Medical labor examination in oncology. Vtek: transcript

Cancer diseases occupy second place as a cause of disability and mortality, and first place in terms of severity of disability.

The return of a disabled person to active work is the logical conclusion of rehabilitation and provides for his complete self-sufficiency, financial independence and improved quality of life.

To develop an optimal rehabilitation program for a particular patient, a comprehensive assessment (examination) of his health condition is necessary.

For this purpose, a medical labor examination is carried out.

Tasks of medical labor examination

Its task is to determine, through an expert study, the ability to work, to establish the level of decline and duration of its loss due to the disease. At the same time, ability to work is understood as the totality of physical and spiritual capabilities of a person determined by the state of health, which allow him to engage in work.

The assessment of working capacity is based on medical (presence of the disease, its complications, clinical prognosis) and social (work prognosis under specific working conditions) criteria.

Thus, the main task of the work capacity examination is to determine the ability of a given person to perform his professional duties, depending on medical and social criteria.

In addition, the tasks medical examination work ability includes: developing optimal treatment and regimen to restore or improve health; determining the degree and duration of disability due to disease or other reasons; recommendations for the rational and full use of the labor of persons with limited ability to work without harming their health; identification of long-term or permanent disability and referral of such patients to a medical and rehabilitation expert commission.

Based on the data of a comprehensive medical examination, the presence of the disease in a particular person is established. If changes in health status are temporary (reversible) and recovery is expected in the near future or significant improvement and restoration of the ability to work, then this type of disability is considered temporary.

In addition, disability is divided into complete and partial. Complete disability occurs when a person, due to illness, cannot and should not perform any work and needs a special treatment regimen.

Partial disability refers to the inability to work in one's profession while maintaining the ability to perform other work. If a person can work in easier conditions or perform less work, then he is considered to have partially lost his ability to work.

Documents certifying temporary incapacity for work and confirming temporary release from work (study) are a certificate of incapacity for work (sick leave) and, in some cases, a certificate of established or free form.

Examination of temporary disability is carried out by medical advisory commission (MAC). It is organized in medical institutions if they have at least 15 doctors on their staff. The VKK includes a chairman - the chief physician or (in large institutions) his deputy for medical labor examination (VTE), head of the relevant department and attending physician.

If necessary, doctors of other specialties may be invited for consultation. The main areas of work of the medical advisory commission are: constant monitoring of the validity and correctness of issuing documents on temporary disability; resolution of complex and conflicting issues of VTE; decision to extend the period of temporary disability beyond 30 days: establishing the need to transfer the patient to another job, release from work on the night shift; issuance of sick leave for sanatorium treatment and for special treatment in another city; referral of patients to Medical and Rehabilitation Expert Commission (MREC).

With long-term or permanent loss of ability to work (complete or partial), a state of the human body occurs that is defined by the concept of disability. Determining disability is within the competence of the medical rehabilitation expert commission.

Long-term and frequently ill persons who have been continuously in a state of temporary disability for more than 4 months (on sick leave), as well as persons who have received sick leave for the same disease over the past 12 months for a period of more than 5 months with interruptions, are subject to referral to MREC.

In addition, the basis for referring a patient to a medical rehabilitation expert commission is the presence of signs of disability, the end of the period of disability, re-examination, early re-examination.

The main tasks of the MREC in oncology are: determining the state of working capacity, establishing the group of disability and the cause that caused it; determining the timing of the onset of disability for temporarily disabled people; development of work recommendations for disabled people based on health conditions (conditions and nature of work); periodic monitoring of the working capacity of disabled people (re-examination); prevention of disability.

A disability group is established for patients suffering from malignant neoplasms in cases where the resulting dysfunction of the body interferes with the performance of professional duties and has become stable, regardless of the therapy performed.

General criteria for assessing the working capacity of cancer patients

There are general criteria for assessing the working capacity of cancer patients. They are based on a combination of clinical, general biological and social factors.

Among them are taken into account:

1) factors related to the tumor (localization, anatomical type growth, histological form and degree of differentiation, stage of the process, metastasis, recurrence);
2) factors of the therapy (treatment options, its duration and complications, the volume of surgical interventions, time intervals before and after the start of special treatment);
3) social factors (gender, age, profession, character and working conditions).

Analysis of all of the above factors allows us to assess the degree of disability of the patient and establish the appropriate disability group.

Group I disability is established for all patients whose health condition is so severe that they cannot care for themselves in everyday life and need assistance. outside help. In most cases, these are patients with an advanced tumor process that is not subject to radical treatment(incurable).

Group I disability is also established for patients who have experienced severe complications as a result of the therapy (amputation of both lower limbs, complete blindness due to the development and/or treatment of a neoplasm, pharyngeal fistulas that make it difficult self-catering and etc.). Disability group I is established for a period of 2 years.

The exception is patients who have malignant tumor detected in an advanced (incurable) form, as well as patients who developed untreatable relapses and metastases after treatment. For these patients, the disability group is established without specifying the period for re-examination.

Group II disability is defined as a patient with complete loss of ability to work, but not in need of outside care. This category includes patients for whom all types of work for a long time are contraindicated due to the possibility of worsening the course of the disease under the influence of work activity. For example, patients after rectal extirpation, persons with radiation proctitis, accompanied by periodic bleeding and severe pain.

Group II disabilities also include patients with severe chronic diseases, combined defects of the musculoskeletal system, significant loss of vision, for whom work is not contraindicated, but is available only in conditions specially created for them.

An example is patients with severe anatomical defects after hip disarticulation, a short stump of an amputated limb and the impossibility of prosthetics. Disability group II is established for a period of 1 year.

Disability Group III is installed for patients with reduced ability to work as a result of chronic diseases and anatomical defects. In cases of minor defects or deformations that do not interfere with the performance of normal work, but require some relief or changes in its conditions, there are no grounds for determining a disability group.

Disabled people III groups are mainly persons who need to be transferred for health reasons to work in another profession due to the inability to continue working in their previous one, as well as persons with significant restrictions on employment opportunities due to severe functional impairments, or who have not previously worked, or who have low qualifications . Appropriate work recommendations are assigned to such patients by decision of the Higher Quality Commission. Disability group Ill is established for a period of 1 year.

The right to receive a pension, its size and various benefits depend in most cases on the causes of disability. Therefore, the medical rehabilitation expert commission, in addition to determining the disability group, establishes its cause.

When considering questions about establishing the cause of disability, the MREC makes its conclusion after a thorough examination of medical documentation and data confirming the nature of the work, profession, and the conditions under which the disability developed. Verification of the diagnosis of cancer is mandatory. In the majority of cancer patients, the cause of disability is classified as a “general disease.”

In this case, a general disease is indicated as the cause of disability in cases where the disability occurred either during working life, or during training in higher and secondary specialized educational institutions, or after leaving work, but has no connection with the profession.

Disability due to a general illness entitles you to a pension if you have a certain length of service and depending on your age. If disability as a result of cancer occurs in childhood or adolescence, then it is defined as disability from childhood or disability before the start of work.

An occupational disease as a cause of disability is established in cases where a malignant neoplasm arises as a result of long-term systematic exposure to the body of any carcinogenic factor characteristic of a given profession.

The basic principles for determining the ability of patients to work after the end of special treatment are as follows: the majority of patients after radical therapy are recognized as group II disabled within the first year after the end of treatment.

Degree of ability to work

In subsequent years, the degree of ability to work is determined taking into account a number of objective factors that are of paramount importance in the further prognosis of the disease.

These include:

1. The age of the patient is an important factor in determining ability to work, since it is associated with the characteristics of cancer treatment and the various adaptation capabilities of the body in different age groups.

2. The stage of the disease at the time of treatment is one of the decisive factors in determining the disability group. In early forms of cancer (when cure is achieved with an economical program), working capacity is restored in the first months after treatment. With advanced forms of neoplasms, any conditions and types of work are impossible, and patients are recognized as disabled people of group II, and with further progression of the disease - group I.

3. Time elapsed after baking. A long (5-, 10-year) disease-free period after treatment is a favorable factor in assessing ability to work.

4. The nature of the treatment performed. In assessing the ability of patients to work, the types of treatment program, differing in finite chains. It is obvious that palliative care, regardless of its immediate effect, does not allow one to hope for a permanent cure for patients, and in such cases the medical rehabilitation expert commission establishes disability groups.

5. Organ damage by cancer and its location are often very important in the prognosis of the disease. As is known, treatment of cancer of the esophagus, liver, and pancreas is still not effective enough and such patients are often diagnosed with group II or even group I disability even in the early stages.

The localization of the tumor in the organ itself is essential for determining the labor prognosis. So. for example, when high location cancerous tumor It is possible to perform a sphincter-preserving operation in the rectum, and this is a favorable factor in relation to the labor prognosis.

