Job description of the district physician-therapist. Job description of a general practitioner Requirements for the qualification of a local general practitioner

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JOB DESCRIPTION

District physician

1. General Provisions

1.1. This job description defines and regulates the powers, functional and job duties, rights and responsibilities of the district general practitioner [Name of organization in the genitive case] (hereinafter referred to as the Medical Organization).

1.2. The district general practitioner is appointed to the position and dismissed from the position in accordance with the procedure established by the current labor legislation by order of the head of the Medical Organization.

1.3. The local general practitioner belongs to the category of specialists and is subordinate to [name of the position of subordinates in the dative case].

1.4. The district general practitioner reports directly to the [name of the position of the immediate supervisor in the dative case] of the Medical Organization.

1.5. A person who has a higher professional education in one of the specialties "Medicine", "Pediatrics" and postgraduate professional education (internship and (or) residency) in the specialty "Therapy" or professional retraining in the presence of postgraduate professional education in the specialty "General Medical Practice (Family Medicine)", a certificate of a specialist in the specialty "Therapy" without presenting requirements for work experience.

1.6. The general practitioner is responsible for:

• effective performance of the work entrusted to him;
• compliance with the requirements of performance, labor and technological discipline;
• the safety of the documents (information) that are in his custody (become known to him), containing (constituting) the trade secret of the Medical Organization.

1.7. The general practitioner must know:

• the Constitution of the Russian Federation;
• laws and other regulatory legal acts of the Russian Federation in the field of healthcare;
• Fundamentals of legislation on the protection of the health of citizens;
• general issues of organizing therapeutic care in the Russian Federation;
• the work of medical institutions, the organization of the work of ambulance and emergency care for adults and children;
• organization of the work of the polyclinic, continuity in its work with other institutions;
• organization of a day hospital and a hospital at home;
• the main issues of normal and pathological anatomy, normal and pathological physiology, the relationship of the functional systems of the body and the levels of their regulation;
• basics of water-electrolyte metabolism, acid-base balance, possible types of their disorders and principles of treatment;
• the system of hematopoiesis and hemostasis, the physiology and pathophysiology of the blood coagulation system, homeostasis indicators in normal and pathological conditions;
• fundamentals of immunology and reactivity of the body;
• clinical symptoms and pathogenesis of major therapeutic diseases in adults and children, their prevention, diagnosis and treatment, clinical symptoms of borderline conditions in a therapeutic clinic;
• basics of pharmacotherapy in the clinic of internal diseases, pharmacodynamics and pharmacokinetics of the main groups of drugs, complications caused by the use of drugs, methods for their correction;
• the basics of non-drug therapy, physiotherapy, exercise therapy and medical supervision, indications and contraindications for spa treatment;
• the basics of rational nutrition of healthy individuals, the principles of diet therapy for therapeutic patients;
• anti-epidemic measures in the event of a focus of infection;
• medical and social expertise in internal diseases;
• dispensary observation of healthy and sick people, problems of prevention;
• forms and methods of sanitary and educational work;
• demographic and social characteristics of the site;
• principles of organization of medical service of civil defense;
• questions of the relationship of the disease with the profession.

1.8. The local general practitioner in his activities is guided by:

• local acts and organizational and administrative documents of the Medical Organization;
• internal labor regulations;
• rules of labor protection and safety, ensuring industrial sanitation and fire protection;
• instructions, orders, decisions and instructions of the immediate supervisor;
• this job description.

1.9. During the period of temporary absence of the district general practitioner, his duties are assigned to [name of the position of the deputy].

2. Job responsibilities

The primary care physician is required to perform the following duties:

2.1. Identifies and monitors risk factors for the development of chronic noncommunicable diseases.

2.2. Provides primary prevention in high-risk groups.

2.3. Performs a list of works and services for diagnosing a disease, assessing the patient's condition and the clinical situation in accordance with the standard of medical care.

2.4. Performs a list of works and services for the treatment of a disease, condition, clinical situation in accordance with the standard of medical care.

2.5. Provides symptomatic assistance to oncological patients of the IV clinical group in cooperation with an oncologist.

2.6. Carries out an examination of temporary disability of patients, presentation to the medical commission, referral of patients with signs of permanent disability for examination for medical and social examination.

2.7. Issues conclusions on the need to refer the patient for medical reasons for sanatorium treatment, draws up a sanatorium card.

2.8. Carries out organizational, methodological and practical work on medical examination of the population.

2.9. Organizes the vaccination of the population in accordance with the national calendar of preventive vaccinations and according to epidemic indications.

2.10. Prepares and sends an emergency notification to the institutions of Rospotrebnadzor when an infectious or occupational disease is detected.

2.11. Organizes and conducts health education activities (health schools, schools for patients with socially significant non-communicable diseases and people at high risk of their occurrence).

2.12. Monitors and analyzes the main medical and statistical indicators of morbidity, disability and mortality in the serviced area in the prescribed manner.

2.13. Maintains accounting and reporting documentation of the established sample.

In the event of an official need, a district general practitioner may be involved in the performance of his official duties overtime, in the manner prescribed by the provisions of federal labor legislation.

3. Rights

The local general practitioner has the right to:

3.1. To give instructions to subordinate employees and services, tasks on a range of issues included in his functional duties.

3.2. To control the fulfillment of production tasks, the timely execution of individual orders and tasks by subordinate services.

3.3. Request and receive the necessary materials and documents related to the activities of the district general practitioner, subordinate services and units.

3.4. Interact with other enterprises, organizations and institutions on production and other issues related to the competence of the local general practitioner.

3.5. Sign and endorse documents within their competence.

3.6. Submit for consideration by the head of the Medical Organization submissions on the appointment, transfer and dismissal of employees of subordinate units; proposals for their promotion or for the imposition of penalties on them.

3.7. Enjoy other rights established by the Labor Code of the Russian Federation and other legislative acts of the Russian Federation.

4. Responsibility and performance evaluation

4.1. The local general practitioner shall bear administrative, disciplinary and material (and in some cases provided for by the legislation of the Russian Federation - and criminal) responsibility for:

4.1.1. Non-fulfillment or improper fulfillment of official instructions of the immediate supervisor.

4.1.2. Failure to perform or improper performance of their labor functions and assigned tasks.

4.1.3. Unlawful use of the granted official powers, as well as their use for personal purposes.

4.1.4. Inaccurate information about the status of the work entrusted to him.

4.1.5. Failure to take measures to suppress the identified violations of safety regulations, fire and other rules that pose a threat to the activities of the enterprise and its employees.

