22.04.2019

Do you need a general practitioner? How does a general practitioner differ from a family doctor?

IN Lately V sick leaves 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 doctor called doctor general practice 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 on an outpatient basis. 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 practical work performed, because he has the right to carry out a whole range of manipulations.

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 in 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 studying at a medical university, 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, while children are supervised by a pediatrician, while the observation system and call system are similar to those used by a local physician. 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 that provides specialized care.

As an example, consider the option when a patient suffers from 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 to get a consultation. General practitioners often use this opportunity.

Of course, the regulatory documents specify the level of competence of a family doctor. 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.

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 connection with this, existing therapeutic departments in city clinics will be renamed into general medical practice departments. 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). In 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, and 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 Dreyling: everything you need for work is at hand

...Marina Dreyling, a general practitioner at the 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

Not long ago it became known that a training program for family doctors will be launched in Moscow in 2015. Within the framework of this program, it is planned to train 2.3 thousand doctors - mainly from among local therapists. How does a traditional primary care physician differ from a family doctor? Let's understand this difficult medical issue.

The head of Moscow healthcare, Leonid Pechatnikov, quite correctly defined this difference as follows: “a family doctor is a competent therapist who has the skills of a number of specialized specialists.” The latter primarily means ENT, ophthalmologist, and gynecologist.

Although, of course, a general practitioner needs to know the basics of surgery, neurology, and many other specialties, not to mention “narrow therapeutic” ones - cardiology, pulmonology, gastroenterology, nephrology, and so on.

There has already been a discussion around this initiative. Supporters of the innovation believe that the innovation will improve the quality of treatment.

Regarding this opinion, we can say quite confidently that it is absolutely unfounded. "General practitioner" is in the plan medical science return somewhere like the beginning of the 19th century in best case scenario. Because by the middle of this century, even therapy began to rapidly divide into subsections, specializing in which scientists moved science forward much faster than before.

Another thing is that within the framework of a “market economy,” say, a small town - no matter where it was located - whether in Europe or Russia - could not support an entire clinic of specialized specialists. Therefore, local doctors had to be jacks of all trades.

In Russia, a real revolution in this area came only after the revolution, when the People's Commissar of Health of the USSR Semashko organized what is still unique even for most developed Western countries system of public outpatient care. When any patient could turn directly to eye doctor, gynecologist, surgeon and so on.

Although even now in the “blessed West” only his “family doctor” is available to the patient. And this doctor decides whether to treat the patient himself (which happens in 95 percent of cases) or send him to a “specialized” specialist.

Moreover, you have to wait a very long time to receive the latter. In Israel, for example, waiting lists to see a neurologist reach 100 days. And in England, a third of cancer patients die only because they have to wait up to 8 months for consultation with a qualified oncologist and surgery - by the end of which the tumor reaches the stage where intervention can only slightly delay the fatal outcome.

The training of doctors itself implies that they study the first three courses of theoretical disciplines at medical institutes, then begin studying clinical subjects. The same surgery, therapy, eye diseases, etc. Note that training in “narrow” specialties goes from the 4th to the 6th year.

But even after this, the young specialist who had received his diploma was still not allowed to see patients! At least until this year - when graduates were allowed to immediately work in hospitals in “broad” specialties - therapy, pediatrics. And ENT doctors, ophthalmologists, surgeons, both before and now, are still required to undergo at least two years of postgraduate training.

Meanwhile, a “general practitioner,” according to the plan of health care organizers, will have to have knowledge not even in one, but in several “narrow” specialties after just six months of specialization courses. It is clear that such knowledge will be very superficial, and such a “specialist” himself will be comparable in skill level to an ordinary paramedic. In any case, precisely in “narrow specializations” - knowledge of therapy, of course, no one can take away from such a doctor.

Of course, he will be able to do a considerable part of the work of his fellow specialists. But by no means as qualified as they are. After all, a “general practitioner” will still have less experience than a “specialty” doctor.

For example, if for many years you treat only vision, then you begin to recognize many diseases “with eyes closed"And if an ex-therapist, promoted to a “family doctor,” sees one conjunctivitis well, if in a day, and not once a month, it’s no wonder someday uveitis or iridocyclitis will be missed under his “mask”, without immediately starting serious treatment fraught with loss of vision.

In general, in modern world There are no longer “just engineers” or even “just teachers.” With the exception of teachers primary classes- already from the 4th grade, children are taught by “subject specialists” specializing in physics, chemistry, biology, etc. Although, it would seem, these are only schoolchildren, not students.

The only place where the Institute of Family Doctors can help is in situations where access to “narrow” specialists is difficult. Either in rural areas, due to the ever-present shortage of personnel, or because of the same shortage - but in urban clinics. Then, as they say, “without fish there is cancer,” it is better to get a prescription for glasses or wash out the “plug” in your ear from a “general practitioner” than to wait several days for an appointment with an ophthalmologist or ENT specialist. Or even go to see them at another clinic.