When the tumor is located in the cardiac part of the stomach, it is often necessary to resort to gastrectomy, which leads to severe disruption of digestive function, whereas with subtotal resections of the stomach such disturbances are rare.

6. Complications caused by use special therapy. It is known that radical surgery It is often a crippling intervention and requires a significant period of time for the body to adapt to new anatomical and physiological conditions.

Therefore, during operations, especially those entailing the inconvenience of being in a group (various stomas), patients are disabled in group II for a longer period of time. When determining the disability group of patients who have undergone chemotherapy and radiation therapy, the presence and duration of myelosuppression, radiation complications are taken into account, and those treated with hormones - the degree of dysfunction of the adrenal glands and other organs.

For a number of nosological forms of neoplasms ( systemic diseases, breast cancer, ovarian cancer, etc.) the need for repeated, anti-relapse courses of chemohormonal and radiation treatment, since this will certainly affect the degree of ability to work.

7. The morphological features of the tumor are very important in assessing work capacity, as they make it possible to predict the course of the tumor process.

8. Social factors (profession, working and living conditions) can significantly affect ability to work.

So, sometimes, even with relatively favorable neoplasms (skin cancer, lips), patients are forced to change their profession or place of work in order to avoid the harmful effects of ultraviolet radiation, chapping, and minor injuries. On the other hand, in a number of professions (mental and creative work), patients return to work immediately after treatment, without undergoing MREK.

Considering the beneficial effect of the patient’s return to work, it is possible and should be recommended and allowed (if the patient wishes) his return to the team and society with certain disabilities. This should be facilitated by employment, retraining, and the creation of favorable conditions for work (shorter working hours, working at home, etc.).

Thus, the rehabilitation of patients with cancer, the issues of determining their ability to work and employment is a complex set of activities that must be consistently carried out both in the immediate period after completion of treatment and over subsequent years in order to obtain the most favorable results.

Uglyanitsa K.N., Lud N.G., Uglyanitsa N.K.

Illness and disability are not identical concepts. In diseases that are not accompanied by a pronounced functional disorder, the ability to work is often not impaired or slightly limited. At acute diseases and injuries with a favorable outcome in the short term, as a rule, only temporary disability occurs. Disability - persistent complete or limited loss of ability to work - occurs more often with chronic diseases with progressive...

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KEC advises patients who have difficulties in resolving expert issues, as well as in conflict, difficult situations, regardless of the duration of temporary disability. At the same time, the expert question is not considered narrowly, but with an analysis of the validity of the diagnosis, the correctness of treatment, the need for special treatment, referral for consultation, additional examinations, including in other medical institutions.

As the capabilities and objectives of social insurance and social security the goals and objectives of medical labor examination. All activities in the field of VTE are aimed at achieving the main overall goal of public health - maximum long-term preservation people's health and ability to work, disease prevention, reducing the level of incapacity and disability. Organization of VTE The organization of VTE in our country is based on three principles: ...

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Establishing the fact of temporary loss of ability to work. Determining the nature of disability - temporary, permanent, complete and partial. Compliance established rules issuance and execution of documents certifying temporary disability. Definition optimal timing disability. Establishing the cause of temporary or permanent disability to determine the amount of benefits, pensions and other types of social security. Rational employment of workers who do not have signs of disability, but are in need due to...

One of the functions of the CEC is the preparation of certain temporary disability documents. Only KEC has the right to issue and extend certificates of incapacity for work in the following cases: for special treatment in another city with the approval of the city health department, for days missing for vacation for sanatorium treatment; caring for a sick family member for more than 3 days; at temporary transfer …

Determination of work recommendations for disabled people, allowing them to use their residual working capacity. This important event allows you to preserve the ability of a disabled person to work in work accessible to his condition, which has great biological, moral, material and social significance both for the disabled person and for the state. Study of the causes of morbidity and disability. Fulfilling this task contributes to the development of various medical, preventive and social measures...

Persons who have signs of persistent limitations in their ability to live and work and who need assistance are referred to MTU. social protection, in the following cases: with an obvious unfavorable clinical and work prognosis, regardless of the duration of temporary disability - immediately after its establishment, but no later than 4 months of disability. Objectives of the examination of work ability in medical institutions: with a favorable clinical and labor prognosis...

Ed. prof. V. G. Vogralik and Assoc. N. N. Iordansky.
Gorky, 1961

Medical labor examination, which determines the state of work ability, is an integral part of the daily work of attending physicians, and the leading role is given to therapists, since they account for approximately two-thirds of all examinations.

A medical labor examination begins with an examination of the patient, identifying his working and living conditions and setting clinical diagnosis. Based on the analysis and synthesis of the obtained biosocial data, the state of working ability, the causes of disability, if any, and rational employment are determined.

In each case of examination, a strictly individual approach is required. Questioning a patient for the purpose of assessing work ability presents some features. The doctor is not limited to simply listening to the patient’s complaints, but reveals to what extent subjective sensations are reflected at work, and on the other hand, how the work process affects painful phenomena. Skill in asking questions is required so that the doctor does not unwittingly suggest answers to the patient. This does not in any way mean that the patient should be treated with distrust. Expert experience shows that simulation - pretense, inventing non-existent complaints - is a rare phenomenon and is observed mainly in mentally disabled people. How more experienced doctor, the less often it detects simulation. If a person refuses to work for a long time, citing illness, and a carefully conducted objective study does not confirm this, the doctor would not be mistaken if he referred such a patient to a psychiatrist for consultation.

I remember: Patient A., 32 years old, a master of harmony, of an athletic build, who had not previously been ill, began to often demand release from work, complaining of pain in his heart. If he was refused a certificate of incapacity for work, he called an ambulance. Assumptions that pain is caused by spasm coronary vessels arising reflexively from a hypertrophied prostate, or from strong smell wood glue in the workshop were not confirmed, and in the end, a diagnosis of “simulation” was made. One day, a dentist came into the doctor’s office who was treating the sick A-va and told him about A-va’s strange request - “for the sake of evenness and beauty” to file down his healthy teeth. A. was referred to a psychiatrist who diagnosed schizophrenia. IN Central Institute examination of work capacity in Moscow, where the patient was hospitalized, the diagnosis was confirmed. Another thing is aggravation - an exaggeration of existing complaints - a frequent phenomenon and in many cases depends on a disorder of the regulation of the central nervous or neurohumoral systems. Patients, neurotically intensifying their sensations, mislead not only the doctor, but also themselves. This obliges the doctor to perceive the complaints of neurotics with some adjustment, without, however, revealing his skepticism.

An expert doctor must have great culture, tact and the ability to win over the patient, sympathetically enter into his interests, help find the most acceptable and correct situation, skillfully combining the patient’s personal interests with the interests of the state. The patient should not see the doctor as a person seeking to infringe on his personal interests. In our state, the interests of an honest worker, not a grabber, should not be infringed. The ability to talk with a patient depends on the breadth of the doctor’s mental horizons, on his endurance, humane attitude towards people, and is achieved through experience. The more experienced the doctor, the greater the results he achieves and the less time he spends on questioning.

With a skillful, compassionate approach, even a refusal to satisfy a patient’s unreasonable demand does not cause a negative reaction in him. We care a lot about people, but we don’t always care about each person individually. Unfortunately, we have to admit that some medical experts develop professional “immunity” over time - an indifferent attitude towards patients and their interests. In this case, the patient loses confidence in the doctor, shows negativism, and questioning becomes difficult.

An objective study, especially in cases of persistent impairment or loss of ability to work - disability, must be comprehensive, i.e. provided by all necessary specialists using the latest locally available methods of functional research of organs and systems. Morphological changes that determine the nature, localization and extent of the disease process are of significant expert significance. Thus, to assess the ability to work and the labor prognosis, especially for people with manual labor, it is far from indifferent, for example, the type of defect: narrowing or insufficiency of the atrioventricular valve. The labor prognosis in patients with rheumatic cardiosclerosis in combination with 2-leaf valve insufficiency is generally much more favorable than in combination with aortic valve disease.

A lot for examination important role plays an etiological factor that determines the nature of morphological changes, the dynamics of the disease process and the effectiveness of therapeutic agents, especially in infectious diseases: tuberculosis, syphilis, malaria, streptococcal infection etc., as well as if surgical intervention is possible using modern methods: surgery on the heart, lungs, etc.

The function of the affected organ or system is the most important point in determining the clinical picture and medical-labor examination. The expert is obliged to correctly assess both functional and morphological disorders. Underestimation of any of these factors can lead to expert errors.