4.1.6. Failure to enforce labor discipline.

4.2. Evaluation of the work of the local general practitioner is carried out:

4.2.1. The immediate supervisor - regularly, in the course of the daily implementation by the employee of his labor functions.

4.2.2. Attestation Commission of the enterprise - periodically, but at least once every two years based on the documented results of the work for the evaluation period.

4.3. The main criterion for evaluating the work of a local general practitioner is the quality, completeness and timeliness of his performance of the tasks provided for by this instruction.

5. Working conditions

5.1. The work schedule of the district general practitioner is determined in accordance with the internal labor regulations established in the Medical Organization.

6. Right to sign

6.1. To ensure his activities, the district general practitioner is given the right to sign organizational and administrative documents on issues referred to his competence by this job description.

Familiarized with the instruction ___________ / ____________ / "____" _______ 20__

Lesson topic. Tasks and duties of the local therapist. Work organization.

Motivation. Currently, much attention is paid to the provision of medical care to the population on an outpatient basis. The healthcare reform involves its restructuring with the strengthening of the outpatient link, as well as the development of a general medical practice service.

1. The purpose of the lesson.

The student must know:

the structure of the clinic;

the main tasks and responsibilities of the local therapist, general practitioner;

organization of work of the local therapist;

principles of clinical examination;

the work of the clinical expert commission;

selection for sanatorium treatment.

The student must be able to:

Organize patient visits at the outpatient clinic and at home;

correctly fill out the documentation with which the district therapist deals;

organize dispensary observation of patients, issue primary and current documentation;

draw up a plan for secondary prevention, evaluate the effectiveness of clinical examination;

take part in the work of the clinical expert commission;

send the patient to a sanatorium - resort treatment.

Main questions:

Organization of the work of the local general practitioner and general practitioner.

A polyclinic is a specialized medical and preventive institution for the provision of out-of-hospital care.

The main principle of organizing the work of the polyclinic is the district principle of providing medical care, which consists in the fact that the territory served by the polyclinic is divided into territorial sections, based on the population in the area of ​​1700 people. Each site is assigned a specific general practitioner and a nurse, who are called upon to provide medical and preventive care to residents of their site.

Specialist doctors work in the therapeutic department: a surgeon, a neuropathologist, an otolaryngologist and an oculist. This method of work is called brigade, when these specialists serve patients in the clinic and at home from certain therapeutic areas.

The work of each department - brigade is organized in such a way that all its members work at the same hours. Under these conditions, the role of the therapist in the process of providing medical care to the population increases. Combining into teams provides an even distribution of workload among doctors, their interchangeability, strengthening continuity, and the possibility of exchanging experience in managing patients.

The main tasks of the local therapist:

Providing qualified therapeutic assistance to the population of the site at the reception in the clinic and at home;

Organization and direct implementation of preventive measures among the population of their site;

Decreased morbidity and mortality in the assigned area.

Responsibilities of the local general practitioner:

Timely therapeutic assistance to the population of the site in the clinic and at home;

Emergency medical care for patients in the event of acute conditions, injuries, poisoning;

Timely hospitalization of therapeutic patients with mandatory preliminary examination during planned hospitalization;

Consultations of patients in the clinic;

Use in their work of modern methods of prevention, diagnosis and treatment of patients, including complex therapy and rehabilitation treatment;

Examination of temporary disability of patients;

Organization and implementation of comprehensive measures for the medical examination of the adult population of the site;

Issuance of a conclusion to residents of the site undergoing medical examinations and leaving abroad;

Organization and implementation of preventive vaccinations and deworming of the population of the site;

Early detection, diagnosis and treatment of infectious diseases, immediate signaling to the head of the therapeutic department and the doctor of the infectious diseases cabinet about all infectious diseases, food and occupational poisoning. Sending an emergency notice to the relevant SES;

Systematic improvement of their qualifications and the level of medical knowledge of the district nurse;

Active and systematic conduct of sanitary and educational work among the population of the site, the fight against bad habits.

The work of the local general practitioner is carried out according to the schedule approved by the head of the department or the head of the institution. The schedule provides for fixed hours for outpatients, home care, preventive and other work.

On average, a doctor works on an outpatient appointment from 2.5 to 3.5 hours, and for home care - from 3 to 4 hours; 0.5 hour daily allocated for sanitary and preventive work.

An important part of the work of the local doctor is the reception of patients in the clinic. Each visit to the sick doctor should be exhaustive and complete. Re-appointments should be based on medical indications.

All the time of observation of the patient in the polyclinic, an "outpatient medical record" is maintained. All examination data, diagnoses, treatment, consultations, exemption from work and other information must be entered in the "outpatient medical record" on the same day.

Home health care plays an important role. On average, the time spent by a local doctor in providing home care should be 30-40 minutes. Having examined the patient at home on call, the district doctor subsequently visits the patient on his own initiative as necessary. Active visits to patients at home are planned by the doctor himself, depending on the state of health of the patient. When providing assistance with the organization of a "hospital at home", the doctor must ensure that the patient takes all the necessary measures: laboratory and other studies, medical procedures, etc.

In modern conditions, day hospitals in outpatient clinics have become widespread. In day hospitals, patients have the possibility of a comprehensive examination and treatment. In addition, it is a more economical form of treatment compared to a 24-hour hospital.

The district doctor in his area is not only the attending physician, but also the organizer of all medical and preventive care for the population.

On August 26, 1992, the order of the Ministry of Health of the RSFR No. 237 "On a phased transition to the organization of primary medical care on the principle of a general practitioner (family doctor)" was issued.

General practice is a specialty that provides continuous and comprehensive medical care to a person and his family. This specialty combines biological, clinical disciplines and psychology. The general practitioner is not limited to the narrow confines of one discipline.

The duties of a general practitioner include:

provision of primary health care;

family monitoring;

providing assistance at home;

continuous monitoring throughout the life of the patient.

The uniqueness of the work of a general practitioner lies in the availability of medical care for the patient at any time, the ability to treat both emergency conditions and chronic diseases, and the importance lies in the preventive focus of his activities.

2. Clinical examination- this is a method of active dynamic monitoring of the health status of all population groups, both healthy and sick; wide implementation of complexes of social, sanitary-hygienic, preventive and health-improving measures.

Medical examination goals:

Preservation and strengthening of public health.