Zhanna Valentinovna Dorosh, Candidate of Medical Sciences, Associate Professor of the Department of Therapy and Family Medicine of the Russian National Research Medical University named after. N.I. Pirogova, chief physician 2 clinical departments of the Medicine clinic.

What does a family doctor do? How is he different from a therapist?

A family doctor or general practitioner provides outpatient medical care. This is a polyclinic, the primary link that a person who applies for medical care. The main difference between a family doctor and a therapist is the amount of what he can do with his hands. Manipulation is within his competence.

If the therapist has two weapons - a phonendoscope and a tonometer, then the general practitioner has otoscopy, rhinoscopy, and laryngoscopy. That is, he can look at the ear, throat, nose, and can look at the fundus of the eye. He carries out some diagnostic minimum for narrow specialists. He can register and decipher an electrocardiogram, maybe, if we are talking about the outback, and not major cities, do primary processing wounds, apply plaster.

What education should a family doctor receive?

For a family doctor there is a basic education - medical school or a university where everyone who graduates receives a diploma, no matter whether it is a general practitioner or a pediatrician. After this there must be either a residency in internal medicine or therapy, or pediatrics, or internship, if the education was received some time ago. Then the doctor can undergo initial retraining in the specialty “General Medical Practice (Family Medicine).” Another option is to go immediately after completing basic education at the institute to a residency in this specialty.

How many family doctors are there in Russia?

If we talk about how many family doctors there are in Russia now, this figure will be close to the number of general practitioners. There is a retraining program under which therapists who provide primary outpatient care in Moscow and surrounding regions are now being retrained and transferred to the positions of general practitioners and family doctors, depending on where they will work. This figure is constantly changing, the number of such specialists is growing.

How does a family doctor work?

The area assigned to the general practitioner is somewhat smaller than the area of ​​the therapist. Depending on where the family doctor works, this is no more than 1800 attached. If we are talking about Moscow, then here the doctor does not see children, they remain under the supervision of pediatricians, so only adults are assigned to the general practitioner. The observation system remains the same as that of a local therapist. If the doctor is on vacation, then his place is taken by a part-time doctor who, during the vacation of your immediate supervisor, is responsible for what happens in his area.

The duration of leave for a family doctor is the same as for a general practitioner. The system for calling a family doctor to your home is also no different from the system for a local therapist. Home visits are carried out by the doctor on duty, not a therapist or general practitioner, who works on site and, if there is no operational need for this, he may not attend the call. If there is a need to visit a patient at home, then he can go on call during non-working hours after the end of the appointment.

What to do if your family doctor cannot make a diagnosis or you need to consult a specialist doctor?

This is a matter of competence of the general practitioner. You should always understand that the higher the level of professionalism of a family doctor, the less he will need consultations from other specialists. And only if highly professional questions arise, the patient will be referred to medical institution which provides specialized assistance.

For example, if a patient arterial hypertension or hypertonic disease, then these nosological units can be treated by both cardiologists and general practitioners. There are practically no indications for a patient to be referred to a cardiologist with such a diagnosis. Good Family doctor can carry out this level of examination and manipulation.

If the patient has, then at some stage when he needs surgical intervention, of course, the general practitioner will send the patient to see a specialist. If the family doctor feels that he cannot cope with the clinical situation, then the treatment he provides is ineffective, he can ask for help from a specialist and send the patient for consultation. This right remains, and general practitioners exercise it.

If a family doctor looks at the fundus of the eye and sees pathology there, he is obliged to send the patient to a specialist. If a doctor sees a pathology during otoscopy, he is obliged to assess how critical it is for the patient. He will leave some patients under his supervision in accordance with his competence, and send some to a specialist.

The level of competence of a general practitioner is prescribed by regulatory documents. These documents are in a state of constant development and are being discussed. They are directly related to what a doctor can do with his hands and see with his eyes.

This doctor is also called a family doctor. Essentially, this is the same local therapist, but with a wider range of knowledge and capabilities.

He diagnoses and treats patients with surgical and neurological problems regardless of their gender and age.

(see also Family doctor)

What is the responsibility of a General Practitioner?

The qualifications of a general practitioner give him the right to advise all family members in any field of medicine, involving specialists for consultations and coordination of treatment only in exceptional cases.

During the initial appointment, the doctor carefully studies the patient’s medical history and conducts a thorough diagnosis. After this, he works to reduce or eliminate the risk of developing pathologies to which the patient is prone.

What diseases does a General Practitioner treat?

Oncological pathology, atherosclerosis, metabolic syndrome, obliterating diseases vessels lower limbs, overweight.

