General practitioner family doctor what treats. Local therapists in the capital will be replaced by general practitioners

When visiting a clinic or any other institution, you will first be referred to a general family specialist.

This type of specialization is somewhat different from therapeutic. General practitioner examining development of diseases in more detail, and is able to independently diagnose and treat the patient.

Quite often, clients diagnose themselves on their own, and when visiting the establishment, they already know the voucher to see which specialist they need to get. However, in most cases the client cannot accurately determine the pathology.

The point here is not only the lack of medical education, but also the lack of real practice. Disease – serious phenomenon, there’s no point in delaying it. Therefore, in order to correctly determine the initial diagnosis and choose the right specialist, you will still have to visit a family doctor.

During his student years, the future doctor researches general development all kinds of diseases . A specialist can conduct a consultation regardless of the gender and age of the person applying, which is why it is called family consultation.

Speaking about work functions, they contain different approach. The doctor can examine and conduct a course of therapy independently, or may refer you to more narrow specialists. Despite the fact that his duties include a comprehensive examination, treatment is carried out only for a certain number of disorders.

Referred to a family specialist during a medical examination. In this case, the examination only includes weighing, examination, and questions about the presence of certain ailments.

In what situations do you visit a specialist?

Despite the fact that a physician is trained in all types of pathologies, it is not always necessary to contact him. Let’s say that in case of bruises, fractures and other types of injuries, you should immediately visit a traumatologist without wasting time.

Although a specialist is considered general, his range of practice is not so wide. Let's consider first main obligations medic:

regularly checking the patient for the presence of cancer;
definition normal weight for the patient and its correction;
prevention of all types of atherosclerosis ( special attention reserved for visitors of mature age);
systematic examination of women during pregnancy, as well as their consultation;
prescribing a therapeutic course for pathology of the veins and vessels of the extremities.

If we talk about when it is worth visiting a specialist, there are almost no exceptions. Many doctors advise you to be more attentive to the processes of your own body. It is inattention and irresponsibility that aggravates the situation.

When a patient consults a doctor because he can no longer tolerate headaches or pain internal organs, the problem needs to be solved already urgently. Unfortunately, the vast majority of clients are confident that in this way they save the family budget, however advanced disease it is much more expensive and difficult to eliminate.

You should contact a doctor when the occurrence of pain in any areas of the body, not excluding headaches, which are already considered normal. You should visit a doctor if you feel frequent, causeless fatigue or internal heaviness.

In addition, you should pay attention to memory problems, the occurrence of absent-mindedness, or the rapid onset of fatigue.

There are also other reasons to visit patient:

fast weight loss, if not connected dietary food And physical activity. This is often a cause for joy for young women, but accelerated weight loss is known symptom stomach or ovarian cancer. The latter pathology applies only to the fair sex;
darkened stool color is a common reason for testing for the presence of ulcers or stomach cancer. This kind of pathology is not something to joke about. Another reason for changing color is internal bleeding, which also carries no small danger;
in mature and elderly years, attention is paid to common stroke symptoms. It is important to inform the elderly patient here. The warning signs are: ringing in the ears, deterioration in skin sensitivity, difficulty speaking, unnatural curvature when trying to smile, sudden occurrences weaknesses;
do not delay visiting your family doctor in case of sudden onset severe headaches. This is a classic sign of an aneurysm or blood flow disorder;
Another common reason for calls is bacterial meningitis. Its known sign is pain syndrome in the neck area, which is accompanied by headache and fever. On initial stage the disease can be eliminated by the use of antibiotics, but with protracted illness Preventing cerebral edema is no longer so easy.

IN lately on sick leave certificates in the column “position of the attending physician” you can see the abbreviation GP.

The question arises, what does this abbreviation mean?

According to Nomenclature of positions medical workers , there is a specialty of a doctor called a general practitioner or family doctor.

Let's try to figure out what kind of specialty this is.

The difference between a general practitioner and a therapist

General practitioner, traditionally also called family doctor, provides medical care outpatient. That is, in the clinic, the so-called primary care, where the sick person goes. The main difference between a general practitioner and a therapist is volume of performed practical work , because he has the right to carry out the whole complex manipulation.

The therapist uses only such tools as a tonometer and a phonendoscope, but a family doctor has the right to perform otoscopy, laryngoscopy and rhinoscopy. Simply put, he has skills that allow him to examine the ears, nasopharynx, and even the fundus of the eye.

The doctor has the ability to conduct diagnostic minimum according to some narrow medical specialties. Also, a general practitioner has the right to decipher an electrocardiogram, and in small towns he is charged with treating wounds and applying plaster casts, in the absence of appropriate specialists.

What education does a general practitioner receive?