Increasing the efficiency and productivity of workers.

Increasing the active longevity of people.

The main tasks of medical examination:

study and elimination of the causes contributing to the emergence and spread of diseases;

active detection and treatment of initial forms of diseases;

prevention of relapses, exacerbations and complications of existing diseases.

Population groups subject to clinical examination:

Group I - practically healthy citizens who do not need dispensary observation, with whom a preventive conversation is held about a healthy lifestyle;

Group II - citizens at risk of developing the disease, in need of preventive measures. For them, an individual program of preventive measures is drawn up, carried out in an outpatient facility at the place of residence;

Group III - those who need additional examination to clarify (establish) the diagnosis (for the first time established chronic disease) or treatment on an outpatient basis (ARI, influenza and other acute diseases, after the treatment of which recovery occurs);

Group IV - those in need of additional examination and treatment in a hospital, who are registered with a dispensary for a chronic disease;

Group V - citizens with newly diagnosed diseases or being observed for a chronic disease and having indications for the provision of high-tech (expensive) medical care.

The following additional studies are required during the medical examination:

Blood test (ESR, hemoglobin, leukocytes).

Urine test for sugar (blood for sugar according to indications).

Urine test for protein.

ECG (for persons 40 years and older).

Fluorography of the chest organs.

For women - breast examination, mammography (after 35 years, 1 p. in 2 years).

Cytological examination of smears (from the age of 18 in women).

Digital examination of the rectum (from the age of 30).

Dispensary group of patients patients subject to dynamic monitoring by a local general practitioner are patients with the following diseases: hypertension of the 1st stage, coronary heart disease, including myocardial infarction, convalescents after acute pneumonia, chronic bronchitis, bronchial asthma, bronchiectasis, peptic ulcer and DPC, atrophic gastritis, chronic hepatitis, chronic pancreatitis, chronic cholecystitis, cholelithiasis, chronic enterocolitis, cirrhosis of the liver, condition after acute glomerulonephritis, chronic pyelonephritis, chronic glomerulonephritis, chronic renal failure in Art. compensation. The effectiveness of clinical examination is assessed by the dynamics of morbidity with temporary and permanent disability, changes in the group of dispensary observation.

The main principle of organizing the work of the polyclinic is the district principle of providing medical care, which consists in the fact that the territory served by the polyclinic is divided into territorial sections, based on the population in the area of ​​1700 people. Each site is assigned a specific general practitioner and a nurse, who are called upon to provide medical and preventive care to residents of their site.

Specialist doctors work in the therapeutic department: a surgeon, a neuropathologist, an otolaryngologist and an oculist. This method of work is called brigade, when these specialists serve patients in the clinic and at home from certain therapeutic areas.

The work of each department - brigade is organized in such a way that all its members work at the same hours. Under these conditions, the role of the therapist in the process of providing medical care to the population increases. Combining into teams provides an even distribution of workload among doctors, their interchangeability, strengthening continuity, and the possibility of exchanging experience in managing patients.

The main tasks of the local therapist:

Providing qualified therapeutic assistance to the population of the site at the reception in the clinic and at home;

Organization and direct implementation of preventive measures among the population of their site;

Decreased morbidity and mortality in the assigned area.

Responsibilities of the local general practitioner:

Timely therapeutic assistance to the population of the site in the clinic and at home;

Emergency medical care for patients in the event of acute conditions, injuries, poisoning;

Timely hospitalization of therapeutic patients with mandatory preliminary examination during planned hospitalization;

Consultations of patients in the clinic;

Use in their work of modern methods of prevention, diagnosis and treatment of patients, including complex therapy and rehabilitation treatment;

Examination of temporary disability of patients;

Organization and implementation of comprehensive measures for the medical examination of the adult population of the site;

Issuance of a conclusion to residents of the site undergoing medical examinations and leaving abroad;

Organization and implementation of preventive vaccinations and deworming of the population of the site;

Early detection, diagnosis and treatment of infectious diseases, immediate signaling to the head of the therapeutic department and the doctor of the infectious diseases cabinet about all infectious diseases, food and occupational poisoning. Sending an emergency notice to the relevant SES;

Systematic improvement of their qualifications and the level of medical knowledge of the district nurse;

Active and systematic conduct of sanitary and educational work among the population of the site, the fight against bad habits.

The work of the local general practitioner is carried out according to the schedule approved by the head of the department or the head of the institution. The schedule provides for fixed hours for outpatients, home care, preventive and other work.

On average, a doctor works on an outpatient appointment from 2.5 to 3.5 hours, and for home care - from 3 to 4 hours; 0.5 hour daily allocated for sanitary and preventive work.

An important part of the work of the local doctor is the reception of patients in the clinic. Each visit to the sick doctor should be exhaustive and complete. Re-appointments should be based on medical indications.

All the time of observation of the patient in the polyclinic, an "outpatient medical record" is maintained. All examination data, diagnoses, treatment, consultations, exemption from work and other information must be entered in the "outpatient medical record" on the same day.

Home health care plays an important role. On average, the time spent by a local doctor in providing home care should be 30-40 minutes. Having examined the patient at home on call, the district doctor subsequently visits the patient on his own initiative as necessary. Active visits to patients at home are planned by the doctor himself, depending on the state of health of the patient. When providing assistance with the organization of a "hospital at home", the doctor must ensure that the patient takes all the necessary measures: laboratory and other studies, medical procedures, etc.

In modern conditions, day hospitals in outpatient clinics have become widespread. In day hospitals, patients have the possibility of a comprehensive examination and treatment. In addition, it is a more economical form of treatment compared to a 24-hour hospital.

The district doctor in his area is not only the attending physician, but also the organizer of all medical and preventive care for the population.

Medical therapeutic area- the most important link in the system of providing medical care, and the district therapist is the leading figure in the area and in the system of public health protection. The number of adult population of the therapeutic area currently averages 1700, shop - 1600 people (in a number of industries, depending on working conditions for shop areas - up to 2000 people and less than 1000 people).

District doctor- is not only a clinician, it is a healthcare organizer at the PHC stage. The district doctor needs knowledge of the basics of public health and healthcare, clinical medicine, sociology and family psychology. The district doctor should be a researcher of the health status of the population of his area and the factors influencing it, he should improve his activities, introduce new methods of diagnosis and treatment, elements of the scientific organization of labor.

A good district doctor is essentially a general practitioner.