Example 1. S, design engineer, 45 years old. Diagnosis - cardiac aneurysm, suffered a myocardial infarction - coronary insufficiency of the 1st degree. VTEK decision - disabled, disabled person of the 2nd group. S. appealed the decision and was transferred to the 3rd disability group. Works in an office setting with shortened working hours and individual deadlines for completing work. He copes with the work and feels quite satisfactory. First VTEC overestimated morphological changes, did not take into account changes in working conditions. With a decrease in the volume of work, it became possible to preserve a valuable worker for production, and for a disabled person - moral satisfaction and material security. Otherwise, there would be difficult moral experiences of a person due to separation from usual work and family with a noticeable decrease in material level and the probability of deterioration of health expected from the totality of circumstances.

Example 2. A 42-year-old tram conductor suffered a limited myocardial infarction. After a 4-month stay on a certificate of incapacity for work, she stated that she felt well and asked to be returned to her job. VTEC overestimated the good functional state of the patient and, having recognized her as able to work, did not take into account the totality of unfavorable, contraindicated moments for her in the work of a tram conductor: extreme crowded conditions in the car during rush hours, work in the cold season and even in heavy outerwear, frequent negative emotions and opportunities occurrence of conflict situations, absence of even small breaks in work. After a second heart attack, which followed shortly after discharge to work, VTEK was forced to establish a 2nd disability group.

The examination should take into account complications, subsequent and accompanying illnesses and caused by them functional disorders organs or systems and the body as a whole. Heart disease is often followed by lung disease; Kidney diseases lead to disorders of the cardiovascular system. With pulmonary tuberculosis, there is a displacement of the mediastinal organs and disruption of their functions and the whole organism as a whole, which is not always taken into account by phthisiatricians and leads to expert errors.

Not every disease leads to a significant disability: reserve adaptive mechanisms - both of the affected and other organs - take over the impaired functions, as a result of which the activity of the body as a whole is compensated. I knew a blacksmith who, from a young age, suffered from a rheumatic defect - mitral valve insufficiency, who retained the ability to work in his profession and only at the age of 65 came to VTEK with a request for a 3rd group of disability, with a transfer to light work. One sometimes has to be amazed at the amazing ability of tuberculosis patients to work. If the reserve adaptive forces are insufficient, the functions of the organ or system and the body as a whole are disrupted - decompensation occurs.

There are acute and chronic failure. At acute failure temporary disability occurs, which is subsequently restored. Sometimes the latter becomes persistent or acquires a stable character from the very beginning and in certain cases is defined as a disability.

In assessing work capacity, the degree of disability often plays a decisive role. In case of circulatory insufficiency, the type of insufficiency is of great importance in the assessment of working capacity and labor prognosis.

The response to pain, depending on the patient’s mental state, plays an important role in determining ability to work. There are examples when a patient with favorable clinical indicators, traumatized by a myocardial infarction, is afraid of any movements and stubbornly refuses to work. The expert’s task, having correctly assessed the state of ability to work, is to find a skillful approach to such a patient and carefully and gradually involve him in work activities.

The acute course of the disease is usually accompanied by temporary disability. There are, however, cases when, with a mild illness that does not interfere with the performance of professional functions, taking into account the general satisfactory condition of the patient and his working conditions, a certificate of incapacity for work is not issued. We have heard complaints from workers and employees against individual doctors that they justify their refusal to issue certificates of incapacity for work by the absence of an increase in body temperature in the sick person. Such medically illiterate motivation is unacceptable from the point of view that the patient may involuntarily get the impression that the doctor does not want to think, but the thermometer thinks for him, and in addition, such an explanation exposes the doctor in an inept approach to the patient.

When deciding on temporary release from work, special care and thoughtfulness are necessary in relation to older people, those with cardiovascular diseases, complaints of abdominal pain, etc.

When being discharged to work, consideration is given not only to the ability to begin professional duties, but also to ensuring that work does not disrupt the recovery process. There are many cases when patients, after regaining their ability to work, ask the doctor to “let me rest for a couple of days.” Not wanting to disrupt the psychological contact established with the patient, the doctor often satisfies the unreasonable requests of patients. Considering that the average duration of incapacity for work for a polyclinic patient is approximately 5-6 days, such “psychological” days can increase the rate of temporary incapacity for work by 15-20 percent. In these cases, you should skillfully explain to the patient the unreasonableness of his request, so that the refusal does not cause irritation and the patient leaves satisfied with the results of the treatment.

Temporary incapacity for work existing rules is not limited to any period, but after 4 months the attending physician, through the medical control commission - VKK - is obliged to refer the patient for control to the VTEK, which determines the disability, if any. Of course, if disability occurs earlier than the specified period, the doctor refers the patient to VTEC immediately. The exception is cases of extremely severe pre-terminal conditions - advanced cancer, the final stage of pulmonary tuberculosis, etc. - when the patient’s life is calculated in days or at most weeks. In order not to inflict additional mental trauma, you can use your right to extend the certificate of incapacity for work. Sometimes the acute course is prolonged, 4 months pass, the patient must be referred to VTEC, and the doctor doubts whether disability has occurred. This is most often observed after myocardial infarction, with some forms of pulmonary tuberculosis, peptic ulcer, with prolonged attacks of rheumatism, etc. In these cases, our experience suggests the following practice:

If in the last, 4th month, the patient’s condition is clearly improving and, based on the clinical picture, there is a high probability that in the next 1-2 months the ability to work will be restored, in the message sheet for VTEC, supported by observation data, the attending physician speaks in favor of continuing the temporary incapacity for a month. If VTEK agrees, this procedure - in the presence of the stated circumstances - can be repeated for another month. If, over the last month, there has been no definite progress in restoring working capacity, the patient is sent to VTEK to establish disability.

There are often cases of early referral to VTEK, when disability has not yet occurred. For example, it is incorrect to refer patients with initial outbreaks or exacerbations of chronic tuberculosis to establish disability before determining the results of active surgical or drug treatment. Further, I know of a case where a young engineer, Iva, with a prolonged attack of rheumatism with multiple joint lesions and mitral valve insufficiency, after a three-month stay on a certificate of incapacity for work, was sent to VTEK to establish disability. VTEC did not agree with the opinion of the attending physician and extended the treatment for a month. The patient returned to work feeling well, and production retained a capable engineer.

The state of working capacity during the chronic course of the disease presents a number of features. With forward movement, an example of which is hypertension in the 1st stage, the ability to work is usually not impaired. However, even at this stage, for preventive purposes, it is necessary to refer to the VKK to determine easier working conditions: exemption from night shifts, overtime work, additional loads, etc. Patients working in contraindicated - difficult to tolerate - working conditions, if this can lead to the progression of the disease, have to be transferred to another job. These types of conditions include: very significant neuropsychic or great physical stress, work in hot shops. Transfer is usually associated with the need to be referred to VTEC to establish disability group 3.

Short-term temporary disability occurs during crises.

In the second stage, depending on the specific course of the disease, approximately one third of patients lose their ability to work; the rest can work in day shifts with little physical stress, not in a hot room or in a noisy environment, and people with intellectual work - without significant mental stress, in a calm environment, without frequent business trips. Temporary disability during crises lasts 10-12 days.

If the course is favorable and there are no hypertensive crises, patients remain at their usual work in professions that are not indicated for them. In these cases, long-term professional skills and adaptation to the familiar conditions of the environment are reflected: weavers, rolling felted shoes, etc.

In the third stage, patients are unable to work. Only in the initial phase of the 3rd stage, in some cases, home work with home delivery of raw materials and removal of finished products is permissible.

Chronic diseases without progressive movement also have their own characteristics. An example is peptic ulcer disease.

In a mild form, the ability to work was preserved in most jobs. Increased pain syndrome is observed with constant significant physical stress, during work associated with trauma to the epigastric region (manual planing in leather production), in working conditions associated with systematic violation of the diet. During exacerbations, temporary disability lasts 2-3 weeks.

In a moderate form, accompanied by severe pain with impaired secretory and motor function and frequent exacerbations, the ability to work is usually limited. Even moderate physical stress, forced body position associated with abdominal tension - shoemaker, work in hot shops (casting), exposure to acid and alkali vapors, long walking, especially with a burden (postman), significant neuropsychic stress associated with negative emotions and possibilities of conflict situations; difficulties in maintaining a strict food regime and diet, night shifts.

In a severe form - usually with a complicated ulcer, occurring with severe pain, impaired motor-evacuation function of the stomach, loss of nutrition, frequent exacerbations and with little effect from treatment, the ability to work is usually lost. In some cases, the easiest work is available close to places of residence, home work, and for intellectual workers - with shortened working hours in a quiet environment.

Chronic diseases with paroxysmal course: bronchial asthma, paroxysmal tachycardia - ability to work depends on the severity, frequency, duration of attacks and the duration of the intervals between attacks. In all cases, you have to leave work related to the allergen that causes attacks, with high or low atmospheric pressure. Moderately heavy work is often unavailable, especially in an inclined position, with pressure on the abdominal area, and in more severe cases, also with long walking; work in unfavorable meteorological conditions (cold), dampness, unheated premises, high temperature near the workplace, sharp fluctuations in temperature near the work area, and also associated with neuropsychic stress, with frequent negative emotions and the possibility of conflict situations.

