#211
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Ãîñïîäà, äàâàéòå ñïîðèòü ïî ñóùåñòâó âîïðîñà. Îñòàâèì ýìîöèè è ïñèõîëîãè÷åñêèå äðàìàòèçàöèè.
1. Êàêîé ïðîöåíò ïàöèåíòîâ â âàøåé ïðàêòèêå ïîëó÷àåò àäåêâàòíîå ëå÷åíèå ïðè ìåòàáîëè÷åñêîì ñèíäðîìå è ñ÷èòàåòå ëè âû ýòî âàæíûì ïîêàçàòåëåì ôóíêöèîíèðîâàíèÿ ïåðâè÷íîãî çâåíà? 2. Íà ÷òî ïîòðàòèòü ìèëëèîí äîëëàðîâ? à. Íîâûé ßÌÐ òîìîãðàô äëÿ ÌÌÀ á. Îñíàùåíèå ïðèáîðàìè áûñòðîãî îïðåäåëåíèÿ INR äëÿ ïîëèêëèíèê â. Çàðïëàòû ñåñòðàì, ÷òîáû îíè ïåðåâîðà÷èâàëè è èçðåäêà ìûëè áîëüíûõ ã. Çàðïëàòû âðà÷àì, ÷òîáû îíè íå äóìàëè ñ êîãî ìîæíî, à ñ êîãî íåëüçÿ áðàòü ìçäó, è èìåëè äåíüãè íà ïîñåùåíèå ìåæäóíàðîäíûõ êîíôåðåíöèé 3. Äîëæåí ëè ðÿäîâîé âðà÷ ðàçáèðàòüñÿ â êëèíè÷åñêîé ýïèäåìèîëîãèè 4. Äîëæíû ëè ñðåäñòâà â çäðàâîîõðàíåíèè ðàñïðåäåëàòüñÿ òàê, ÷òîáû ïîëó÷èòü íàèáîëüøóþ îòäà÷ó â âèäå ñíèæåíèÿ ñìåðòíîñòè çàáîëåâàåìîñòè è ïîâûøåíèÿ êà÷åñòâà æèçíè, èëè äîïóñòèìî ñîçäàíèå "ïîòåìêèíñêèõ äåðåâåíü" 5. ×òî ëó÷øå? à. 10 Ãîñïèòàëåé ñ 200 âðà÷åé, ïîëó÷àþùèõ ïî 200 äîëëàðîâ á. Îäèí ãîñïèòàëü ñ 100 âðà÷àìè ïîëó÷àþùèìè ïî 5000 äîëëàðîâ |
#212
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Äóìàþ, âñåì î÷åâèäíî, ÷òî ëó÷øå áûòü áîãàòûì è çäîðîâûì, ÷åì áåäíûì è áîëüíûì. Ïîýòîìó, äàâàéòå ïîãîâîðèì íåìíîãî î ôèíàíñàõ.