In accordance with the regulation "On the general practitioner of the local polyclinic (outpatient clinic)", the local therapist is obliged to ensure:

Timely qualified therapeutic assistance to the population of the site in the clinic (outpatient clinic) and at home;

Emergency medical assistance to patients regardless of their place of residence in case of direct treatment in the event of acute conditions, injuries, poisoning;

Timely hospitalization of therapeutic patients with mandatory preliminary examination during planned hospitalization;

Consultation of patients, if necessary, together with the head of the therapeutic department, doctors of other specialties of the polyclinic (outpatient clinic) and other health care institutions;

The use of modern methods of prevention, diagnosis and treatment of patients, including complex therapy and rehabilitation treatment (drugs, diet therapy, exercise therapy, massage, physiotherapy, etc.);

Examination of temporary disability of patients in accordance with the current regulation on the examination of temporary disability;

Organization and implementation of a set of measures for the medical examination of the adult population of the site (identification, registration, dynamic observation, medical and recreational activities), analysis of the effectiveness and quality of medical examination;

Organization and implementation of preventive vaccinations and deworming of the population of the site;

Early detection, diagnosis and treatment of infectious diseases, immediate notification to the head of the therapeutic department and the doctor of the infectious diseases cabinet about all cases of infectious diseases or patients suspected of infection, about food and occupational poisoning, about all cases of non-compliance with anti-epidemic requirements by infectious patients, referral to the appropriate SES department emergency notification of an infectious disease;

Systematic improvement of their qualifications and the level of medical knowledge of the district nurse;

Active and systematic conduct of medical and educational work among the population of the site, the fight against bad habits.

The local therapist works according to a schedule approved by the head of the department, which provides for fixed hours for outpatient reception of patients, home care, preventive and other work. The distribution of time for reception and assistance at home depends on the size and composition of the population of the site, on the prevailing attendance, etc.

Home health care- one of the main activities of the clinic. Medical care at home is provided around the clock: from 9 am to 7 pm - by a local doctor, the rest of the time in urgent cases - by an ambulance and emergency doctor.

When making a doctor's call to the house, the patient's condition is ascertained, and in emergency cases, the doctor on duty (in the absence or employment of the district doctor) goes to the patient immediately. In emergencies requiring hospitalization, an ambulance is called. The call data is logged. Subsequent visits by the doctor to the patient at home are called active if they are made on the initiative of the doctor, without calling the patient. The doctor ensures the conduct of clinical diagnostic studies, the performance of medical procedures by the nurse, consults the patient with doctors of other specialties.

48. Application of the dispensary method in the work of medical institutions.

Preventive work consists, first of all, in the wide use by doctors of outpatient institutions, especially district therapists, dispensary method. This is an active method of dynamic monitoring of the health status of certain contingents (healthy and sick) of the population with the aim of early detection of diseases, registration and comprehensive treatment of patients, taking measures to improve working and living conditions, to prevent the occurrence and spread of diseases, and promote a healthy lifestyle. .

A distinctive feature of medical care provided in polyclinics is the organic combination of medical and preventive work in the activities of all doctors of this institution.

3 main directions in the preventive doctor:

a) sanitary and educational work- when communicating with each patient, he should be explained the principles of a healthy lifestyle and regimen for a specific disease, the basics of rational and therapeutic nutrition, the harm of smoking and alcohol abuse, and other sanitary and hygienic aspects; the doctor also conducts lectures in the clinic and at enterprises, issues health bulletins and other information materials, and so on.

b) vaccination work- carried out under the guidance of immunologists by infectious disease specialists and district therapists of the polyclinic (in recent years, the need for general vaccination of the adult population against diphtheria has become acute)

V) medical examination (dispensary method) is a method of active dynamic monitoring of the health status of the population, aimed at improving health and increasing working capacity, ensuring proper physical development and preventing diseases through a complex of therapeutic and preventive measures. In the dispensary method of work of the health care facility, the preventive orientation of the health care facility is most fully expressed.

Contingents subject to medical examination include both healthy and sick people.

Group 1 (healthy) includes:

Persons who, due to their physiological characteristics, require systematic monitoring of their health (children, adolescents, pregnant women);

Persons exposed to adverse factors of the working environment;

Decreed contingents (food workers, public utilities workers, public and passenger transport workers, staff of children's and medical institutions, etc.);

Special contingents (persons affected by the Chernobyl disaster);

Disabled people and participants of the Great Patriotic War and contingents equated to them.

Clinical examination healthy aims to preserve health and ability to work, identify risk factors for the development of diseases and eliminate them, prevent the occurrence of diseases and injuries through the implementation of preventive and recreational measures.

Group 2 (patients) includes:

Patients with chronic diseases;

Convalescents after some acute diseases;

Patients with congenital (genetic) diseases and malformations.

Clinical examination sick provides for the early detection of diseases and the elimination of the causes that contribute to their occurrence; prevention of exacerbations, relapses, complications; preservation of working capacity and active longevity; reduction of morbidity, disability and mortality through the provision of comprehensive qualified medical care, health and rehabilitation measures.

Dispensary tasks:

• identification of persons with risk factors and patients in the early stages of diseases by conducting annual preventive examinations of mandatory contingents and, if possible, other groups of the population;
• active monitoring and rehabilitation of patients and persons with risk factors;
• examination, treatment and rehabilitation of patients by negotiability, dynamic monitoring of them;
• creation of automated information systems and data banks for dispensary registration of the population.

Stages of medical examination:

1st stage. Accounting, examination of the population and selection of contingents for dispensary registration.

a) registration of the population by districts by conducting a census by a paramedical worker

b) survey of the population in order to assess the state of health, identify risk factors, early detection of patients.

Identification of patients is carried out during preventive examinations of the population, when patients seek medical help in health facilities and at home, with active calls to the doctor, as well as during special examinations regarding contacts with an infectious patient.

Distinguish 3 types of preventive examinations.

1) preliminary- is carried out by persons entering work or study in order to determine the suitability (suitability) of workers and employees for their chosen work and to identify diseases that may be contraindications for work in this profession.

2) periodic- carried out by persons in a planned manner within the established time limits for certain groups of the population and with the current appeal for medical care to medical institutions.

To contingents subject to mandatory periodic inspections, relate:

Workers of industrial enterprises with harmful and dangerous working conditions;

Workers of leading professions of agricultural production;

Decree contingents;

Children and adolescents, young men of pre-conscription age;

Students of vocational schools, technical schools, university students;

Pregnant women;

Disabled people and participants of the Great Patriotic War and contingents equated to them;

Persons affected by the Chernobyl disaster.