Identification of social conditions is carried out by questioning the patient, and the expert must clearly imagine what the production process consists of: what is being done with the object being processed and present in more detail the labor process, what exactly the patient himself is doing, working conditions, especially its unfavorable aspects.

If questioning the patient about working and living conditions turns out to be insufficient, which happens rarely with skillful questioning, an examination is undertaken at work and at home. VTEK has a permanent nurse examiner on its staff. A standard questionnaire, which by the way is very cumbersome and at the same time does not contain some necessary questions, often does not give the required results. Best method- for each case, draw up a short questionnaire relating only to data that is unclear to the expert about working conditions, how the patient copes with work and the true motives for appearing for the examination. In the absence of a nurse examiner, her duties are performed by the insurance delegates, who should be at the clinic. In the absence of an asset, the trade union body, notified by telephone, sends an insurance delegate for this. A household survey provides information about household workload and clinical picture diseases.

Often, a patient, out of necessity, does housework, and some zealous experts draw a conclusion from this about the patient’s ability to work. We must understand that necessity is the greatest force and that homework can be interrupted at any time and can only be compared with work in production only conditionally.

From the documents submitted to the VTEK and from questioning the patient, the expert receives all the required information about the professional route and professional skills of the patient. The expert is obliged to determine the patient's main profession. If the patient has a document-diploma of completion of a special educational institution The acquired specialty is his main profession, regardless of the duration of work in it. If the specialty is mastered practically, the main one is considered to be the highest qualified profession in which the patient worked for a long time. The main profession, however, most often does not coincide with the last job. If there is an upcoming change of profession due to health reasons, the future profession in terms of qualifications is compared with the main profession of the person being certified and a conclusion is made whether there will be a reduction in qualifications or whether the latter will remain unchanged or even increase.

After diagnosing the disease and analyzing all the obtained biosocial data, the issue of working capacity is resolved. A disability is not always a disability. If the disability meets the requirements existing instructions on determining the disability group, VTEK establishes one of three disability groups. If the state of working capacity does not meet the requirements of the existing instructions, the patient is recognized as able to work. If in this latter case he needs easier working conditions, he is recommended to contact the medical control commission, VKK, which will give an appropriate recommendation in the form of a certificate.

The determination of permanent or long-term disability and the establishment of disability groups is the responsibility of medical and labor expert commissions (VTEK). The responsibilities of VTEK also include determining the causes of disability, and for disabled people - the conditions and nature of work available to them for health reasons. VTEK acts on the basis of a regulation approved for them, which sets out in detail the organization and procedure of work, the composition of the commission, the circle of persons served, etc. .

Based on the above instructions, the 3rd disability group is established:
a) if it is necessary to transfer for health reasons to work in another profession, of lower qualifications, due to the inability to continue working in one’s previous profession (specialty). Example: tool maker. Diagnosis - pulmonary tuberculosis, fibrous-cavernous form without symptoms of intoxication in a period of remission, in the presence of pulmonary heart failure of 1-2 degrees. Resolution of VTEK - disabled person of the 3rd group. Subject to transfer to work as a parts assembler or tool distributor.
b) If, for health reasons, there is a need for significant changes in working conditions in one’s profession, which leads to a significant reduction in the volume production activities and thus to a decrease in qualifications. Example: chief accountant of a plant. The diagnosis is stage II hypertension, with a predominance of cardiac syndrome, cardiosclerosis with pronounced changes in the myocardium. VTEK resolution - disability of the 3rd group. Can perform the work of an accountant without additional workload.
c) If the possibility of getting a job is significantly limited, due to severe functional disorders in persons with low qualifications or who have not previously worked. Example 1. Janitor. Diagnosis: peptic ulcer, pyloric ulcer of the operated stomach (gastroenterostomosis) with impaired secretory function of the stomach, perigastritis, periduodenitis with moderate pain and decreased nutrition. VTEK resolution - 3rd disability group. Can perform light work, with little physical stress, without forced body position, with the ability to comply with the diet. For example: cartoner, stacker or packer small items etc. Example 2. Housewife, 47 years old, who had not previously worked for hire. Diagnosis: hypertension, stage 2, with a predominance of cerebral syndrome, myocardial dystrophy. Obesity. Definition of VTEC - disability of the 3rd group, can perform work with low muscle tension. For example, the greengrocer in the dining room.

The third group of disability, in addition, is established, regardless of the work performed, in case of anatomical defects or deformations that entail dysfunction and significant difficulties in performing professional work.

The second group is installed:
a) Persons who have experienced complete long-term or permanent loss of ability to work due to impaired body functions, but who do not need constant outside care. Example: pulmonary tuberculosis, artificial pneumothorax ineffective, presence of functional disorders when surgical intervention is impossible.
b) Persons who do all types of work a long period contraindicated due to the possibility of worsening the course of the disease under the influence of work activity. Examples: repeated myocardial infarction, with symptoms of severe coronary insufficiency, repeated strokes, after surgery for a malignant neoplasm.
c) Persons with severe chronic diseases, combined defects of the musculoskeletal system and significant loss of vision, for whom work is not contraindicated, but is permissible only in conditions specially created for them. Examples: severe form of peptic ulcer with severe loss of nutrition and short-term remissions; bronchoectatic disease with symptoms of severe intoxication and frequent exacerbations. It is possible to work as homeworkers with the delivery of raw materials and delivery of finished products without establishing production standards, or in specially organized workshops.

The first group is installed:
a) Persons who have experienced complete or long-term disability and require constant outside care or supervision. Examples of such conditions are: pulmonary tuberculosis with a severe progressive course in the stage of decompensation, incurable malignant neoplasms, lesions of the cardiovascular system with persistent circulatory failure of the third degree.
b) Persons who, despite persistent, pronounced functional impairments and the need for constant outside care or assistance, can be adapted to certain types of work activity in specially organized individual conditions: special workshops, work from home, work equipment, etc.

The tasks of the VTEK include, as was said, determining the causes of disability: general illness (from common causes), occupational diseases, work injury, etc. We are deprived of the opportunity to explain other reasons (childhood, military service), which, if necessary, can be found in the guidelines of the Department of Medical Labor Expertise of the Ministry of Social Security of the RSFSR dated December 20, 1956 “On determining the causes of disability.”

Disability most often depends on many, rather than on any one reason: wrong image living conditions, unfavorable working conditions, bad habits infections, excesses suffered during life, age-related changes, unsuccessful family life, etc. All these reasons, each individually, in various combinations with each other and all together during life, negatively affected the function of the body. As a result, it is not possible to establish which specific cause led to disability. In these cases, disability from common diseases (common causes) is determined. Non-occupational injuries are also conventionally included here.

There are, however, cases when disability occurs from one specific cause. This includes, first of all, occupational diseases and work injuries.

Occupational diseases arise among workers and employees under the influence of systematic and long-term harmful effects factors characteristic of this profession. For example: silicosis - chronic poisoning with silicon dioxide in sandblasters working on grinding metal products with a jet of sand ejected under a pressure of 6-8 atmospheres; radiation sickness that develops in workers and employees exposed to radioactive ionization, etc.

The cause of disability from an occupational disease is established when exposure professional factor was the unconditional and sole etiological factor of the disease and subsequent disability, as well as with all complications and all consequences of an occupational disease; finally, in cases where occupational diseases serve as a moment for the development, intensification and rapid progression of another disease of non-occupational etiology, which causes even greater disability. For example, the rapid progression of pneumosclerosis when exposed to dust. It should always be borne in mind that some occupational diseases continue to progress even after the patient has left the “harmful” profession. In the event of disability, the latter in these cases is also determined by an occupational disease.

Every attending physician should know about occupational diseases, and primarily because already in initial stage professional disease, even before the onset of disability, it is sometimes necessary for preventive purposes to raise the question of transferring from a “harmful” profession to another, for example, with silicosis even in stage I. In addition, if a VTEC determines disability due to an occupational disease, seniority for pensions, as well as for work-related injuries, is not mandatory, and the pension itself is paid at an increased rate.

In the Soviet Union, a list of occupational diseases was approved (approved by the USSR Ministry of Health and the All-Union Central Council of Trade Unions on August 1, 1956), giving the right to the mentioned and other benefits. Unlike capitalist countries, to establish disability due to an occupational disease, mandatory work experience under conditions of this hazard is not required. Taking into account the working conditions of a disabled person, VTEK, in its own opinion, determines whether the experience in this hazardous work is sufficient.

Disability due to work injury is an occupational accident resulting from external reasons when performing work duties, as well as when performing any actions in the interests of an enterprise or institution, even without instructions from the administration, on the way to or from work and in some other circumstances (for details in the guidelines, see “On determining the reasons disability" guidelines Department of VTEK MINSO RSFSR dated December 20, 1955).

