The recent report that the staff of the Moscow ambulance is prescribed to reduce the number of hospitalizations at any cost has given rise to another scandal. Why do physicians have to refuse patients the necessary help?
In December 2017, during the annual press conference, President Vladimir Putin said that in many cases, the reduction of the network of medical institutions is unacceptable and unreasonable.
"With all the fairness of the statements that our bed fund is not used for the treatment of patients, but for prevention and simply recovery, with all the technical means that must be such that staying in a hospital bed is shortened, it is not always reasonable to reduce institutions "- said the president.
A little more than a year has passed since then, but during this time nothing seems to have changed. Hospitals are still closing, there are not enough places at all, and the doctors themselves have to clear up the results of optimizing health care. And first of all, the ambulance staff.
"CUT DOWN HOW!"
The scandalous message was first heard on the air of Radio Liberty. The idea was that ambulances would soon be hospitalized only in the most difficult situations. In all other cases, the paramedics of the ambulance are obliged to convince the person that he can be treated at home.
“The order was announced at meetings of substation managers and regional deputy chief medical officers of ambulance. No excuses or justifications are accepted. The wording is simple: "Cut as you like." Substations solve the problem as they can: they are cunning with statistics, they force patients to refuse hospitalization, they leave the patient at home if he is in a borderline state, ”said the head of one of the ambulance substations in Moscow.
The information was confirmed by the chairman of the Feldsher.ru trade union, the acting ambulance paramedic Dmitry Belyakov: “Before, when a person had a serious illness, the visiting doctor insisted on hospitalization. If a person refused, and then died or became disabled, the doctor was reprimanded with the wording: “You didn’t explain his situation to the patient well”. And now, doctors are required to offer hospitalization to the patient so that he will refuse it. But in any case, if there is any incident, then the emergency doctor will be the last thing to do, because no one gave the relevant instructions signed. ”
Some of his colleagues believe that doctors will have to ignore such a strange installation. An official document with signatures and seals, none of the doctors have not seen. Probably, it simply does not exist.
“I want to believe that the pressure on doctors will not affect patient care, because, after all, every working team has a head on its shoulders and is much more important than its own safety. They will get better from the authorities than they will receive from the prosecutor. Most, I think, will ignore all this, ”is the opinion of another ambulance officer.
Representatives of the health department did not agree with the accusations of their colleagues. In an official press release, it is said that patient care will be provided in full.
NEW TURN OF OLD STORY
The first scandal associated with the rules of hospitalization of patients, occurred in 2013. It was then that an official order was issued in the capital with new rules for the evacuation of patients to hospitals. The list of indications for a trip to the clinic was changed so much that it became clear: most patients will have to be treated on their own.
The result was not long in coming. Muscovite Anna Novikova wrote in her LJ text under the heading "To stay alive, or the New rules for hospitalization." The woman spoke about the illness of her husband, who had an abscess on his leg joint.
“I called an ambulance. The arriving doctors reported that the new order of hospitalization is now in effect, according to which our case is not an emergency, so we need to be treated in the clinic, ”wrote Anna Novikova.
The district therapist sent Dmitry to the surgeon, and the one to the nurse for dressing. The man was getting worse.
“The ambulance arrived again, refused hospitalization, referring to the same order, and redirected the case to an ambulance. There, the doctor made square eyes: “Why are you not in the hospital ?!”, recalls Anna.
Only after long phone talks with the department’s staff and the head of the polyclinic, they agreed to hospitalize the man. As a result, Dmitry amputated a finger. After a couple of days of waiting, he would have lost his foot.
This story instantly scattered on the Internet. The resonance was so powerful that the representatives of the Ministry of Health of the Russian Federation had to explain themselves. Soon, officials acknowledged that the new rules, to put it mildly, are far from perfect, so the order should be revised. Today, five years later, industry leaders repeated the same trick. Only now, no one decided to put his signature on the order.
Most Russians are confident that today you can go to the hospital, but you need to know certain secrets. Here's a resident of St. Petersburg appeals to users of social networks: “Mom has severe back pain, compression fracture of the spine, moves with difficulty, called an ambulance 4 times, they come, make an injection, and don’t take it to the hospital. Since there is no stroke, heart attack, is not paralyzed, it means that we cannot be admitted to the hospital. Advise what to do in this situation? ”
The author of the question is answered by knowledgeable people. There are many ways. It is necessary to obtain admission from the head physician of the hospital and persuade him to sign a permit for hospitalization. You can pay an ordinary doctor in the hospital, and he will figure out how to "push" the patient into a hospital bed.
It would be nice to read the legislation on the rights of patients. It makes sense to make an appointment with the deputy mayor for social programs. And all this in order to get proper treatment in the hospital!
OPTIMIZATION BEFORE GOOD
Why throughout the country ambulance forced to refuse patients? Doctors themselves do not doubt that the main (however, not the only) reason is the lack of beds in hospitals.
Since the beginning of the “optimization of health care” thousands of hospitals were closed in Russia. According to Rosstat, in 2002–2018, the number of hospitals in the country has halved – from 10.3 thousand to 5.4 thousand, and an average of 353 hospitals are closed per year. Patients have nowhere to put.
“It seems to me personally that no one cares about either the sick or the employees themselves. If you do not know, last week two ambulance paramedics for 31 years and 36 years of age received strokes. These are wild processing, this is one and a half stakes, the race "come on”, says the head of the trade union Dmitry Belyakov.
Emergency doctors admit that they are accustomed to work in the strictest economy. The main thing is to save the money of insurance companies. And hospitalization is really expensive. That probably someone, it seemed better to do without it.
Photo: TASS / A. Geodakyan.