In relation to the rest of the population, the doctor should use each visit of the patient to a medical institution for a preventive examination.

3) target- carried out for the early detection of patients with certain diseases (tuberculosis, malignant neoplasms, etc.)

The main forms of preventive examinations are

A. individual- are carried out:

According to the appeal of the population to health facilities (for a certificate, in order to issue a sanatorium card, in connection with a disease);

With the active call of persons served by the polyclinic for a dispensary examination at the polyclinic;

When doctors visit patients with chronic diseases at home;

Among those who are being treated in a hospital;

When examining persons who have been in contact with an infectious patient.

This is the main form of medical examinations of the unorganized population.

b. massive- are carried out, as a rule, among organized groups of the population: children of preschool and school institutions, young men of pre-conscription age, students of secondary specialized institutions and university students, workers and employees of enterprises and institutions. Mass preventive examinations, as a rule, are of a complex nature and combine periodic and targeted ones.

Examinations of organized groups are carried out on the basis of agreed schedules and are regulated by the relevant orders of the Ministry of Health.

The data of medical examinations and the results of the examinations carried out are entered in medical records(“Medical record of an outpatient”, “Individual card of a pregnant woman and a puerperal”, “History of the development of a child”).

Based on the results of the examination, a conclusion is given on the state of health and is determined observation group:

a) group "healthy" (D1)- these are persons who do not complain and who have no deviations in their state of health in their history and during examination.

b) group "practically healthy" (D2) - persons with a history of chronic diseases without exacerbations for several years, persons with borderline conditions and risk factors, often and for a long time ill, convalescents after acute diseases.

c) group "chronic patients" (D3):

Persons with a compensated course of the disease with rare exacerbations, a short disability that does not interfere with the performance of normal work activities;

Patients with a subcompensated course of the disease, who have frequent annual exacerbations, prolonged disability and its limitation;

Patients with a decompensated course of the disease, with stable pathological changes, irreversible processes leading to permanent disability and disability.

If a disease is detected in the examined, the doctor fills out a statistical coupon (f.025 / 2-y); makes records about the state of health in the medical record of an outpatient (f.025 / y). Persons assigned to the third health group are taken for dispensary registration by a district doctor or a specialist doctor. When taking a patient for dispensary registration, the patient is registered control card of dispensary observation (f.030 / y), which is kept by the doctor who carries out dispensary observation of the patient. The control chart shows: doctor's surname, date of registration and deregistration, reason for removal, disease for which he was taken under dispensary observation, patient's outpatient card number, his surname, first name, patronymic, age, gender, address, place of work, doctor's attendance, records of changes in the initial diagnosis, concomitant diseases, a complex of therapeutic and preventive measures.

Carrying out a preventive examination without subsequent therapeutic and preventive measures does not make sense. Therefore, for each prophylactic follow-up, a plan for dispensary observation is drawn up, which is noted in the control card of dispensary observation and in the medical record of the outpatient.

2nd stage. Dynamic monitoring of the state of health of those undergoing medical examinations and carrying out preventive and therapeutic measures.

Dynamic monitoring of the medical examination is carried out differentially according to health groups:

a) observation of healthy people (group 1) - carried out in the form of periodic medical examinations. Mandatory contingents of the population undergo annual inspections according to the plan within the established time limits. For the rest of the contingents, the doctor should make the most of any visit of the patient to the medical facility. In relation to this group of the population, health-improving and preventive measures are carried out aimed at preventing diseases, promoting health, improving working and living conditions, as well as promoting a healthy lifestyle.

b) observation of persons assigned to group 2 (practically healthy) is aimed at eliminating or reducing risk factors for the development of diseases, correcting hygienic behavior, increasing compensatory capabilities and body resistance. Observation of patients who have undergone acute diseases is aimed at preventing the development of complications and chronicity of the process. The frequency and duration of observation depend on the nosological form, the nature of the process, the possible consequences (after acute tonsillitis, the duration of medical examination is 1 month). Patients with acute diseases with a high risk of chronicity and the development of severe complications are subject to dispensary observation by a general practitioner: acute pneumonia, acute tonsillitis, infectious hepatitis, acute glomerulonephritis and others.

c) monitoring of persons assigned to group 3 (chronic patients) - is carried out on the basis of a plan of medical and recreational activities, which provides for the number of dispensary visits to the doctor; consultations of medical specialists; diagnostic studies; drug and anti-relapse treatment; physiotherapy procedures; physiotherapy exercises; diet food, spa treatment; sanitation of foci of infection; planned hospitalization; rehabilitation measures; rational employment, etc.

Dispensary group of patients with chronic diseases patients subject to dispensary observation by general practitioners are patients with the following diseases: chronic bronchitis, bronchial asthma, bronchiectasis, lung abscess, hypertension, NDC, coronary artery disease, peptic ulcer of the stomach and duodenum, chronic gastritis with secretory insufficiency, chronic hepatitis, cirrhosis of the liver, chronic cholecystitis and cholelithiasis, chronic colitis and enterocolitis, ulcerative colitis, urolithiasis, chronic glomerulonephritis, chronic pyelonephritis, osteoarthritis, rheumatism, rheumatoid arthritis, often and for a long time ill. If there are doctors of narrow specialties in the polyclinic, profile patients, depending on the age and stage of compensation, may be under dispensary observation by these specialists.

A group of dispensary patients subject to dispensary observation by a surgeon, are patients with phlebitis and thrombophlebitis, varicose veins of the lower extremities, post-resection syndromes, chronic osteomyelitis, endarteritis, trophic ulcers, etc.

In the course of dynamic monitoring, the planned activities are carried out, adjusted, and supplemented during the year. At the end of the year, a stage epicrisis is filled out for each prophylactic, which reflects the following points: the initial state of the patient; carried out medical and recreational activities; dynamics of the course of the disease; final assessment of the state of health (improvement, deterioration, no change). The epicrisis is reviewed and signed by the head of the department. For convenience, many health facilities use special forms such as "dispensary observation plan epicrisis", which are pasted into the medical record and can significantly reduce the time spent on paperwork.

3rd stage. Annual analysis of the state of dispensary work in health care facilities, evaluation of its effectiveness and development of measures to improve it (see question 51).