In contrast to the legislation of capitalist countries, people with disabilities from work-related injuries also include those persons who were injured at work as a result of their negligence or failure to comply with safety regulations. Trauma leading to disability can be mechanical, thermal, chemical, radiation, mental, etc.

The basis for recognizing disability from injury is not only the work injury suffered, but also its consequences. For example, exacerbation pathological process, which cannot be excluded as a result of trauma: detection or sharp progression of hypertension after a concussion, appearance or exacerbation of thyrotoxicosis or diabetes mellitus after psychotrauma, etc.

In special cases, overexertion may also be considered a work injury. This happens when, under extreme circumstances, an untrained person applies muscle tension that is unusual for him, or a trained subject produces excessive physical effort. Example 1: Software Inspector blanks T-v lifted an iron barrel weighing 110 kg (this was not part of his duties), after which a severe attack of angina pectoris and myocardial infarction occurred. Example 2. Two loaders were carrying a heavy load, one stumbled and fell, the other, fearing to be crushed by the load, through excessive efforts, one held the load and put it on the ground. Soon I felt severe pain in the abdomen - perforated ulcer, peritonitis and death.

To establish disability from a work injury, a properly drawn up act or other document from an enterprise, institution, or police about an accident at work, or during the performance of public duties or civic duty, must be submitted to the VTEK. If the act is drawn up late, confirmation of the Regional Committee of the trade union is required, and if the act was not drawn up at all, the conclusion of the technical inspector of the trade union Central Committee or a court ruling is required, which is a document that VTEK is obliged to follow.

A very important task of VTEK is to determine the labor forecast and employment of people with disabilities. The latter, by increasing the material and cultural level and satisfying the natural craving of disabled people to return to a working family, has big influence and on their morale. Rationally conducted employment in many cases is a therapeutic tool that helps improve their health. Employment of disabled people in the conditions of planned management of the national economy plays a significant role in preserving qualified production workers.

VTEC prepares labor recommendations for disabled people. Experts must know the indicated and contraindicated occupational conditions for diseases internal organs at all. In each specific case, the expert needs to know which of the conditions characterizing this profession are contraindicated for a disabled person and what types of work in his enterprise he could perform in the future due to his health and qualifications. It is also necessary to be familiar with the production conditions in the area where VTEK operates.

When determining employment, you should be guided by the following provisions:
1. Labor recommendations are established in accordance with medical indications and contraindications, approaching strictly individually, avoiding any template.
2. Prevention of deterioration in the health of the employed person should always be the focus of the expert’s attention.
3. Try to maintain the main or similar profession as much as possible, especially for persons over 40 years of age, using, if necessary, other professional skills available to the disabled person.
4. The upcoming employment should satisfy the disabled person materially and morally to the maximum extent possible, and therefore professional orientation the person being employed should be taken into account as much as possible.
5. If difficulties in finding employment are expected, the disabled person should be registered with a special person and, through the district social security department, all measures should be taken to ensure actual active employment, followed by verification, and not rest until stable employment is obtained.
6. In cases where retraining is required, for the latter they strive to choose the profile of a well-paid skilled profession, which is in short supply in the area where the disabled person lives. Labor training is not recommended for persons who can expect frequent disruptions in their studies due to temporary disability, patients with a progressive course of the disease, with extreme instability of the nervous system, with reduced intelligence and persons over 40 years old, allowing individual exceptions for the latter.
7. Employment recommendations must be specific, realistic and properly formatted. When formulating labor recommendations, do not limit yourself to a simple listing of recommended professions. Such professions may not be available at all in a given enterprise (in the area), or they will be occupied, not to mention the fact that this method extremely limits the range of actions of the person involved in employment. In these cases, he begins to act at his own discretion and easily falls into error. It is necessary to recommend not professions, but the demonstrated and accessible professional conditions, and two or three professions should be given as examples.
8. Labor recommendations should be formulated quite concisely: general contraindications should not clutter up the conclusions, but should be based on the nature of the disease and the demands that the future profession will place on the body. If, for example, work with low muscle tension, so-called “light work”, is recommended, there is no need to add “without long walking, without sharply inclined positions, without uncomfortable working postures,” since the very concept of “light work” excludes these conditions. There is no need to list all contraindicated conditions; only the most important ones need to be indicated; the rest are given only as needed.
9. When formulating labor recommendations, the following major professional conditions should be kept in mind:
a) great muscle tension - heavy physical labor. In this case:
The general muscular tension of the vast majority of the muscles of the musculoskeletal system is of great strength - static and dynamic, in high degrees, reaching up to 160 kg. General muscular tension, individual elements of which have an average strength of 4-8 kg, but due to the frequency and speed of movements, leading to a large total expenditure of muscle energy during the working day. Examples: loader, rigger, mechanic, assembler of large machinery, tractor repairman, plumber, carpenter, white woodworker by hand, ash maker and large leather washer, hookmaker and roller (metallurgy), steelmaker, steelmaker's assistant, hammer hammer, blacksmith by hand , assembler of large parts on a conveyor belt, metal turner in the mass production of heavy parts, boilermaker, locomotive fireman, baker, hand laundress.
Long walking in difficult conditions: with a load, frequent climbing of stairs: a laborer at a construction site, a postman.
Heavy physical work is always performed in a standing position, when moving the body, or in another (uncomfortable) working position; as a rule, there is abdominal tension and large movements in the shoulder and elbow joints.
The conditions given above, as well as in the future, the conditions of heavy manual and insufficiently mechanized labor, as well as other unfavorable working conditions, as mechanization and automation are introduced, go into the realm of legends. Since, however, they - as a relic of the old - still exist in some places, experts have to take this into account.
b) Moderate muscle tension - moderate physical labor. Under this condition, there is more or less significant muscle tension upper limbs(more often), or the lower extremities (less often) and partly the muscles of the trunk. Work, as a rule, is performed primarily while standing, but some work is performed primarily while sitting. The range of motion in the shoulder and elbow joints is usually significant. Example: tool maker, metal turner, revolver maker, milling maker, drill maker, press maker on an eccentric machine, machine operator on automatic and semi-automatic machines, grinder on a machine, nickel platter, cabinetmaker with mechanized jointing and sawing, miller on a woodworking machine, wood planer on a jointing machine, a turner or woodcarver, a model maker, an assembler of parts from 1 kg and above, a shoemaker, a tailor, a hand-dyer of leather, a pasta press screw operator, a janitor, a groom on a collective farm.
V) Muscle tension small strength, in the hostel - light physical labor. The leading professional condition is muscle tension - small - less than 4 kg, mainly in the hands, forearms, and sometimes in the shoulder. Movements in the shoulder and elbow joints are mostly small. The working position is predominantly sitting, sometimes standing. Light work excludes long walking, sharply inclined positions, and frequent bending. Examples: an assembler of small products - locks, penknives, etc., a press operator for punching small parts on an eccentric press, a press operator on a friction machine, for small bending work, cutting out small-volume parts, a small knife blade remover, a controller, a sweetener of small hardware , thin wire cutter, machine operator on a tenon-cutting box machine, glue maker, switch operator, typist on a Fortuna typewriter, hammer operator on a hand puncher, soft leather cutter, piston operator, etc. - (shoe production), seamstress, hand-cutter, bobbin winder, (bobbin maker ), furniture trimmer (varnisher), notepad maker and other small cardboard work, sorter and quality control grader of light items, packer of small items, storekeeper (no heavy lifting). Agriculture: beekeeper, some garden work: sweeping greenhouse frames, pruning onion seedlings, raking hay, cutting belts of sheaves at the thresher, scattering seedlings, planting potatoes under a hoe, harvesting raspberries and currants, sorting and sorting potatoes (without lifting heavy objects) ), a greengrocer in the dining room.
d) Long walking under normal conditions - at least 50 percent of the working time. Examples: agent, delivery boy, courier, trackman, forester, etc. e) Prolonged, sharply inclined standing position - at least half a bend, frequent large bends - at least 1 time in 1-2 minutes, prolonged pressure on the abdominal area, body shaking . Examples: brick and pottery burner, washerwoman by hand, reaper with a sickle, worker with a horse-drawn rake, utility worker with a low-power frame saw (pressure on the abdominal area).
f) Work in the cold: outdoors in the cold season and in an unheated damp room. Examples: carter, janitor, yard worker, car worker, some storekeepers and watchmen.
g) High temperature of the working area - 30 degrees and above, and exposure to radiant heat: work in hot shops - hot metal, in dryers, etc. Humidity should also be taken into account as a factor that aggravates the harmful effects of high temperature. Sharp temperature fluctuations at the workplace and transitions from hot to cold. Work in hot shops is usually hard, less often - moderately hard.
h) Greater neuropsychic stress with insufficient conditions for quiet work: tension of the intellect, will, memory, attention, combined with increased responsibility for the assigned work with the need for frequent switching, anticipation of the occurrence of various circumstances and immediate action regarding emerging unexpected circumstances. Examples: director and chief engineer of a large and medium-sized enterprise, heads of institutions, public organizations, heads of large workshops, duty officer at a junction station with large train traffic, railway dispatchers of large railway junctions, pilot, diver, locomotive driver, etc.
i) Significant neuropsychic stress in a more or less calm environment. Examples: the work of a scientist, writer, composer, artist, chief accountant, engineer of various specialties, doctor, economist, planner, fast-paced worker: cooper, manual tinsmith. Overtime and extended working hours in agriculture in the warm half of the year. Shift and night work, irregular working hours for some categories of employees. Frequent business trips: at least 70 calendar days per year - 25 percent. annual working time. Exposure to certain toxic substances: carbon monoxide, aniline, benzene, lead, mercury, etc. High and low atmospheric pressure - caisson operator, pilots. Other conditions: increased risk of contracting infectious diseases: work in infectious diseases hospitals, sanitary checkpoints, during epidemics, increased responsibility for people’s lives, for cars, for valuable property, in the absence of substitute persons; driving professions, work at a switchboard, in warehouses, etc.

