What to call the doctors from the children's clinic or what I almost turned gray.

The profession of a pediatrician is one of the most sought after in pediatric medicine. The pediatrician evaluates the child’s physical and neuropsychic development and his school maturity. The doctor also evaluates children according to their health groups, gives recommendations on education and feeding, and prevents chronic diseases in children.

A pediatrician must know the clinical symptoms of the main diseases and borderline conditions of childhood, the causes of the occurrence and development of diseases of the body organs and infectious diseases; modern methods of therapy; basics of pharmacotherapy in children, etc.

What does a pediatrician do?

The list of responsibilities of a pediatrician was approved by order of the Ministry of Health and Social Development of Russia. In accordance with it, the responsibilities of a pediatrician include:

• obtaining information about the child’s health;
• organization and implementation of anti-epidemic measures in the source of infection;
• monitoring the child’s health and providing medical and preventive care (dispensary examination);
• organization and implementation of immunoprophylaxis in children (in accordance with the vaccination schedule);
• development and implementation of individual rehabilitation programs for disabled children;
• carrying out sanitary, hygienic and preventive measures to protect children's health;
• issuing certificates and certificates of incapacity for work to care for a sick child.

What is another name for a dermatologist?

Dermatology studies many diseases and their main symptoms, so it has more specific specialties. In addition to a dermatologist, skin diseases are treated by:

Skin problems cannot be ignored as they indicate serious illnesses. If you have any alarming symptoms, you should go to a dermatologist - he will help determine the cause of their appearance, prescribe adequate treatment or refer you to another specialist. Unfortunately, many patients self-diagnose and treat themselves. This threatens with serious problems, one of which is the transition of the disease to a chronic form.

How does a pediatrician work?

At the appointment, the doctor collects anamnesis (receives information about the child’s illness, studies complaints about his health, his medical history), and conducts an examination. After the initial consultation, the pediatrician writes a referral for the necessary tests (for example, to do a culture, donate blood or urine for analysis). Based on the results of the examination, after studying the tests and studies, the pediatrician prescribes treatment or, if necessary, refers to a doctor of a narrow specialization (for example, if vision problems are identified - to an ophthalmologist, if heart disease is suspected - to a cardiologist).

Pediatric urology andrology: when to contact

Parents may not always know that it is time to see a doctor; they think that everything will go away on its own. In any case, if one of the following factors is detected, it is advisable to contact a specialist for advice as soon as possible:

• The presence of protrusions and other foreign formations in the scrotum area;
• The newborn has one or both testicles missing, or they do not descend for a long time;
• In children over three years old, the head of the penis does not open or does not come out completely (most often the problem is just the last few millimeters before complete exposure, although there are other situations);
• A child 14 years of age or older does not show the first signs of puberty;
• The child experiences pain when urinating;
• urinating too frequently;
• One testicle is significantly larger than the other;
• Pathological location of the opening of the urethra, located outside;
• Complaints of pain in the groin area, which may manifest itself more specifically in the penis or scrotum;
• Redness of the genital organs and the presence of swelling on them;
• Children over five years old experience urinary incontinence, both during the day and at night.

It is worth understanding that an andrologist, when examining boys, can detect diseases that neither the child himself nor his parents are aware of. This is due to the fact that they are quite difficult to diagnose for a person far from this area. It is for this reason that it is worth visiting this specialist not only when any symptoms occur, but also for prevention. This especially needs to be done in the first years of life and during puberty.

What does the pediatrician treat?

First of all, the pediatrician must be able to diagnose and carry out the necessary treatment of infectious diseases (influenza and acute respiratory infections, dysentery, whooping cough, measles, rubella, scarlet fever, chickenpox, mumps), food poisoning, etc. In addition, the pediatrician must be able to diagnose heart and vascular diseases , respiratory system, liver and kidneys, a number of lesions of the gastrointestinal tract, lesions of the nervous system, metabolic disorders, infectious lesions. In these cases, the pediatrician refers the patient to the appropriate specialist and monitors the overall progress of treatment.