Ê ñîæàëåíèþ, áåñïëàòíîãî çäðàâîîõðàíåíèÿ íå áûâàåò. Ïðè çíà÷èòåëüíîì óïðîùåíèè ôèíàíñîâàÿ îñíîâà ìåäèöèíñêîé äåÿòåëüíîñòè ïðåäñòàâëÿåòñÿ ìíå ñëåäóþùèì îáðàçîì. ×åëîâåê Õ, çàðàáàòûâàþùèé 100000 äîëëàðîâ â ãîä, èç-çà áîëåçíè òåðÿåò, ñêàæåì, 20% ñâîåãî çàðàáîòêà (20000 äîëëàðîâ). ×åëîâåê Ó, çàðàáàòûâàþùèé 1000 äîëëàðîâ â ãîä, èç-çà òîé æå áîëåçíè òåðÿåò, òå æå 20% ñâîåãî çàðàáîòêà (200 äîëëàðîâ). Åñëè âðà÷ ñîêðàùàåò ïåðèîä íåòðóäîñïîñîáíîñòè ïàöèåíòîâ âäâîå, òî âïîëíå ðàçóìíîé îïëàòîé åãî òðóäà áóäóò 10000 äîëëàðîâ â ïåðâîì ñëó÷àå è 100 äîëëàðîâ - âî âòîðîì. Ïðåäïîëîæèì, ÷òî çàòðàòû âðà÷à (ò.å. ëåêàðñòâà, îáîðóäîâàíèå è ïð.) ïðè ýòîì ñîñòàâëÿþò 2000 äîëëàðîâ. Ëå÷åíèå ïåðâîãî ïàöèåíòà ò.î. ïðèíîñèò ïðèáûëü, ïîçâîëÿÿ æèòü âðà÷ó è ðàçâèâàòü ñâîå äåëî. Ëå÷åíèå âòîðîãî ïàöèåíòà ÿâëÿåòñÿ óáûòî÷íûì è ïðèâåäåò ê ðàçâàëó âðà÷åáíîé ïðàêòèêè. ×òî äåëàòü? Òóò ñóùåñòâóþò ïðèíöèïèàëüíî äâà âàðèàíòà: 1) Åñëè ïàöèåíò õî÷åò ëå÷èòüñÿ, ïóñòü èùåò äåíüãè - ññóäà áàíêà, ñåìüÿ è ò.ä. 2) Ìåäèöèíñêàÿ ñòðàõîâêà. Ïàöèåíòû Õ è Ó (âàðèàíò - ñ ó÷àñòèåì ðàáîòîäàòåëÿ èëè\è ãîñóäàðñòâà) åæåìåñÿ÷íî îò÷èñëÿþò îïðåäåëåííóþ ñóììó â ñðàõîâóþ êîìïàíèþ, êîòîðàÿ ïîëíîñòüþ èëè ÷àñòè÷íî, â çàâèñèìîñòè îò ïðèíÿòûõ â íåé ïðàâèë è óñëîâèé ñòðàõîâêè, îïëà÷èâàåò ñ÷åòà ïàöèåíòîâ, ïðîâåðÿÿ, êàê è ëþáàÿ ñòðàõîâàÿ êîìïàíèÿ, èõ îáîñíîâàííîñòü. Ïðè ýòîì âàæíî ñîáëþäåíèå ïðàâèëà êîíêóðåíöèè íà ðûíêå ìåäèöèíñêîãî ñòðàõîâàíèÿ, ÷òî ïðåäïîëàãàåò, ïî êðàéíåé ìåðå, íàëè÷èå íàñêîëüêèõ ñòðàõîâûõ êîìïàíèé. Ãîñóäàðñòâî â êà÷åñòâå ñòðàõîâîé êîìïàíèè íåýôôåêòèâíî. Âòîðîé âàðèàíò ïðåäñòàâëÿåòñÿ íàèáîëåå ïðèåìëèìûì â êà÷åñòâå áàçîâîãî, à ïåðâûé âàðèàíò - êàê èñêëþ÷åíèå èç îáùåãî ïðàâèëà ïî æåëàíèþ ïàöèåíòà. "Òðåòèé âàðèàíò" - ýòî ñîçäàííàÿ â ÑÑÑÐ ñèñòåìà çäðàâîîõðàíåíèÿ ñ ïðèíÿòîé â íåé ñèñòåìîé ôèíàíñèðîâàíèÿ è îïëàòû òðóäà. Îäíàêî, îíà ìîãëà ñóùåñòâîâàòü òîëüêî íà îñíîâå ïîëíîé èçîëÿöèè îò ìåæäóíàðîäíîãî ðûíêà ìåäèöèíñêèõ óñëóã è ìåæäóíàðîäíîãî ðûíêà â öåëîì. Ìíîãèå ðîññèéñêèå âðà÷è ïîëó÷àþò ñâîþ ìèçåðíóþ çàðïëàòó â òîì ÷èñëå è ïîòîìó, ÷òî ïîäîáíûå äîõîäû íå