Basic education for a general practitioner is training in medical school, in which the graduate is certified as a general practitioner or pediatrician. Then you need to complete a residency in the field of “therapy,” “pediatrics,” or “internal medicine,” and perhaps even undergo an internship.

If a general practitioner received his education a long time ago, he has the right to obtain the specialty “General Medical Practice ( Family medicine) carry out advanced training, having undergone retraining.

At this stage in Russia there are approximately the same number of general practitioners as there are therapists. Thanks to retraining programs, therapists retrain and get positions family doctors or general practitioners, it depends on the place where they plan to work. The number of such doctors is constantly growing.

What is the job of a family doctor?

A general practitioner is assigned a smaller area than a therapist, because he has more responsibilities in relation to each patient. Usually about 1800 patients, but it all depends settlement where the doctor practices.

For example, in Moscow a family doctor deals only with adult patients, and children are supervised by a pediatrician, while the observation system and call system are similar to those used by a local therapist. When a family doctor goes on vacation, another doctor comes in to replace him and is given responsibility for the entire area. The duration of vacations for general practitioners and therapists is the same.

However, the family doctor and internist do not visit sick people The doctor on duty responds to calls. In some cases, when there is a need for a visit, the family doctor visits the patient outside of working hours.

What to do if the general practitioner was unable to make a diagnosis?

The higher the professionalism of a general practitioner, the greater the capabilities he has and the less he needs advice from other specialists. But when they arise highly professional questions, the family doctor refers the patient to the appropriate specialist or to a separate medical institution providing specialized assistance.

As an example, consider the option when the patient suffers arterial hypertension (hypertension). This disease is within the competence of internists, family doctors and cardiologists. There are no indications to redirect the patient to a cardiologist, since a qualified general practitioner is able to examine such a patient and prescribe him treatment.

But if the patient is diagnosed with ischemic disease heart,” then he may need the intervention of a surgeon; naturally, in this case, the family doctor will refer the patient to a specialized specialist.

Also, when a family doctor believes that he cannot cope with the situation and the treatment he prescribes does not give the desired effect, he has the right to ask for help from another specialist, that is get advice. General practitioners often use this opportunity.

Of course, in regulatory documents the level of competence of a family doctor is prescribed. At the same time, these documents are constantly being revised, taking into account precedents arising in practice. The standards developed in this way determine what types of examinations and manipulations the doctor will have the right to perform.

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

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

How is a general practitioner different from a regular therapist?

The difference in the actions of district police officers and GPs can be shown using examples from existing work experience. A woman came to the appointment complaining of a lump in her breast. Upon palpation, a round, painless formation is determined. In this case, the district police officer will send you to a surgeon or gynecologist, while the GP will immediately send the patient for a mammogram, and if a tumor is detected, to an oncologist. Another situation - a man complains of headaches, ringing in the ears, unsteadiness of gait, deterioration of hearing and memory. The therapist passes it on to the neurologist. The family doctor himself refers the patient to duplex scanning arteries and for tests. The study determines a critical narrowing of the internal carotid artery, responsible for the blood supply to the brain. A man is walking for a consultation vascular surgeon to resolve the issue of surgery. After consultation and passing all the tests, the GP sends him for hospitalization.

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

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

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

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

Judging by the equipment, doctors of the new profile must be universal specialists, be able to give an enema and draw blood, and simple surgery carry out, and even resuscitation.

How many specialists have been retrained?

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

Only in 1992 did a corresponding position appear in the list of specialties. By 2000, about a thousand GPs were trained in the country, by 2005 - almost four thousand.

What is the retraining program based on?

The retraining program consists of educational modules on internal medicine, neurology, ENT diseases, surgery, skin and infectious diseases. Training, which involves both full-time and distance learning, is divided into theory and practice. The regular program is designed for 864 hours (study period is six months), but there is also a shortened one - 504 hours (about four months).

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

In 2014, 113 specialists were trained. In 2015, their number exceeded a thousand, but the capital’s clinics need more than 4.5 thousand general practitioners.

How long will it take to see a doctor now?

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

A general practitioner's office should have a manipulation room (for mini-operations) and a procedure room. Perhaps, due to organizational difficulties, GPs and district police officers will work in parallel for some time.

Will retrained therapists be able to replace specialized specialists?

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

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

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In developed countries, the majority medical problems is decided at an initial outpatient appointment with a general practitioner. A family doctor helps save not only patients’ time, but also money. In many cases, he is able to replace specialized doctors and even emergency care teams.

General practitioner - who is it?

When visiting a hospital with any symptoms, a person first tries to get an appointment with a therapist. At the same time, patients rarely ask the question: who is the general practitioner in the clinic? A family specialist also sees medical institutions, but the scope of his activities is more extensive. Thanks to a consultation with such a doctor, you can quickly establish a diagnosis without unnecessary instrumental and laboratory research.