Division of endocrinologists by specialization

An endocrinologist is a specialization that has many branches: pediatric specialist, geneticist, gynecologist and others. So, the first doctor deals with pathologies of the child’s endocrine system. It is necessary to understand that the disease develops rapidly in childhood, as do concomitant pathologies. In this regard, it is strongly recommended to consult a doctor in a timely manner - immediately when the first symptoms appear or simply if your health worsens.

The specialization of a geneticist is to cover hereditary pathologies, which include diabetes mellitus. No less in demand is a gynecologist who treats diseases associated with the reproductive system in diabetics. Including when it comes to female and male infertility. In addition, when talking about specialization, pay attention to:

• surgeon - he treats the disease at an operable stage, allowing one to determine the technique and degree of surgical intervention;
• a diabetologist is a doctor who deals with patients with diabetes insipidus or other abnormalities in the development of the disease;
• A thyroidologist devotes himself to diagnosing and determining the necessary therapeutic measures for pathological conditions in the endocrine gland. All this is very important for diabetics.

Mathematics and the patient

Elena Evgenievna! It is customary that the MHIF is ruled by a physician. But you are an economist by profession?

Elena Chernyakova: Closer to the accountant.

To come to such a position at a time when almost everyone is surrounded by Covid and so many problems... Were there doctors in the family? Or are you, a graduate of the Moscow branch of the university in Kazan, from a family with a “mathematical bent”?

Elena Chernyakova: Neither one nor the other. Although I have doctors, dynasties of doctors have always evoked special reverence. But my dad is a military man, a lieutenant colonel. Mom is a teacher of foreign languages ​​- German and French.

Do you know languages?

Elena Chernyakova: To be honest, the ability to learn languages ​​was not passed on to me from my mother. But I love mathematics. I don’t know her so much as I feel her.

Can you feel mathematics?

Elena Chernyakova: Yes! When they bring me tables with calculations, with some hindsight I always understand where and why the mistake was made.

So, today we have a conversation with the new head of the Federal Compulsory Medical Insurance Fund, who has a feel for mathematics. But they also say that you are a systems person. What does “systemic” mean?

Elena Chernyakova: Whatever I do, even if I just go to the store or raise my child, and even more so when I am engaged in professional activities, it is important for me to have a clear coordinate system. Where is the y, where is the x, what is the scale of divisions and how do all these processes take place. It is important for me to understand the location of all participants, their roles, functions.

Arrange everything on shelves?

Elena Chernyakova: Yes. It somehow works out on its own.

In a new position, do you also need to put everything in order? With the Federal Compulsory Medical Insurance Fund, judging by the disputes surrounding it, not everything is up to par. I have a favorite character - Aunt Masha from the entrance. She has a compulsory medical insurance policy. What is she entitled to, what medical care?

Elena Chernyakova: In accordance with the Constitution - for all available medicine available in the Russian Federation and necessary for it at a given specific point in time.

Do you believe this?

Elena Chernyakova: I firmly believe in the law.

Where, for example, should Aunt Masha turn if she needs to have a stomach ulcer removed?

Elena Chernyakova: First of all, she needs to go to her doctor, who is now called in different regions either a therapist, a family doctor, or a general practitioner. That is, it is the primary care doctor who must “routine” her depending on what she needs.

What if this same Aunt Masha knows a specific clinic and a specific specialist? How to get there?

Elena Chernyakova: If we rely on the regulatory framework, there are two ways. The first is through the same clinic from her doctor, who should know what she is sick with and the history of her illness. Or she comes to a specific clinic that she considers necessary.

And who will receive her there?

Elena Chernyakova: If you come from another constituent entity of the Russian Federation, most likely through a paid unit. But to be fair, let's still treat a stomach ulcer in a good local hospital, where knowledgeable specialists work. A unique specialist cannot be enough for everyone.

According to our rules, the money follows the patient. This means that the more patients, the better. Maybe money should go not to the sick, but to the healthy?

Elena Chernyakova: Money should work for the citizen, whom it would be better to prevent from getting sick, to do everything to prevent him from getting sick.

What, according to a system specialist, does compulsory health insurance give a person?