Statistical analysis of dispensary work is carried out on the basis of the calculation of three groups of indicators:

Indicators characterizing the organization and volume of clinical examination;

Indicators of the quality of clinical examination (activity of medical supervision);

Indicators of the effectiveness of clinical examination.

A) indicators of the volume of medical examination

1. Coverage of dispensary observation of patients with this nosological form:

2. The structure of patients registered in the dispensary:

B) quality indicators of clinical examination

1. Timeliness of dispensary observation coverage of newly diagnosed patients:

2. Activity of making visits to the doctor:

3. Percentage of hospitalized dispensary patients:

Similarly, the activity of performing other medical diagnostic and health-improving measures among those undergoing medical examinations (diet nutrition, sanatorium treatment, anti-relapse treatment, etc.) is calculated.

C) indicators of the effectiveness of clinical examination

1. Changes in the state of health of those undergoing medical examination (with improvement, with deterioration, without changes)

2. The proportion of patients who had an exacerbation of the disease, for which dispensary observation is carried out.

3. Morbidity with temporary disability of medical examinations (in cases and days):

4. Primary disability among those under medical examination:

5. Mortality of medical examination patients.

The general practitioner is one of the key figures in modern clinical medicine. This is a generalist with a rich medical outlook and deep encyclopedic knowledge, possessing a number of special knowledge and skills that help him competently carry out primary diagnostics, prescribe preventive measures, analyze the results of additional studies and prescribe the correct, effective treatment.

The need to consult a therapist

In the life of almost every person, sooner or later, health problems arise, entailing the need for qualified advice or even medical care. If there are ailments complicated by pain in the abdominal cavity or chest, fever, insomnia, aching joints, weakness or other uncomfortable conditions, and it is difficult to determine the nature of these phenomena, you should go to see a therapist. In this situation, it is the therapist's consultation that is the right choice, since his duties include conducting primary diagnostic measures, prescribing extended diagnostics if necessary, analyzing the results obtained and deciding on further actions. Timely consultation with a therapist will identify the causes of ailments and prevent the transition of the disease into a protracted chronic or complicated phase.

At the appointment, the therapist performs an initial examination and collects an anamnesis, that is, finds out the details of the patient's lifestyle, the individual characteristics of his body, hereditary predispositions, clarifies the details of the onset and course of the disease. Based on the information received during the initial consultation, the therapist makes a preliminary assessment of the patient's state of health and prescribes an appropriate examination, if necessary, sends him for a consultation with specialized specialists. As an additional examination, the therapist may prescribe the following procedures: clinical and biochemical blood tests; radiography of bones, joints and organs of the chest, ultrasound of the abdominal cavity, FGDS, ECG and some other diagnostic measures. Based on the results of the analyzes, the data obtained from examinations and the conclusions of specialized specialists, the therapist makes a diagnosis and prescribes a course of medication and physiotherapy, or refers the patient for treatment to a specialized specialist.

Subsequent consultations of the therapist are carried out as necessary in order to control the course of treatment and subsequent rehabilitation.

Local therapist

A special category of doctors are district therapists. These are the “number one” doctors, the specialists who are the first to encounter the manifestation of ill health in most people in our country. From this point of view, such a therapist is the most important, key link in the healthcare system.

The circle of their patients for a long time includes approximately the same people. To some extent, district therapists are family doctors, because they know the medical history of most patients permanently residing in their areas. As a rule, the district doctor is familiar with the living conditions of patients, their lifestyle, hereditary predispositions and other factors that can complicate the patient's condition, and therefore, faster than an ordinary general practitioner, can assume the causes of the disease and take measures to eliminate them.

The district therapist keeps a systematic record and observation of patients with chronic diseases (dispensary records), controls the timeliness of the passage of preventive measures, and facilitates the referral of those who need it to sanatorium-and-spa treatment.

The competence of the local therapist includes the initial diagnosis of the disease, the appointment and implementation of therapeutic and preventive measures necessary for the treatment of seasonal infectious diseases of mild and moderate severity, as well as some other diseases, the treatment of which is carried out at home and does not require hospitalization. After the patient's recovery, the local therapist assesses the degree of his ability to work and issues a sick leave - a document certifying the fact of the disease and provided at the patient's place of work.

Responsibilities of the local therapist

The responsibilities of the local physician include:

• be well prepared to perform the basic functions of a local therapist: organizational, diagnostic, advisory, preventive, therapeutic and rehabilitation;
• competently combine thorough theoretical training with practical therapeutic skills, continuously engage in self-education, improving and increasing their professional competence;
• navigate in modern sources of scientific and technical information and use the knowledge gained in practice;
• as necessary, prescribe additional special research methods: laboratory tests, fluoroscopy, functional studies;
• if necessary, refer the patient for consultations to specialized specialists;
• determine the degree of disability of the patient or send him to the examination of temporary disability;
• organize rehabilitation activities for needy patients;
• identify infectious diseases at an early stage, notify the SES about the infection and take the necessary anti-epidemic measures;

Besides,

• the therapist must establish indications for hospitalization of the patient and take organizational measures for its implementation;
• according to the established procedure, the district doctor must organize and carry out preventive vaccination and deworming of residents in the area entrusted to him;
• must organize and implement a set of measures for the medical examination of adults living in his area, i.e. conduct preventive examinations, determine the need for therapeutic and preventive measures, draw up and maintain medical documentation, timely make reports on the work done;
• the general practitioner working at the site must be able to make a preliminary diagnosis and provide all possible first aid in case of emergency conditions of patients specified in the job description;
• at the initial appointment, the therapist should be able to correctly prescribe a set of necessary therapeutic and preventive measures;
• the local therapist must have strong skills to carry out a number of manipulation procedures specified in the job description.

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Comments on the material (30):

1 2

Quoting Adeline:

Hello. For 2 months I suffered from chest pains. Once I got to the therapist, they prescribed NSAIDs. No diagnosis. The second time I almost got to a neurologist, but the doctor quit, and I had to go again for a coupon. I went to the paramedic this time. She doesn't give directions. As a result, I spent 5,000 to be examined by a neurologist in another city, they did an MRI and said that I had the initial stage of osteochondrosis and hernia. And that the therapist should have examined me. Tell me, is it legal that my therapist did not refer me for examinations (after all, due to ignorance of my illness, I could live to see complications when an operation would be required) and did not give a referral to the appropriate doctor?

