Gynecologist-tarologist under Mercury retrograde: a joke job revealed a serious problem

In the description of the vacancy, the authors of which in a sense of humor exactly do not refuse, it is said that the sought-after successful candidate should be able to predict the date of birth according to the layout on three cards, determine the sex of the child on the coffee grounds, instead of ultrasound look into a crystal ball (a medical license for the ball is not required), diagnose the position of the moon in Capricorn and have experience with Mercury retrograde from two years. For this, he is waiting for a corporate discount on medical equipment in the form of candles and incense and career growth to the senior lasso, and there to the main magician of the network is not far away.

But this is what the patient says, who visited the clinic of the sleeping district of the capital, serving according to the MHI.

“I made an appointment with a dermatologist because of irritation on the face,” explains Larisa. I’m not a doctor, but even my knowledge was enough to understand that this is no ordinary irritation. Usually people know their usual sores, and I have known myself a lover for 45 years, that I live, and then clearly poured out something that I did not have before. Plus, just before that, I was on vacation in an Asian resort, suddenly there was something there. I called the clinic at the place of residence, they asked me if there was a fever and accompanying complaints, they were not, so they recorded with a dermatologist.

According to our interlocutor, she was received by a very beautiful young doctor of Caucasian appearance and first of all began to take silent photographs. The patient was surprised.

“I thought she would ask me first, and she sits and takes pictures and where my photos are sent,” a resident of the capital describes the reception. I said, Doctor, what are you doing? And she said, I'm going to download the chatbot and get a diagnosis. Well, I'm thinking maybe it's some special medical chatbot. And then she tells me you have rosacea! I'm not a doctor, and I know that rosacea looks very different, just in the same areas of the face. I mean, the doctor taking me doesn't even know that! Meanwhile, she's already asking her chatbot what they're treating rosacea, and she's gonna write it to me!

The frightened patient chose to move silently to a paid clinic, where she was quickly helped. After that, she shared with her paid dermatologist how she was accepted in a free clinic. And in response, I heard the following:

- And what do you want, they have such a shortage of personnel that they are happy to anyone, as long as the medical school brings a diploma. The rest are expected to be taught along the way. In our country, for example, when hiring seniority in free clinics is not even taken into account, unlike "state hospitals". In public hospitals, young specialists really have a lot of experience for little money. But there the work is hard and the two-man from the paid medical school will immediately calculate and bulge. Such can only sit in district clinics, especially the main thing for them is to fill in all electronic forms: accepted - examined - discharged. The fact that the patient did not recover, well, it happens.

A survey among friends of doctors shows that they also know the system of “sit, but do no harm” in polyclinics for compulsory medical insurance.

- What about the Hippocratic Oath? - I address my question to the doctor who agreed to explain the situation in a private conversation. A doctor from medicine can kill you!

- Well, they're doing their best. The AI is addressed, as, apparently, during the study in the “honey” used. And they will not let their elder comrades kill the patient. Looks like the acne dermatologist was wrong. But if you had a fever and a suspicious rash, you would be sent to a normal doctor. As if you came with complications after the initial intake. And recruits are tested on simple cases and on pensioners, who mostly want to tell someone in detail about their sores and get attention and sympathy.

But the story of a graduate of the capital medical school, six months looking for work in Moscow, so as not to return to his native Siberian town. Catherine is a dentist with a red diploma, a specialty in demand, but the girl is not taken anywhere.

I have two years of practice in a university clinic, everything is excellent, Katya says. But they don’t take me to paid clinics because there is no practice. Or rather, take, but only a hygienist, assistant doctor. I work this way, but this experience does not give me any advantages, since when applying for a job, they want medical experience. And the doctor does not take without practice - and the circle closed.

- What do we do?

Those who know the owners of private clinics, even the smallest ones like an office, ask for them and incubate “work experience” there, even if they are really bad doctors. And not all with a medical school diploma are good specialists, this is not a secret. But with the practice of private people, they are then taken to really cool clinics.

Are they not testing their skills?