In conclusion, VTEK sets the deadline for re-examination of disabled people. In accordance with the regulations on VTEC, re-examination of disabled people of group I is carried out once every 2 years, and disabled people of groups II and III once a year.

Without specifying the date for the next re-examination, the disability group is established for men over 60 years of age and women over 55 years of age; disabled people with irreversible chronic diseases and anatomical defects provided for by the approved list of diseases.

Diseases of internal organs included in the list:
1. Hypertonic disease Stage III(with organic components from the central nervous system, fundus of the eye, heart muscle, kidneys).
2. Coronary insufficiency, sharply expressed in persons who have suffered a myocardial infarction, with significant changes in the heart muscle with circulatory disorders of the third degree.
3. Heart disease (narrowing of the left atrioventricular orifice, defects aortic valves, combined defects) in the presence of persistent circulatory disorders of the third degree.
4. Chronic lung diseases, accompanied by persistent respiratory failure of the third degree and heart failure.
5. Chronic nephritis in the presence of persistent severe symptoms of renal failure (edema, isosthenuria, increased blood pressure, fundus changes, increased residual nitrogen in the blood).
6. Liver cirrhosis with impaired portal circulation (ascites).
7. Diabetes- severe form with acetonuria and a tendency to coma.
8. Malignant neoplasms are incurable.
9. Condition after total gastrectomy.
10. Condition after lung removal.

According to the Regulations on VTEK, if the witness disagrees with the decision of the VTEK, the witness submits a written statement to the district or city social security department about this within a month. The appeal procedure must be explained to the witness.

Popular site articles from the “Medicine and Health” section

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MEDICAL OCCUPATIONAL EXAMINATION (VTE) is a type of examination consisting of determining the duration and degree of a person’s disability due to illness or injury, identifying the causes of disability, and establishing a disability group.

Doctors of various specialties take part in conducting VTE: therapists, surgeons, neurologists, occupational pathologists and other specialists, sometimes psychologists are involved.

VTE to establish the group and cause of disability and indications for prosthetics, provision of vehicles is carried out by medical and labor expert commissions (VTEK), and the examination of temporary disability is carried out by medical advisory commissions (VKK).

Story. For the first time in the history of mankind, the Great October Socialist Revolution made it possible to implement a broad social security program, including one of its sections - the examination of work ability. The Labor Code of 1918 stated that permanent or temporary loss of ability to work is certified by a medical professional. examination conducted by the Bureau of Medical Examination (BME) at city-wide, district and regional health insurance funds. Later, BVE came under the jurisdiction of social security authorities. In 1932, the All-Union Council of Social Insurance introduced a three-group classification of disability, which was based on the principle of determining the state of working capacity taking into account medical and social factors. In the same year, BVEs were reorganized into medical labor expert commissions (VTEK). In 1937, VTE was finally transferred to the jurisdiction of social security authorities (see Medical and Labor Expert Commission).

Over the years of socialist construction, the regulations on VTEC and the list of diseases and defects for which a disability group is established, including for an indefinite period, were regularly revised. Since January 1, 1985, a new standard regulation on VTEC, approved by the Resolution of the Council of Ministers of the USSR (1984), has been in force.

On the basis of this Regulation, the councils of ministers of the union republics, together with the republican councils of trade unions, approve regulations on VTEK for each republic.

The organizational foundations of medical labor examination include the following provisions: bodies carrying out examination of working capacity are the same for all groups of the population and are created on an administrative-territorial basis; loss or significant limitation of working capacity is divided into temporary disability, which is determined by the attending physician and the VKK, and long-term or permanent, persistent, determined by the VTEK; In the process of assessing the ability to work, disabled people are assigned one of the disability groups - I, II or III - depending on the degree of loss of ability to work; each group has its own clinical, physiological, social and legal norms (see Disability). To conduct additional examinations of clinical expert and functional status in difficult cases in a number of Union republics, hospitals or beds are allocated in wards, departments, as well as in research institutes for assessing the ability to work of the social security system; When disability is established, a uniform form of VTEK certificate is issued, which is equally valid throughout the entire territory of the USSR.

Over the years of socialist construction, basic VTE standards have been developed and tested in practice, which are based on the principles of Soviet healthcare and the principles of social security. The leading one is the state nature of VTE, that is, material support for citizens in the event of their loss of ability to work is provided at the expense of the state, and the right, volume and nature of social security are determined by an expert opinion. This provision is implemented by specially created state bodies that carry out VTE.

The main tasks of the VTEK in accordance with the standard regulations are: determining the state of working capacity, permanent or long-term loss, establishing the group and causes of disability; determining for disabled people the conditions and types of work, jobs and professions available to them due to health conditions, as well as the conditions and methods by which impaired working capacity can be restored or increased, checking the correct use of disabled people at work in accordance with the conclusions of the commissions; promoting public health and preventing disability; study together with health authorities, administration of enterprises, institutions, organizations and trade union bodies of the causes of loss of ability to work in case of disability and participation in the development of measures to prevent disability and restore ability to work.

One of important tasks VTE is the determination of the cause of disability. In each specific case, disability is established according to one of the following reasons: general disease, occupational disease, work injury, disability since childhood; for military personnel - a wound, concussion, injury received during the defense of the USSR or while performing other duties of military service, or a disease associated with being at the front, or an injury received as a result of an accident not related to the performance of military service duties, or a disease not related to being at the front, but in cases specifically provided for by law - an illness acquired during the performance of military service duties. USSR legislation may establish other causes of disability.

The preventive direction of VTE involves the prevention of disability through the timely transfer of workers (employees) to such working conditions that correspond to their state of health, which prevents the “aggravation” of disability due to the elimination or reduction of the negative influence of the working environment.

Rational employment of disabled people includes the use of their residual professional capacity or training in a new profession, activity within the limits of a person’s real capabilities and is a social and health means that promotes the development of compensatory resources of the body and the restoration of its social position.

Medical monitoring of the working capacity of disabled people (systematic re-examination) makes it possible to identify existing changes in the state of health and, in accordance with this, return the person to normal work activities or, conversely, transfer the disabled person to disability group I or II, increasing the level of pension provision.

Collegiality and complexity in the work of VTEK, the participation in it of representatives of trade unions and other public organizations ensures the objectivity of the expert opinion and its scientific validity, since it minimizes the possibility of an erroneous decision.

Legal aspects of work ability examination. An expert opinion on disability is a normative act that determines the right of workers to social security, to exemption from work in public production or to more preferential working conditions, the right to free prosthetics, the provision of wheelchairs or cars adapted for disabled people, sanitary resort treatment and other types of social assistance. In accordance with specific facts established by the examination of working capacity, the personal rights of citizens to social security for disability arise, change or terminate. The legislation provides for various rights, scope and nature of material support, depending on the social conditions and circumstances under which the disability arose. The right of citizens to material support in old age, in case of illness, complete or partial loss of ability to work, as well as loss of a breadwinner, is enshrined in Article 43 of the Constitution of the USSR.

Composition of the medical labor expert commission. For examination of disability due to various diseases The following fuel and energy complexes are formed: general profile; specialized profile for examination of tuberculosis patients, persons with mental disorders, diseases and defects of the organ of vision, diseases of the circulatory system and other diseases; mixed profile.

District, inter-district, city fuel and energy complexes consist of three doctors, a representative of the relevant social security body and a representative of the trade union organization (trade union body). The republican, regional, regional, central city (in cities of republican subordination) VTEK includes four doctors, a representative of the relevant social security body and a representative of the trade union organization (trade union body). For the general management of VTEK in the republic, territory, region, city (republican subordination), a chief expert in medical labor examination is appointed. If there are less than five members of the commission, the duties of the chief expert are assigned to the chairman of one of the commissions.