Nadezhda doctor / 01 Sep 2018, 00:06

Quoting Lisa:

Hello. Was at the therapist because of frequent and prolonged dizziness, shaking hands, sweating, weakness, frequent urge to empty the bowels. She felt my thyroid gland and said that I had VSD. In a few days, I will give some tests by number (venous blood, urine and ECG), but they did not refer me to a neurologist or an endocrinologist. Now I am tormented by a lump in my throat and its tightness. I will go to the doctor only after passing the tests (I will go through all of them only on the 4th). So far, she has prescribed only glycine and pills for the heart. What should I do about the lump in my throat? Go back to the therapist?

Quoting Larissa:

Hello! I have oncology, I have completed 8 courses of chemistry, mastectomy, and a radiation course is ahead. Before irradiation, again tests, the conclusion of a gynecologist and a therapist. Under the therapist's office, it became bad, severe headaches and shaking of the whole body is a side effect of tamoxifen and after paclitaxel. And here at the therapist's door, it would seem that the therapist should take action, at least measure the pressure. No!!! She told me - "Let's calm down already, I don't need your tantrums here, your hemoglobin is normal, you are healthier than me..." and she remained alive, but what a sediment ... In the evening, only when she left, I read the conclusion of the "specialist" - "Healthy in therapy" and before that, my oncological diagnosis. I have been in shock for the third day, I don’t like to complain about walking, all the more you can’t be nervous, I’ll make it worse for myself. But is this doctor number 1? And given that I have hypertension of the 2nd degree, is this the conclusion of a general practitioner?

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The main goal of professional medical activity is to save a person's life and improve its quality by providing immediate medical care.

It is the duty of the doctor to constantly maintain his professional skills at the highest level. When making professional decisions, he must first of all think about the good for patients, and not about his own material interest.

What are the duties of a physician?

Regardless of what specialization the doctor belongs to, he must put respect and compassion for the human dignity of the patient at the head of everything, while being responsible for all aspects of medical care. This specialty obliges him to be honest and open with patients and colleagues. He has no right to cover for his colleagues if they cheat on their patients.

The general responsibilities of doctors in relation to the patient include:

• Using all your professional potential in order to save the life and health of the patient. In cases where the treatment and conduct of the necessary examination exceeds the level of the doctor's capabilities and knowledge, his task becomes to redirect the patient to his more competent colleagues.
• In the event of the death of a patient, the doctor is not released from the obligation to maintain medical secrecy.
• The provision of emergency medical care is one of the main conditions of professional activity.

It is the duty of a doctor to be constantly ready to provide medical care to any person, regardless of age, gender, social status, nationality and race, political and religious beliefs of the patient, as well as other non-medical factors.

A real doctor should strive by all legal means available to promote the protection of health, life of the population, to carry out educational activities related to issues of medicine, ecology, hygiene and culture of communication.

The main condition for medical activity is the presence of professional competence. The doctor must constantly improve his knowledge, because he is responsible for the quality of the medical care provided.

As you know, a doctor has the right to make independent medical decisions, on which a person’s life sometimes depends. Only the presence of professional competence, along with a clear moral position, which implies the highest demands on oneself, gives the doctor the right to do so.

The duties of a doctor imply the inadmissibility of causing both intentional and accidental harm to a patient, as well as inflicting material, physical or moral damage to him.

People of this specialty must be able to clearly compare the potential benefits and possible complications of the intervention, especially in cases where treatment and examination are associated with pain, coercion, and painful factors for the patient.

What is a physician entitled to?

The code of ethics of Russian doctors is guided by the Hippocratic Oath, the principle of mercy and humanism, as well as the documentation of the World Medical Association of ethics and the legislation of the Russian Federation. It also enshrined the rights and obligations of the doctor, as a person who plays the most important role in the health care system as a whole.

It is documented that the doctor has every right to refuse to work with the patient, transferring him to another specialist in the following cases:

• If he feels himself insufficiently competent in a particular case, and also does not have the technical capabilities that are necessary to provide medical care in the proper form.
• If this particular type of medical care in any way contradicts its moral principles.
• If he fails to establish contact with the patient for therapeutic cooperation.

In no case is it permissible for a doctor to abuse his position and knowledge.

The doctor does not have the right to:

• Using their knowledge and capabilities for inhumane purposes.
• Application of medical measures or denial of them without sufficient grounds.
• The use of methods of medical influence on the patient with inhumane goals: his punishment, in the interests of a third party, etc.
• Imposing on the patient their philosophical, religious and political views.
• The doctor's personal prejudices or other non-professional motives should not affect treatment and diagnosis in any way.

Chief physician, what does he do?

This profession involves first and foremost a huge responsibility. The duty of the head physician of a medical institution is to possess not only a high level of qualification, but also the ability to quickly, clearly make the right decisions, regardless of the scale of the issue.

Of course, he must have good medical experience, but in addition, he needs to understand the legal, economic, accounting structures. The head physician completely manages the entire hospital, he is subordinate to: the main head of the structural divisions, the planning and economic service, the managers of the economy, etc.

Instruction: general provisions for the activities of the chief physician

The founder or the head of the health department (in the case of budgetary medicine) has the right to appoint to the position, as well as to dismiss it.

The duties of the chief physician include monitoring the order in all areas of the hospital's activities: epidemiology, sports recreation, culture, medical work, and more.

A person who has:

• higher medical education;
• a certificate that confirms the fact of studying knowledge in the areas of management and organization of health care;
• certificate of residency, internship;
• At least 5 years of experience as a manager.

When a manager has a need to temporarily leave his workplace (vacation, training, etc.), he is obliged to appoint one of the managers to perform his duties for this time.

The standard job description states that the head physician must have:

• all information that is set out in orders, resolutions, regulatory documents related to the work of the institution;
• knowledge that is necessary for the competent management and organization of the hospital;
• the latest information on promising social, economic and technical directions for the development of a medical institution;
• methods of effective hospital management;
• rules that should be followed in the execution and conclusion of contracts for medical, economic, economic and other purposes;
• knowledge that regulates the service life and repair of medical equipment;
• staffing information;
• the procedure for conducting and executing measures of a sanitary and hygienic nature;
• information about the job responsibilities of employees who are subordinate to him;
• a regulatory framework that describes the procedure for the preparation of medical documentation;
• the main main principles for the provision of medical care, etc.

