

A general practitioner does not replace a narrow specialist, - said Radmila Chernaya, head of the therapeutic department of the polyclinic. - He just can perform certain functions, daily routine work. Everything else is left to narrow specialists.

Thanks to the work of general practitioners, it is expected to reduce the burden on general practitioners, district physicians, otorhinolaryngologists, ophthalmologists, surgeons, neurologists, endocrinologists and doctors functional diagnostics. The burden on specialist doctors will also be reduced by selectively referring patients to a narrow specialist.

An experience foreign countries shows that with the introduction of the position of a general practitioner, 80% of patients start and finish diagnostics and treatment with one doctor, the workload of narrow specialists decreases, and the number of hospitalizations decreases.

Six months of retraining

The retraining of future general practitioners takes 864 hours, the training period is six months. At the same time, half of the hours are devoted to on-the-job training, and half to distance learning and on-the-job training. For two recent years about 2.5 thousand general practitioners and pediatricians have been retrained in this field on the basis of the best medical universities in the capital.

Practicing the practical skills of general practitioners is carried out in real conditions. Doctors adopt the experience of narrow specialists-mentors - neurologists, otorhinolaryngologists, ophthalmologists, surgeons, etc.

A special category of patients

This spring, doctors for elderly patients with multiple chronic diseases began to work in all polyclinics of the capital.

Due to the fact that the population of Moscow is aging, life expectancy is growing and has already exceeded 77 years, there is a large category of patients who need not just a standard, but individual approach, more attention, more opportunities to communicate with doctors. And two years ago, at the suggestion of the medical community, they launched an experiment that concerns the care of patients with chronic diseases, when special areas are created, a small amount of these patients in such a way that the doctor could individually work with each, individually prescribe a course of treatment, communicate, give directions for hospitalization, - said Moscow Mayor Sergei Sobyanin.

A qualified therapist sees only patients assigned to one group. These are women over 55 years old and men over 60 years old who have been diagnosed with three or more chronic noncommunicable diseases(e.g. at the same time diabetes, heart failure and bronchial asthma).

The initial appointment of such patients with this doctor lasts 40 minutes. Repeated reception - 20 minutes. Doctors will develop for everyone individual plan treatment and lifestyle advice. And, in addition, they will teach patients to keep self-control diaries, observe themselves and draw correct conclusions about their state of health. At the same time, each patient will be able to receive telephone consultations from his doctor or nurse.

Pilot project for medical care patients with multiple chronic diseases were implemented, including in the city polyclinic No. 45 in the Northern District. Olga Krasilnikova, Chief Physician of State Enterprise No. 45, emphasized that elderly patients with several chronic diseases, require more attention.

To implement this project, Polyclinic No. 45 is preparing the best doctors who will work in tandem with a nurse. The task of these doctors is to develop special comfortable examination and treatment programs for older patients, individual for each, she emphasized.

Patients approved the experiment

City statistics speak of a positive result experiment with older patients. Patients are 60% less likely to call a doctor at home, 18% less likely to visit specialist doctors, 9% less likely to call ambulance. Among patients aged 60 to 75 years, this figure decreased by 17%.

At the same time, the number of patients satisfied with medical care increased from 65 to 92%. Therefore, such an organization of work will be gradually introduced in the clinics of the capital.

Already today, about 60,000 patients have expressed a desire to switch to this system, which gives a much greater effect, - Sergei Sobyanin noted.

Now 209 doctors are participating in the project. It is planned that by the end of the year there will be more than 400 doctors working with chronic patients.

Pioneers will receive grants

Polyclinics staffed by general practitioners and physicians who manage older patients with multiple diseases, The Government of Moscow has allocated a grant that adds 20,000 rubles to the salaries of doctors working in these areas.