Responsibilities and rights of medical labor expert commissions. District, interdistrict, city VTEK are assigned the following responsibilities: establishing the state of working ability, long-term or permanent loss of it, the group, cause and time of onset of disability, as well as the degree of loss of working ability (in percentage) of workers or employees who were injured or lost health due to their performance of labor duties and their need for additional types of assistance; determination of measures for social and labor rehabilitation; establishing a causal connection between the death of the breadwinner and an industrial injury, occupational disease, time at the front and other circumstances to resolve the issue of granting a pension and compensation for damage to family members of the deceased; providing citizens with assistance in finding documents necessary for conducting VTE, the submission of which, according to current legislation, is entrusted to persons undergoing examination; checking at the place of work of disabled people the correctness of their employment and their use in accordance with the recommendations of the commissions; participation in the study of working conditions, certification of workplaces in order to identify factors that adversely affect the health and working ability of workers, and in the development of measures to eliminate them; determination of conditions and types of work, jobs and professions available to people with disabilities; submission through district and city social security departments to the relevant military commissariats of information on all cases of recognition of persons liable for military service and conscripts as disabled.

Republican, regional, regional, central city (in cities of republican subordination) VTEK exercise organizational and methodological management and control over the activities of district, interdistrict, city VTEK, check their decisions and, if unfounded, change them; will re-examine persons who appealed the decisions of the VTEK; carry out examinations in difficult cases of persons in the areas of district, interdistrict and city VTEK; will examine disabled people to determine their need for special vehicles; introduce scientific principles and examination methods developed by research institutes into the practice of VTEK, prepare proposals for further improvement of VTEK, study, generalize and disseminate best practices in the work of VTEK; conduct a study of the causes of disability and, on this basis, develop measures to eliminate them, prevent disability and restore the working capacity of citizens; take measures to improve the qualifications of VTE workers and ensure the participation of VTE specialists in the advanced training of doctors in healthcare institutions.

VTEK have the right to: receive from health authorities and institutions, administration of enterprises, institutions, organizations information necessary for the work of the commissions, including data on the nature and working conditions of persons undergoing examination; refer persons undergoing examination to treatment and preventive institutions to clarify the diagnosis and rehabilitative treatment; visit enterprises, institutions, organizations in the prescribed manner, inspect work sites, production and office premises, get acquainted with reports, statistical and other materials on issues related to the activities of the commissions.

The procedure for examining citizens in medical labor expert commissions. Examination of citizens in VTEK is carried out in medical institutions at the place of residence or at the place of attachment in the direction of the corresponding medical institution.

VTEK will examine citizens in cases where, in accordance with the law, the establishment of disability is associated with granting them the rights to social assistance or with exemption from performing relevant duties, and in other cases provided for by current legislation. In addition, in order to improve services for workers, employees and members of collective farms, on-site meetings of the VTEK are held in the relevant medical institutions. To conduct on-site meetings, the commissions are provided with transport in accordance with the procedure established by the councils of ministers of the union republics.

If a patient, for health reasons, according to the conclusion of the VKK of a medical institution, cannot come to the VTEK, the examination is carried out at home or in the hospital where he is being treated. In exceptional cases (for example, in remote, hard-to-reach areas), examinations of citizens, with their consent, can be carried out in absentia.

VTEK meetings are held in in full force, decisions are made after a collegial discussion of the examination results. The data of the expert examination and the decision are entered into the minutes of the VTEC meeting and into the examination report, which are signed by the chairman, other members of the commission and certified with a seal. If the chairman or individual members of the commission do not agree with the decision made, then their dissenting opinion is entered into the inspection report, and the report is submitted within 3 days to the republican, regional, regional, central city (in cities of republican subordination) VTEK, which makes a decision on this case. Decisions of republican, regional, regional, central city (in cities of republican subordination) VTEK (including during examination in complex cases, in the order of control or appeal and in other cases) are made by a majority vote of the commission members. In case of equality of votes, the opinion of the chairman of the commission is decisive. A member of the commission who does not agree with the decision made expresses his dissenting opinion in writing, which is attached to the file.

The date of determination of disability is the day the VTEK receives the documents necessary for examining the patient.

VTEK issues certificates to persons undergoing examination and, within 3 days, sends a notification in the established form about the decision made to the relevant enterprises, institutions, and organizations. The forms of documents used in the work of the commissions are approved by the USSR State Committee for Labor and Social Issues in agreement with the relevant ministries and departments. Persons guilty of making a deliberately incorrect decision or illegally issuing a certificate to the fuel and energy complex bear liability under current legislation.

The work capacity examination, along with VTE, also includes a medical insurance examination (MIE), which examines insured persons in order to establish the percentage of disability due to injury, accidental acute poisoning poisonous plants, chemicals, various medications, taken by the patient or introduced into the body as prescribed by a doctor, poor-quality food products, etc., as well as identifying the causes of death using medical and other documents. Examination of the insured and determination of the percentage of disability is carried out by medical insurance expert commissions (VSEC).

Medical and insurance examination of deaths is carried out by a doctor-expert of the State Insurance Department (city, region, territory, autonomous, union republic) in the presence of insurance documents, extracts from medical records and outpatient records, a death certificate from the registry office or a notarized copy thereof, and, in necessary cases, documents of forensic investigative bodies and a report of a forensic medical or pathological examination of the corpse. For mixed life insurance against accidents and insurance for children (in the event of the death of a child), an expert doctor’s opinion is not required. The basis for the examination is a statement from the insurers outlining the circumstances of death, insurance certificates, and extracts from the medical history (outpatient card).

Organization of scientific research on the examination of work ability.

Scientific research on the examination of work ability in the RSFSR and some union republics is carried out in research institutes of the social security system, as well as in research and development medical institutes M3 of the USSR and ministries of health of the union republics. Head scientific institution is the Central Order of the Red Banner of Labor Research Institute for the Examination of Working Capacity and Labor Organization of Disabled Persons (CIETIN).

In the pre-war years, the institutes developed theoretical, organizational and methodological foundations for the employment of disabled people and labor recommendations of the VTEK, medical indications and contraindications for vocational training, retraining and rational employment of disabled people in various sectors of the national economy.

During the Great Patriotic War, a differentiated expert approach to assessing the working capacity of persons with anatomical defects was developed, new diagnostic methods were sought and justified, and indications for employment and restoration of working capacity of war invalids were clarified. All this, together with the establishment of appropriate benefits and benefits for disabled veterans of the Patriotic War, made it possible to ensure the return of a significant part of them to work collectives.

Currently, the attention of institutes is aimed at increasing the level of diagnosis and quality of VTE when examining sick and disabled people, improving prevention and reducing disability, improving medical and professional rehabilitation of disabled people, restoring the social and personal status of disabled people.

Examination of work capacity in foreign countries. In socialist countries, taking into account the experience of the USSR, they have developed national systems work ability examinations. In Czechoslovakia, for example, it is carried out in the same way as in the USSR, by medical expert commissions that resolve the following issues: justification for increasing the size of the pension due to helplessness to cover additional costs of care; recognition of complete or partial disability; transfer to another job; provision of special benefits to persons with particularly severe impairments of health and ability to work (including the provision of strollers and vehicles); resolving the issue of the need for sanatorium-resort treatment for non-working pensioners.

The examination of work capacity in the GDR is carried out by the chief physician of the district (district) for the examination of work capacity on the basis of an examination of the patient and documents prepared by the attending physicians. Control over the organization of examination in the country is entrusted to the Ministry of Health and Social Welfare. The Ministry has a Central Expert Commission, whose tasks include studying the state of disability in the country and making recommendations for its reduction, analyzing complaints and carrying out advisory and control activities.

In capitalist countries, the system of social security and work ability examination is of a different nature. In a number of capitalist countries, if necessary, functional units with a non-permanent composition of experts are created. In England, for example, there is no single standardized system for assessing working capacity.

A request for a medical examination to determine the state of ability to work is sent by the patient to the relevant insurance fund no later than three years from the time of the onset of temporary disability, the presence of which is established by the attending physician who has a corresponding agreement with the fund. The main organizer of the expert examination is the expert doctor. He begins his duties from the moment he is chosen for this examination by the patient’s attending physician.

The examination is paid; the costs for it are borne by the social insurance fund, which in some cases (for example, if the examination is unreasonable from its point of view) may impose costs on the patient. Recognition of disability due to illness or injury in many cases is a justification for a reduction in wages.