Instruction: general provisions of the activity of a general practitioner

In medicine, the profession of a therapist is quite in demand. He deals with the primary reception of patients and, accordingly, prescribes treatment. It is also the responsibility of the general practitioner to refer the patient, if necessary, to a narrower specialist. A person visits this doctor in cases where he does not know who exactly he should turn to with his problem. A general practitioner (district) may be a person with a higher professional medical education, and he must also have documents that confirm the assignment of the title of doctor of the relevant specialty. Appointment and removal from office occurs by order of the head physician of the medical institution.

What should he know?

1. Concepts of legislation on health care, as well as documentation that determines the activities of institutions and bodies and health care.
2. General issues related to the organizational measures of therapeutic care, the work of institutions of medical and preventive orientation, the organization of the work of emergency ambulance to the population.
3. Organizational moments in the work of the polyclinic, day hospital.
4. Issues related to normal as well as pathological anatomy, physiology, the processes of interconnection of the functional systems of the body.
5. Fundamentals of water-electrolyte metabolism, acid-base balance of the body, as well as all possible types of disorders and principles of treatment of pathologies in this area.
6. The work of the hemostasis and hematopoiesis system, physiology, pathophysiology of the blood coagulation system, norms of homeostasis indicators.
7. Basic concepts of immunology and reactivity of the human body.
8. Pathogenesis and clinical symptoms of therapeutic diseases, measures for their prevention, their treatment and diagnosis. In addition, the doctor must recognize clinical symptoms in borderline conditions, diseases in a therapeutic clinic.
9. Pharmacotherapy of internal diseases, pharmacokinetics and pharmacodynamics of drugs, as well as possible complications from drugs and methods for their correction.
10. Activities for non-drug therapy: physiotherapy, exercise therapy and medical supervision.
11. The main points regarding rational nutrition, the principles of diet therapy.
12. character.
13. for both sick and healthy people.
14. Methods and forms of work of a sanitary and educational nature.
15. Social and demographic characteristics of your site.
16. Ways to interact with medical specialists, institutions, various services, insurance companies, associations of doctors, etc.
17. The internal labor schedule of the medical institution.
18. Norms and rules of safety, labor protection, fire protection, industrial sanitation.

Responsibilities of the district doctor

First of all, he must be trained to conduct professional independent activities. The duties of the polyclinic doctors include the following functions: advisory, organizational, therapeutic, diagnostic and preventive. His task is to be able to combine practical skills with deep theoretical training in his activities.

A doctor in this specialty must be responsible for his work, be demanding of himself and his subordinates, and continuously improve his professional competence. In his work, he needs to use medical diagnostic and electronic computing equipment, to navigate in modern scientific and technical processes.

The doctor includes:

1. The use of objective methods in the examination of the patient, the identification of general and specific signs of the disease.
2. Assessment of the severity of the patient's condition, taking measures that are necessary to remove him from this condition. He must determine the sequence and scope of resuscitation measures, provide urgent necessary assistance.
3. Determine the need for specialized research methods (X-ray, laboratory and functional).
4. Determine the indications and identify the need for hospitalization, as well as organize it.
5. Carrying out differential diagnosis, substantiation of clinical diagnosis, development of a plan and tactics for patient management.
6. Prescribing the necessary medicines and other therapeutic measures.
7. Assistance in organizing the necessary consultations of the patient by narrower specialists.
8. Definition of disability of the patient.
9. Implementation of measures for the rehabilitation of the patient.
10. Work with early detected infectious diseases, their diagnosis, taking the necessary anti-epidemic measures.
11. To organize preventive vaccinations for the population of the site.
12. Organization and implementation of a complex of events in the population of the site.
13. Carrying out preventive examinations.
14. Carrying out sanitary and educational work of the population of the site, the implementation of measures to combat bad habits.
15. Registration of medical documentation provided for by the legislation on health care, as well as timely preparation of a report on the work done.

The duties of a general practitioner also include establishing a diagnosis and providing emergency care for the following conditions:

• with bronchial asthma, asthmatic status;
• hypoxic coma, acute respiratory failure, pulmonary embolism;
• pneumothorax;
• acute cardiovascular insufficiency, syncope, cardiac asthma, pulmonary edema;
• shock (toxic, traumatic, hemorrhagic, anaphylactic, cardiogenic);
• hypertensive crisis and acute cerebrovascular accident;
• violation of the heart rhythm;
• acute allergic conditions;
• acute renal failure, renal colic;
• liver failure;
• coma (diabetic, hypoglycemic, hepatic, hyperosmolar);
• burns, frostbite, electric shock, heat and sunstroke, lightning, drowning. sudden death;
• cardiac conduction disorders and Morgagni-Adems-Stokes syndrome.

The duties of a doctor include the ability to establish a diagnosis, as well as the necessary therapeutic and preventive measures for various diseases of the cardiovascular system, respiratory system, digestion, urinary system, hematopoietic system, endocrine system, rheumatic disease, infectious diseases, occupational diseases, acute surgical diseases. .

Instructions: general provisions and duties of a dentist

This profession covers a fairly wide range of activities: prevention, treatment, various surgical interventions, bite correction, prosthetics and much more. Modern dentistry is a high-tech science that continuously improves various methods for the prevention and treatment of oral diseases. The duties of a dentist include:

• examination of patients to identify the diagnosis;
• primary, repeated inspections;
• if necessary, directing a person to laboratory, instrumental studies;
• referral of patients to other physicians for consultation;
• conducting a survey on the subject of health in general;
• identification of the patient's facial, dentoalveolar deformities, anomalies, as well as the prerequisites for their development;
• assessment of risk factors for oncological pathology.

Instructions: general provisions of the veterinarian

The main goal of his professional activity is to protect the health and life of animals. It is the duty of the veterinarian to prevent by all legal means any form of cruelty to animals, and to:

• Carrying out veterinary measures to prevent diseases in animals.
• Compliance with the implementation of veterinary and zoohygienic rules for keeping, feeding, caring for animals.
• Examining animals and diagnosing their injuries and diseases.
• Study of the possible causes of the occurrence, the process of the course of animal diseases and the development of methods for their treatment and prevention.

The duties of a doctor also include surgical and therapeutic treatment of animals, conducting a veterinary and sanitary examination of poultry and livestock. Its task is to provide advice on issues related to the treatment, feeding and maintenance of animals, as well as to monitor the mandatory treatment and preventive measures.

Conclusion

The doctor, taking advantage of his position, has no right to conclude property transactions with the patient, use his labor for personal purposes, have sexual intercourse with him, engage in bribery and extortion, taking advantage of the patient's insolvency.

The rights and obligations of the doctor suggest that he must be free and have professional independence.