Elena Chernyakova: The draft state guarantee program, which has been submitted to the government, indicates that the volume of assistance for preventive measures and research is increasing. To prevent the development of the disease, identify it at an early stage. The main trend is prevention and early detection of diseases.

Some federal centers, significant throughout the world, are often empty. Because locally, especially in large cities, there are city hospitals. And they are not sent to the federal center so that the money going to the patient does not leave the local budget.

Elena Chernyakova: There is an order from the Russian Ministry of Health, and I think that it will be further developed, which defines the criteria for the need to refer a particular patient for treatment in a federal clinic or in a regional clinic. We are currently amending the legislation on compulsory health insurance. The basic program will allocate two amounts of assistance. One volume of assistance provided by the constituent entities of the Russian Federation. And the second - which turns out to be federal clinics. Only within the framework of specialized care in a 24-hour or day hospital.

This does not apply to the initial appointment. These volumes of assistance will be financed either from subventions and from the budget of territorial funds, or from the budget of the federal fund within the limits that are determined for federal institutions. And we will change the situation when a subject, referring his citizen to a federal clinic, understands that at least the help there is more expensive, but more qualified, but now he will not need to give money to the “federal” from his own territory for this.

How is it going today? The territorial program includes all assistance to all residents living in the territory. Conventionally, Moscow, or Tatarstan, or the Samara region. That is, all medical care for residents of this region is included in the territorial program. And as soon as a person leaves abroad - whether he was sent there or left at his own request - if he ended up in a federal clinic, then this entity receives a bill from the federal clinic. And it needs to be paid. Therefore, of course, the economic motivation to send “our” patients to a federal clinic is weak. That's why we are changing the situation.

We say that we will determine the volume of assistance provided by federal clinics and finance this assistance ourselves. The criteria for referrals will be established by the Ministry of Health, and compliance with the criteria will be determined by the doctor. When they send specialists, they will not be asked to pay, because we will pay for this assistance from the federal center. Thus, it is precisely those, mostly complex, patients who need help from federal centers who will be able to receive it without any problems.

Doctors complain that they cannot always provide expensive treatment because compulsory medical insurance does not pay for it.

Elena Chernyakova: Compulsory medical insurance pays for everything that is included in clinical recommendations and standards of medical care.

Does the patient have the right to choose a doctor?

Elena Chernyakova: Of course. This right is written down in laws and regulations. This means choosing a doctor. Which will determine the need for treatment, its urgency, and suggest medical organizations that can provide this assistance.

Now there are many paid medical institutions. Some of them work under the compulsory medical insurance system. But not everyone is allowed to do this.

Elena Chernyakova: Clinics are included in the compulsory medical insurance system on a notification basis. That is, they submit a notification: I want to enter the compulsory medical insurance system. They are included in the register of medical organizations operating in compulsory medical insurance. Next comes the commission procedure - distribution of volumes. This is stated in the law. The commission includes representatives of the Ministry of Health, representatives of the fund, and representatives of insurance organizations, medical organizations, including the professional medical community.

It is important that a private citizen, when he enters the compulsory medical insurance system, still provides comprehensive medical care. Not only a specific type of assistance that is convenient for treatment and profitable for the clinic today, but also could take care of the consequences if they occurred. For example, if complications arise after an operation and rehabilitation or intensive care is then required, the patient often goes to a public clinic. Because the private owner does not, for example, have an intensive care unit.

In any organization, in any production, there are profit centers and cost centers. The same in any clinic or hospital. There are types of assistance that are more profitable to provide purely economically, and there are those that are less profitable. It is important that it does not happen that all profitable types of assistance go to the private sector, while all unprofitable ones remain at the state level. Our task is to prevent this situation from happening.

How?

Elena Chernyakova: Adequate tariff policy, provision of comprehensive medical care, criteria for the distribution of volumes between organizations.

Is it necessary to divide medical institutions into public and private, federal, city, and departmental? There are healthcare institutions, and let me, the holder of a compulsory medical insurance policy, have the right to be treated wherever I want.