Bibliography: Medical and labor examination, ed. A. F. Tretyakova, M., 1959; Medical and labor examination at the present stage, ed. T. A. Sivukhi et al., M., 1980; Fundamentals of medical labor examination, ed. A. F. Tretyakova, M., 1960; Guide to medical labor examination, ed. Yu. D. Arbatskaya, M., 1977; Social insurance in the USSR, comp. G. S. Simonenko, p. 3, M., 1976; Directory of documents on VTE and employment of disabled people, ed. P.A. Makkavesky, JI., 1981; Handbook of State Insurance, ed. I. A. Motyleva, p. 121, M., 1978.

The examination of long-term or permanent loss and the study of the health status of patients is carried out by VTEK, which are organized on a territorial basis on the basis of medical institutions, are under the jurisdiction of social security authorities and are subordinate to them. VTEC accepts for examination patients who have been disabled continuously for 4 months. or a total of 5 months. over the past year.

The main tasks of VTEK are: to establish the degree of disability, the causes and time of onset of disability, as well as its group (see Disability); determination of conditions and types of work for disabled people (labor recommendations), as well as measures that contribute to the restoration of their ability to work (vocational training, retraining, rehabilitation treatment, provision of means of transportation, etc.).

Workers, employees and collective farmers who, according to the conclusion of the VTEC, have been assigned a disability group, are permanently or for a long time exempted from professional work (students - from training), they are assigned a pension, provided with easier working conditions and other types of benefits are determined. This conclusion is issued in the form of a VTEK certificate, which is issued to the disabled person. Without a labor recommendation from medical experts, managers of enterprises and institutions do not have the right to provide work to disabled people.

VTEC carries out its activities on the basis of special provisions and acts as a state body that secures the rights of workers to social assistance in accordance with the procedure established by law (see,). The organization and functions of medical labor examination are a link in the system of measures that form the basis of social and labor rehabilitation of disabled people (see).

There are city, district and interdistrict VTEK, each of which includes three doctors (therapist, neurologist, surgeon), a representative of the social security department and a representative of the trade union organization. One of the expert doctors is appointed as chairman. To conduct medical and labor examination of patients with tuberculosis, mental, oncological, cardiovascular, eye diseases and consequences of injuries, specialized VTEK are created; they consist of two doctors of the relevant specialty (one of them is the chairman) and a general practitioner or neurologist. All VTEC staff have a medical registrar, and in commissions that work full-time, an additional senior position is approved.

VTEK makes a decision based on a collegial discussion of the patient’s medical examination data, taking into account his profession and production characteristics from the place of work. No member of the VTEK has the right to single-handedly carry out an examination of work capacity and make an expert decision.

A comprehensive analysis of biological and social factors is one of the most important principles, determining the content of the medical expert decision. This takes into account the causes and mechanism of development of the disease, features of its course, anatomical and functional disorders, prognosis, etc., as well as the patient’s attitude to work, his professional activity before (during) the disease and the dynamics of disability after the disease has become chronic or left behind persistent pathological consequences. The uniformity and unified nature of expert decisions are due to the fact that the methodological basis of medical labor examination is a normative, generally accepted definition of disability criteria and the degree of reduction or loss of ability to work.

Paramedical workers, together with representatives of trade union organizations, doctors of medical institutions and VTEK, monitor the provision of working conditions for disabled people, in particular, the transfer to work that corresponds to their state of health.

This is the definition of permanent disability, permanent or temporary, in persons who have certain impairments of body functions due to illness, injury or congenital underdevelopment. A thorough and comprehensive examination of the patient, studying the depth and extent of the pathological process, checking the functional state various systems, taking into account the dynamics of compensatory adaptations, determining the influence of social factors and the external environment make it possible to make an objective conclusion about the ability to work and the degree of its impairment.

The basic principles of medical labor examination in determining the state of ability to work: 1) its state nature (the state regulates and finances expert activities and authorizes expert commissions, with appropriate indications, to make a decision on establishing disability, which determines the legal status of the person who has lost the ability to work); 2) taking into account biological and social factors when making decisions and determining the feasibility and nature of further work activity; At the same time, special importance is attached specific situation in production (in an institution) - microclimate, chemical and physical factors, the degree of nervous and physical stress associated with this work; 3) the principle of the integrity of the body (comprehensive accounting of all diseases and the degree of loss or preservation of the labor functions of the person being certified); 4) the preventive focus of the examination in the fight to reduce disability by transferring long-term and frequently ill people to jobs that correspond to their state of health.

When determining disability, it is necessary to accurately diagnose the disease thorough examination sick; to find out the influence of the environment of the enterprise, workshop, office premises, atmospheric conditions, lighting, etc., work itself on the functional state of the patient and on his compensatory capabilities; carry out specialized examinations on the main forms of diseases, in connection with which cardiological, tuberculosis, ophthalmic, oncological, psychiatric, traumatological and other commissions are created. The conditions in which the patients worked must be examined with the participation of specialists who know production well - doctors of medical units, health centers, heads and foremen of workshops, foremen of collective and state farms, heads of personnel departments, etc. This is carried out by on-site meetings of the VTEK.

Medical and labor expert commissions (VTEK) are under the jurisdiction of the social security authorities of the union republics, but are organized on the basis medical institutions on a territorial basis. There are the following expert commissions: a) city, district and inter-district general type consisting of three doctors - a therapist, a surgeon, a neurologist (one of them is the chairman of the commission), a trade union representative and a representative of social security authorities; b) specialized commissions, city and inter-district, to determine the ability to work of patients suffering from tuberculosis, eye, oncology, mental illness, heart disease, consequences of injuries, etc. Each commission includes two doctors of this specialty and a third - a therapist or neurologist, as well as one representative each from trade unions and social security authorities. The chairman of the commission is appointed a doctor of the main specialty in this commission; c) regional, regional and republican VTEK and central (in Moscow and St. Petersburg) city commissions consisting of 4 expert doctors. When there are a large number of surveys in the region and territory, several commissions of the same type are organized, but essentially they all constitute a single commission. Being the highest expert body of the region, region, republic, such commissions make final decisions. The chairman is at the head; he is also the main expert of the republic, region, region, Moscow and Leningrad.

The activities of expert commissions are regulated by the regulations on VTEK (approved by the councils of ministers of the Union republics), which set out the basic principles, tasks and structure of the commissions, the methodology for conducting surveys and the legal provisions of the commissions’ work; instructions for determining disability groups with a list of diseases for which the disability group is established indefinitely (the instructions were approved by the USSR Ministry of Health, the All-Russian Central Council of Trade Unions and agreed with the Ministry of Social Security); instructions from the ministries of social security of the union republics. In its work, VTEK is also guided by manuals and guidelines that are developed by research institutes for assessing the ability to work and organizing the work of disabled people.

The tasks of expert commissions include: a) establishing the degree of disability and determining disability groups (see Disability); b) determining the degree of disability of workers who have received any damage or injury related to their work, in order to compensate for the damage caused;
c) establishing the causes of disability in connection with a general disease, occupational disease, work injury, disability since childhood, disability that occurred before work, injury, concussion, injury received while defending the USSR or while performing military service duties, etc.;
d) making a decision on labor recommendations, on the basis of which a disabled person should be employed (see Employment), and monitoring the ability of disabled people to work; e) giving opinions on the need for special manual vehicles; f) establishing indications for sending disabled people to special vocational schools; g) determination of indications for free travel on public transport for disabled people of the Great Patriotic War.

A work capacity examination is carried out only after appropriate treatment and long-term medical supervision. In cases where it becomes clear to the doctor that it is impossible to restore the patient’s ability to work through treatment, he, together with the head of the department, fills out a referral for VTEC. This document is approved by the VKK or the head of the medical institution.

In expert commissions, an examination report similar to a medical history is filled out for each patient. An extract from the act is sent to the organization paying the pension. The disabled person is issued a VTEK certificate, which indicates the disability group, the deadline for the next re-examination and a work recommendation.

To conduct an examination in an inpatient setting, the patient is sent to the department of medical labor examination at republican, regional and regional hospitals.

The development of problems of medical labor examination is carried out by research institutes for the examination of working capacity and organization of work for disabled people. In the RSFSR and the Ukrainian SSR there are two of them: central in Moscow (branch in Rostov-on-Don) and Kharkov; in Leningrad and Dnepropetrovsk. In addition to scientific work, the institutes train medical experts. The Central Institute for Advanced Medical Studies (Moscow) has a department of medical labor expertise. The institutes have clinical departments in the main medical specialties (therapy, surgery, neurology, psychiatry, tuberculosis and eye diseases) and consultants in other medical specialties, as well as all the necessary diagnostic laboratories and experimental workshops. Institutes publish manuals and guidelines for topical issues medical labor examination.

Together with leading health research institutes, examination institutes hold republican scientific and practical conferences and seminars on diagnostics, clinical practice and labor examination. The institutes have postgraduate courses in basic medical disciplines and clinical residency, which trains scientists and practitioners in the field of medical examination and organization of work for people with disabilities. See also Work Capacity.