Therapist and general practitioner - the difference

A qualified family doctor is a multidisciplinary specialist with knowledge in all areas of medicine. The main difference between a therapist and a general practitioner is the scope of his work. The responsibilities of a family specialist include more items. Unlike a therapist, the doctor described can perform the simplest diagnostic and therapeutic manipulations, and the appropriate equipment is installed in his office.

General practitioner – qualification

The specialist in question first receives a basic higher education medical education. Not all patients understand what a “general practitioner” means, confusing him with a therapist. Such a doctor has advanced qualifications. To obtain it, after a basic diploma and internship, you must complete a residency in the specialty “Family Medicine (General Medical Practice).” Hospital employees who received higher education before the introduction of the specified qualification, they can undergo accelerated primary retraining.

Where can a general practitioner work?

A family doctor is a universal specialty that allows you to get a job in both public and private clinics. While the work of a general practitioner is not appreciated in terms of material remuneration, many experienced professionals open their own consulting rooms. Some doctors only provide individual consultations with one or more families.

The described specialist can perform various diagnostic and therapeutic procedures. A family doctor has not only a phonendoscope, a thermometer and a tonometer, but also other devices. According to the standard, a doctor’s office must have all the necessary furniture for a specialist’s work, nurse and the following equipment:

portable electrocardiograph;
defibrillator;
express analyzers of urine, glucose, cholesterol, cardiac markers in the blood;
smokelizer;
pulse oximeter;
measuring equipment physical indicators(scales, stadiometer, stopwatch, pedometer, medical tuning fork and more);
negatoscope;
spirometer;
artificial lung ventilation device;
peak flow meter;
tonometer for measuring fundus pressure;
sterilizers;
conicotomy kit;
dynamometers;
breathalyzer;
gynecological set, chair;
otolaryngological devices (tongue holder, mouth dilator, laryngeal forceps and others);
tracheotomy kit;
ophthalmoscope;
equipment for providing primary traumatological and surgical care(stretcher, wooden shield, crutches, ice bladder and others);
otorhinoscope;
styling;
oxygen inhaler;
suction device;
bactericidal irradiator;
neurological equipment (hammer, light guide);
breathing tubes and apparatus;
sterile scalpels and other devices.

What does a general practitioner do?

A qualified family doctor provides any type of medical care on an outpatient basis. If a patient presents with a pathology that is not included in the list of what a general practitioner treats, he is referred to a specialized specialist. The doctor controls all stages of diagnosis and therapy of his “ward” and makes adjustments if necessary.

General practitioner - job responsibilities

Family medicine involves long-term systematic monitoring of patients’ condition, organization of consultations with highly specialized doctors and laboratory tests, inpatient treatment and disease prevention. The main responsibilities of a general practitioner:

collecting a detailed medical history of all family members;
thorough examination of patients using objective medical methods;
definition special research and analyses;
making a diagnosis;
entering all information into a personal card;
appointment effective treatment, referral for hospitalization if necessary;
identification of risk factors for the development or exacerbation of chronic pathologies;
registration medical documentation(outpatient, health resort card, certificates, sick leave and others);
pregnancy management (rarely, more often this is done by a gynecologist together with family doctor);
emergency assistance and consultations.

Necessary tests

and urine;
immunological and;
bacterioscopy;
biochemistry of urine.

If basic set tests are not enough, the family specialist refers for additional examinations:

hormonal panel;
blood test for sugar;
identification;
virology;
analysis for helminthic infestations;
cytology and others.

Types of diagnostics

There are many procedures that a family doctor performs - responsibilities include:

listening to heart sounds and respiratory tract sounds;
examination of lymph nodes;
percussion of the back and chest;
examination of the ears, larynx, nose;
palpation of the digestive and urinary system;
gynecological examinations;
diagnostics of the condition of the musculoskeletal system;
examination of the organs of vision;
neurological examination and other diagnostic procedures.

When to contact a general practitioner?

The reason for consultation with a family specialist may be any change in health or physical condition, including pregnancy. A general practitioner will not only make a preliminary diagnosis and give valuable recommendations, but will also develop an effective individual scheme treatment. If the identified disease is outside the scope of his competence, the patient is referred to specialists of the appropriate narrow profile, and a list of necessary laboratory tests is provided.