Elena Chernyakova: Nothing like that! The issue is not the form of ownership. The question is that the doctor must determine the need for your treatment. A person cannot determine it for himself. It is not right. There are medical specialists and the Ministry of Health who determine the procedure and indications for medical care. The choice of a person, the choice of a clinic, is carried out under two conditions. First. This is if there is a referral from a doctor at your place of residence. Or there is a referral from a doctor from the clinic he has chosen. But both must meet the criteria for referral to a Ministry of Health clinic. That is, the attending physician makes a decision on hospitalization if it is a federal clinic or, for example, if it is a clinic of a subject - republican or regional. There are criteria when it is better for a person to be treated in primary care and when to be treated in a second or fourth level institution.

Does the patient have the right to want?

Elena Chernyakova: Everyone has the right to want to be healthy.

When a person gets sick, he is in a special state. And this must be taken into account. We need to regulate, but maybe not that much. I understand that these are emotions. Is medicine possible without emotions?

Elena Chernyakova: The doctor must show sympathy for the patient and provide all the necessary assistance.

Complete regulations in everything? But medicine cannot be digitalized.

Elena Chernyakova: We have no choice. Any limited resources must have rules for their distribution and consumption. Today we have a Compulsory Health Insurance Fund and there is a procedure for replenishing it. There is a procedure for routing a patient depending on his condition. I would like, on the one hand, that every patient actually knows his doctor. On the other hand, he must know his insurance representative. We have a whole institute of insurance representatives, and they are obliged to protect the patient’s health.

There's nothing you can do: Covid forces you to wear masks. Photo: Vladimir Anosov

Key Question

How do I find out who my insurance representative is?

Elena Chernyakova: On the back of your policy you have the phone number of the insurance company. And you have the right to ask for any question. It is very strange that this is not developed here. Here is one of my tasks: so that every person knows that he has an insurance representative, knows who he is. Because it is he who should help a person navigate the scope of medical care. There is a phone number on the policy where you should be able to contact the insurance representative.

On the back of your policy you have the phone number of the insurance company. And for any question you have the right to contact them

Are you sure that he will respond, to put it mildly?

Elena Chernyakova: They get money for it. One percent of the entire healthcare system. Alas, few of my acquaintances, colleagues or acquaintances of my acquaintances actually communicated with insurance representatives or received calls and messages from their insurance companies about the need, for example, to undergo a medical examination. But insurers must do this.

The main task of compulsory medical insurance?

Elena Chernyakova: Provide citizens with the opportunity to exercise their rights to medical care.

Are we receiving medical care or medical services?

Elena Chernyakova: Medical assistance, definitely. Moreover, we charge medical care today. We do not charge a fee for the service. And we are not paying for a service, but for help. If you open the law on compulsory health insurance, you will see that care is paid and assistance is provided. Our legislation does not contain the words “medical service”.

The man is in a state city hospital. He is scheduled for an MRI. Such research is not performed at this hospital. They advise him: there is a private clinic next door. There will be an MRI...

Elena Chernyakova: You need to call the insurance representative and tell them that they offer you this. And the insurance representative, having contacted the administration of this clinic, will say that either you fulfill your duties, or I will present you with a fine for failure to comply with the procedure for providing medical care.

There is no escape from the covid situation.

Elena Chernyakova: At the country level, at the level of the entire healthcare system, measures have been taken so that no one faces a choice of who to provide assistance and who not to provide.

Do we all need to be in the compulsory medical insurance system?

Elena Chernyakova: And we are already all in the compulsory medical insurance system. Because we are guaranteed free medical care. If we don't want free help, we don't have to ask for it. But we are there from the start. Because if we don’t work, then the subject of the Russian Federation pays for us without asking us. And if we work, the employer pays the contributions. We cannot go ahead and say: I have nothing to do with the compulsory medical insurance system at all. We may not use help, but we are still in the system.

Do you like your new job?

Elena Chernyakova: I generally like to work. When accepting the offer to transfer to the Compulsory Medical Insurance Fund, I understood that there were issues that could actually be resolved. And some of them are even sufficient in the short term.