Cover photo of the article: In 2019, a children's and adult polyclinic will be built in Molzhaninovsky

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, 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 on social policy and local self-government, the issue of general practitioners' offices was considered comprehensively.
About what is included in the duties of a general practitioner, commented chief physician City polyclinic No. 5, deputy of the State Revenue Office Vladimir Levanov.
- 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 them. psychological problems responsible for the ongoing therapeutic and preventive measures.
Prevention is the prevention of emerging health problems. By observing older family members, the doctor has the opportunity to prevent or reduce the risk of developing the disease in the younger generation.
— In your opinion, where are the general practitioner’s offices most in demand?
“Today, the most pressing issue is the provision of medical services in remote areas of the city where there is the greatest need for doctors. This 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. Special attention this issue is addressed 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, thanks to the versatility of knowledge, who is able to deliver provisional 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: selection of glasses, washing ear canal, measurement 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 general practitioner. 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

Deputy Mayor of the capital for social development Leonid Pechatnikov shared plans for the development of education and medicine

The average life expectancy of Muscovites has increased to 77 years. As Leonid Pechatnikov, Deputy Mayor of Moscow for Social Development, explained, this improvement cannot be immediately noticed, but the trend is extremely important. Although the capital's health care and education still have something to strive for. " Social sphere- the one that causes the most dissatisfaction and complaints. And that's okay. Everyone wants to have more than what he has,” Pechatnikov said, adding that despite the budget deficit expected in 2017, all social guarantees will be met.

About the school for young actors

“We are now creating social elevators, integrating the university system into the school,” Pechatnikov said. As of 2016, about four thousand Moscow schoolchildren are already participating in the Medical Class program, nine thousand in the Engineering Class, and about ten thousand more schoolchildren attend the Cadet Class. Such a system is focused on making young people interested in the professions necessary in modern life and, in addition, trying to get rid of the reputation of the college (medium special education) as a fate for people of the "second class".

However, something unusual is planned within the framework of this program.

“We want GITIS to start cooperating with the theater college and school No. 123, which prepares children for art from the first grade. Perhaps it will be possible to put this system on rails. But it is important that theater teachers themselves be able to assess the talents of children in a timely manner and inform them, as well as parents, about the prospects. And for those who are not ready to become just an artist or director, there will be a college - other theater specialists are trained there, for example, lighting masters.

Now it is planned to discuss the question of whether having many children in itself is a reason for social support from the city.

About benefits for large families

"It seems to me that controversial issue. We all know some very wealthy people who have many children. So should they get help from the city? Let's put it this way: it's not enough to have many children. You need to understand whether your family really needs support. We investigate the condition of all families who receive benefits from the city. And we see amazing results! These people may be owners of several apartments, successful entrepreneurs - and these people receive money from us. But there are those large families, for whom our two or three thousand rubles can become a fundamental support. Therefore, I believe that the criterion should be not only having many children, but also the real financial situation of the family. It is necessary to observe targeting, then the amounts that the needy will receive will grow,” the deputy mayor explained.

About General Practitioners

Muscovites often blame the difficulty of making an appointment with a doctor: as long as you have time to get to a specialist, the flu will pass by itself ... To get rid of this flaw in the healthcare system, some clinics in Moscow have already appeared new doctor- general doctor.

“In Soviet times, we followed the European path and began to produce narrow specialists. This is not entirely correct. A general practitioner is, in fact, a therapist who at the same time can look at the nose, throat, eyes ... We hope that they will soon replace the district therapists. But we do not destroy pediatrics - this is the property of Russian medicine, so the treatment of children remains a separate item. In addition, a pediatrician is a general practitioner, only for children, ”Pechatnikov explained.

In addition, the possibility of increasing the allowable zone of self-recording is currently being discussed - that is, expanding the list of specialists who can be accessed without going through the office of the local therapist. Recall that now there are several of them - an oculist, a gynecologist, a surgeon, a dentist and an ENT. To visit the rest, you need to send a district police officer - according to practicing doctors, this measure helps to avoid situations where the patient himself makes a diagnosis (erroneous) and is sent to the wrong office.