An experienced family doctor will help with the following symptoms:

high body temperature;
skin rash;
digestive disorders;
pain syndrome of any intensity and localization;
chronic fatigue;
insomnia;
deterioration of visual acuity or hearing;
the appearance of new moles or changes appearance existing nevi;
shortness of breath, difficulty breathing;
dizziness, decreased concentration;
cough, hoarseness of voice;
nasal congestion;
sudden jumps in blood pressure;
deterioration in performance;
unreasonable loss or unreasonable weight gain;
feeling of thirst, dry mouth;
tingling in the limbs, numbness;
limited mobility of the back and limbs;
neuroses;
depressive episodes and other symptoms.

In addition to treating existing diseases, a family specialist takes care of preventing the occurrence of pathologies. Standard doctor’s advice includes basic recommendations for leading the healthiest and most fulfilling lifestyle:

Get enough sleep. It is advisable to go to rest no later than 22-23 hours. Total time sleep is 8-10 hours.
Eat a balanced diet. The diet should contain vitamins, proteins, minerals, amino acids and carbohydrates. It's important to satisfy daily requirement body in energy.
Make time for physical activity. The minimum recommended by your family doctor is five to ten minutes of exercise in the morning.
Avoid emotional overload. Stress negatively affects not only psychological state, but also impairs the functioning of the immune system.
Treat chronic diseases in a timely manner. In the presence of indolent pathologies, it is important to prevent their relapses by strictly following the preventive courses of therapy prescribed by the family doctor.
Attend regular checkups. It is advisable to undergo a complete examination once a year medical examination, consult a dentist or gynecologist every 6 months.

The Ministry of Health informs: in Belarus in 2020 there will be no local therapists in clinics; they will be completely replaced by general practitioners. And medical officials will most likely keep their word. In 2017, about 40% of local doctors retrained as general practitioners (GPs). It is expected that in the capital in 2018, 60% of local therapists will become GPs, in 2019 - 75%, in 2020 - 100%. The question arises: why is this necessary? A correspondent from the Minsk-Novosti agency was looking for an answer.

- General medical practice is modern organization district police officer medical service, - said the chief therapist of the Ministry of Health of the Republic of Belarus Alexander Verbovikov. - In this connection, in city clinics the existing therapeutic departments will be renamed into general departments medical practice. This won't just be a sign change. This means retrofitting doctors’ offices and bags with modern electronic tonometers and thermometers, portable electrocardiographs and other medical equipment. Each doctor will have a computer installed at his or her workplace, connected to the clinic’s database.(in the capital, almost all workplaces of local therapists are equipped with computers, in the regions - not yet. - Note auto). On the computer - full information about the patient with his hospitalizations, prescribed treatment, medications taken. There are also the results of laboratory, instrumental, ultrasound, and radiographic studies.

GP has basic skills in ENT diseases

Three years ago, only six general practitioners worked in Minsk - at outpatient clinic No. 1 in Sukharevo, the villages of Sokol and Sosny. Now in the 39th city clinic there is a department of general medical practice of the Belarusian State medical university. This is where the capital's local therapists undergo retraining.

A GP is a generalist doctor with basic knowledge in neurology, endocrinology, cardiology, surgery, and otorhinolaryngology. This doctor's bag contains a portable electrocardiograph, a neurological hammer, a glucometer, a portable otoscope, and an electronic tonometer.

- In Rus' there was a zemstvo doctor who knew how to do everything,- added Lyudmila Lugovets, head of the primary health care department of the Health Committee of the Minsk City Executive Committee. - Both as a neurologist could look at the patient, and as a cardiologist. What now? The patient complains to the doctor that his back hurts, he refers him to a neurologist, so he can sort it out.

They started expanding the powers of local therapists in the capital two years ago: they organized a series of seminars, practical classes, tests in neurology, endocrinology. Due to which patients with diabetes mellitus, for example, were completely transferred to local therapists. With basic knowledge of neurology, these doctors are also quite capable of providing consultation and medical assistance to patients. Only diagnostically complex patients are referred to neurologists and endocrinologists.

- We analyzed the work of general practitioners in the capital - the patients are very satisfied,- noted L. Lugovets. - During one visit, a person receives advice from several specialists in one person. If the case is complex, you need additional examination or an examination of a specialist colleague, the doctor will write a referral. And doctors like to work in a new way, their self-esteem has increased.

Marina Dreiling: everything you need for work is at hand

...Marina Dreyling, general practitioner, 39th city clinical clinic, explained that she personally is interested in working.

- I don’t remember any patients complaining. For us, local service doctors, this fact is especially important. There are no queues for me,- she said.

As for the workload, according to the standards in the city, one GP is assigned 1,700 patients, and in rural areas - 1,300. On average, one person is given 15 minutes to see each other.

For information

From January 24, 2018, outpatient clinic No. 1 in Sukharevo was reorganized into the general medical practice department of the 10th city clinic.

Photo by Sergei Sheleg