When to contact a General Practitioner

The first symptoms are discomfort, a feeling of fatigue, inconvenience, a feeling that there is a tugging or pressure in some place. The cause of frequent and seemingly causeless headaches may be blocks in cervical vertebrae, which are closely associated with vascular spasms, causing disturbance outflow of blood from the head. All this leads to headaches, dizziness, and “spots” flashing before the eyes. And we are used to chalking it all up to age, fatigue, and lack of sleep. The reasons for weakening attention, absent-mindedness, forgetfulness - eighty percent are the result of problems in our cervical spine.

Below are 5 symptoms that should not be ignored.

1. You have unexpectedly lost weight. Your diet hasn't changed, but you've lost a lot of weight. Any woman can only dream about this. However, if you notice such changes, then do not rush to rejoice - they may be a harbinger of some forms of stomach cancer (or ovarian cancer in women).

2. Slurred speech, paralysis, weakness, ringing in the ears and stiffness of the limbs are all signs of an impending stroke. If you provide it on time necessary treatment, then a stroke can be avoided and, as a result, serious brain damage can be prevented.

3. Black chair. This symptom is one of the most serious. It can serve as a signal of such dangerous diseases, such as ulcers or cancer of the stomach or intestines. The stool becomes black as a result internal bleeding, which in itself can be very dangerous. The faster you can identify its cause and stop it, the greater your chances of extending your life.

4. Severe headache extending to the neck, as well as heat. These symptoms may be caused by: serious illness like meningitis. If you have a very high fever and strong pain prevents you from reaching your chin to your chest, you should consult a doctor immediately. You may have bacterial meningitis which is treated with special antibiotics.

5. Sharp, painful headache. If you've never experienced before headache such strength, then, without hesitation, consult a doctor. Such pain can serve as a signal of a cerebral hemorrhage. Although aneurysm is quite rare, its possibility cannot be ruled out.

When and what tests should be done

- General blood analysis;
- General urine analysis;
- Analysis of stool for worm eggs;
- Blood testing for HIV and Wasserman reaction;
- Analysis of ejaculate;
- Hormonal studies;
- Blood tests (Screening TORCH - infections, serological test blood, aAntibodies to hepatitis C virus (anti-HCV), general analysis blood with ESR, hematological blood test, blood group, Rh factor, antibodies to Rh factor, biochemical research blood, tumor markers, coagulological blood test);
- Collection of material for research from the urogenital tract;
- Culture for microflora and sensitivity to antibiotics;
- Candida culture and sensitivity to antifungal drugs;
- Culture for U Urealyticum and M hominis with determination of titer and sensitivity to antibiotics;
- Biopsy from the cervix with histological examination;
- Aspiration of the endometrium with histological examination;
- Bacterioscopy of discharge from the female genital organs;
- Cytological examination of the contents of an ovarian cyst (ovarian punctate).

What are the main types of diagnostics usually carried out by a general practitioner?

ECG, ultrasound, EEG, EchoEG, EchoCG, X-ray, colposcopy, fluorography, organ radiography chest, MRI, CT, mammography. It is important to take care not only of your cardiovascular health, but also of the health of future generations.

1. Plan an active holiday

Set aside one day on the weekend for active recreation with the whole family: in the summer - swimming, in the winter - sledding or walking, in the spring and autumn - cycling. The day will pass without any discomfort if you take a light breakfast with you and pamper yourself a little healthy food after a good workout.

2. Exercise together

Find sport Club in your area, where yoga and aerobics classes are held with children. If your child is too young for such activities, find activities that will help you and your child burn calories, such as having your child do yoga with you or go on long walks. If you don’t have kids yet, then find where they offer yoga classes with a partner or even “dog yoga”, yes - this is yoga for you and your dog.

3. Remodel the family room in your apartment

Very often, common rooms are the “laziness center” of the house: a comfy sofa, a games console, a shelf with DVDs and nothing encouraging to exercise or exercise. physical activity. There are ways to add subtle reminders to your room without remodeling the entire room or taking up space with exercise equipment. Set a weekly limit on TV viewing and limit “inactivity” time to get your whole family moving.

4. Make chores fun

Instead of dividing up chores among family members, turn them into games for everyone to play. Compete to see who can clean the house faster, and next time try to improve your result. While doing laundry, play music to encourage children to sing and dance as they help fold and put away clothes. In your spare time, run a little, rollerblade or jump rope.

5. Review your diet

This advice isn't just about physical activity, but it's still worth mentioning: families who eat healthy foods tend to engage in healthy habits, such as physical activity.

If you want to lose weight after giving birth or just want to eat well, get the whole family involved and you'll be more likely to succeed. Take the kids to a farmer's market, let them choose their own fruits and vegetables, and get the kids involved in the cooking process. They will enjoy “their” food more and wash the dishes.

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