- How and who will check them? Do I need an exam? If patients complain, they will check. I'm not sure. But when hiring, only the papers are checked.

But what about those who don’t know other people?

- Go to the district clinic, there are always not enough doctors, especially dentists. It's not hard to work there, grandma's mostly. But not money, and most importantly, does not affect the attitude of employers to you, for them experience in the clinic is not experience. We had a guy on the course who was an excellent student, a dentist straight from God. But work in Moscow and found, went dental in prison, there doctors are always needed. Call him, however, there is a “denture crusher” and the atmosphere is so so-so, but for medical practice will count for sure. He says you can't sit quietly in prison, they knock someone's teeth out every day.

Judging by the admissions of doctors themselves, mostly anonymous, in the pursuit of compliance with staffing standards, state clinics found themselves in a situation where “the presence of a specialist” became more important than “the presence of competencies.” In the conditions of an acute shortage of medical personnel, the administration of medical institutions often goes to extreme measures: almost any specialist who presented a diploma of a specialized university is hired, closing his eyes to the real level of his training, experience or gaps in knowledge.

For the head doctor of any district clinic, reporting to the regional Ministry of Health is a matter of survival, one of these chief doctors admits in a private conversation. If there is a gap in the staffing of the therapeutic department in 40% of rates, it threatens with inspections, fines and disciplinary penalties.

Apparently, as a result, the HR departments of polyclinics cease to conduct strict professional selection, and interviews become a formality. If the candidate has a doctor's degree, clinicians are ready to tear it off with their hands. And the phrase “learn as we go” has become an unspoken motto of many personnel services. Young specialists who have just left the walls of the university, or doctors who have spent years outside the profession, are thrown into the embrasure of the admission of patients, promising “curatorship”, which in practice is often reduced to signatures in the visiting log. After that, the process begins, which the doctors themselves call “search bar therapy”.

“When I came to the clinic three years ago after an internship, I was given 30 patients to replace,” says Anna, a young physician in one of the clinics of a large regional center. - I had no experience with chronic patients, I was confused in the appointment of drugs even with banal hypertension. My mentor, the supervisor, just came by once a week to check if the cards were filled. As a result, when a patient came to me with a complex complaint, I pretended to write something on the computer, and myself in the next tab frantically Googled the “treatment protocol” by the name of the symptom. It was very scary. I knew I was responsible, but no one taught me how to make decisions in conveyor mode.

Today, Anna has already gained experience and feels more confident, but for the fact that she managed not to hurt anyone, she thanks only fate. That in the context of the recently appeared vacancy of a gynecologist-tarologist not far away from divination on maps and ultrasound on a glass ball.

And Igor, 33, a patient complaining of acute joint pain, personally encountered the "magical" approach at a young rheumatologist's appointment.

“The doctor kept silent for a long time, flipping through my card,” the patient describes, “and then, right in front of me, he opened the website of the drug directory and began to infuse my symptoms.” When he was prescribing, I noticed that the drug was contraindicated for my stomach problems, which I just told him about. When I asked him why he wrote it, he said bluntly, “Well, it’s written on the Internet that it’s the most popular treatment for this kind of pain.” And the stomach in autumn, everyone is naughty, off-season, and Mercury is retrograde.

With the help of the esculapes themselves, we collected the consequences of such a personnel policy for the quality of medical care:

Of course, the doctors themselves cannot be blamed. The CHI system, put in a strict framework of per capita financing, often does not leave time for quality reception. But when the solution of personnel hunger is replaced by imitation of work, the most vulnerable participant in the process suffers - the patient. “Learning on the go” in medicine is not an office internship where a mistake can be corrected. The price of error is human health. As long as the criterion for the success of the clinic will remain a “closed rate” in the staffing table, and not the real level of knowledge of the doctor, the situation will remain critical. To rectify the situation, it is necessary to review not only the remuneration system, making it worthy for professionals, but also to change approaches to mentoring. A doctor should not search for a diagnosis in a search engine - he should have access to quality clinical recommendations, have time for the patient and, most importantly, have sufficient qualifications to be responsible for every word he says and the name of the drug he prescribed.