èíòåðåñóþò áîëåå êâàëèôèöèðîâàííûõ ñïåöèàëèñòîâ. Èçìåíåíèå ïëàòåæíîñïîñîáíîñòè ðîññèéñêèõ ïàöèåíòîâ íå îáÿçàòåëüíî ïðèâåäåò ê ðîñòó äîõîäîâ èõ òåïåðåøíèõ âðà÷åé, à , âîçìîæíî, ê ïîòåðå èìè ðàáî÷åãî ìåñòà. Î÷åâèäíî, ÷òî åñëè íà îáùåæèòèè ïîâåñèòü âûâåñêó "Áîëüíèöà", à íåïîäãîòîâëåííîìó ÷åëîâåêó âûäàòü "äèïëîì" âðà÷à èëè ìåäñåñòðû, òî îò ýòèõ ïðîñòûõ ìåðîïðèÿòèé â ñòðàíå íå ïðèáàâèòñÿ íè áîëüíèö , íè âðà÷åé, íè ìåäñåñòåð. Ïðèáàâèòüñÿ òîëüêî êîëè÷åñòâî îáìàíóòûõ â ñâîèõ íàäåæäàõ ëþäåé.  òî æå âðåìÿ óñïåøíûé îïûò èíòåãðàöèè ìíîãèõ ðîññèéñêèõ âðà÷åé (ïîñëå ïåðèîäà ïåðåïîäãîòîâêè) â ñàìûå ðàçâèòûå â ìèðå ñèñòåìû çäðàâîîõðàíåíèÿ ãîâîðèò î òîì, ÷òî âñå åùå ìîæíî è íóæíî èñïðàâèòü. Íî äëÿ ýòîãî, ïðåæäå âñåãî, íåîáõîäèìî ïðåêðàòèòü ñàìîîáìàí, ðåàëüíî îöåíèòü ïîëîæåíèå âåùåé è ïðåêðàòèòü ïðèäóìûâàòü âåëîñèïåäû. |
#213
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Da, so skriningom ja silno lopuhnulsa. Shutki ne ponial i razoshelsia. Nu, ladno sve-taki polezno inogda vspomnit zto eto takoe.
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#214
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îòâåòû "ãëàâíîãî âðà÷à"
Àëåêñàíäð,
Âàøè âîïðîñû îáðàùåíû ê ðàçíûì àóäèòîðèÿì. Ãëàâíûå âðà÷è íå ëå÷àò ìåòàáîëè÷åñêèé ñèíäðîì è ìîãóò äàæå íå çíàòü î ñóùåñòâîâàíèè òàêîé ïàòîëîãèè, à ïðàêòè÷åñêèå âðà÷è íå ðåøàþò, ÷òî çàêóïàòü è êàê ðåôîðìèðîâàòü çäðàâîîõðàíåíèå. ß ïðåäñòàâèë ñåáå íåêîåãî óñëîâíîãî "ãëàâíîãî âðà÷à" êàê íåêîå ñðåäíåå èç èçâåñòíûõ ìíå ðóêîâîäèòåëåé çäðàâîîõðàíåíèÿ è ïðèäóìàë çà íåãî îòâåòû: 1. Íå ñîâñåì ïîíèìàþ î êàêîì ñèíäðîìå èäåò ðå÷ü, íî â ìîåé áîëüíèöå (ïîëèêëèíèêå, èíñòèòóòå) âñå ïîëó÷àþò àáñîëþòíî àäåêâàòíîå ëå÷åíèå: äèáàçîë ñ ïàïàâåðèíîì è ìàãíåçèþ. 2. Êîíå÷íî, ßÌÐ. Êàêîé-íèêàêîé â îòêàò ÿ îò ýòîé ñäåëêè ïîëó÷ó, êðîìå òîãî ýòî ïîâûñèò ðåéòèíã ìîåé áîëüíèöû, äàñò âîçìîæíîòü îðãàíèçîâàòü ïëàòíûå óñëóãè è ò.ï. Êîëü ñêîðî âðà÷è è ìåäñåñòðû âñå îäíî ðàáîòàþò çà òàêóþ çàðïëàòó, êàêîé ñìûñë åå ïîâûøàòü? 3. Ýòî åãî ëè÷íîå äåëî, ëèøü áû ïîòîì íå ëåç êî ìíå ñ äóðàöêèìè ñîâåòàìè. 4. Íà÷àëüñòâî ìåíÿ öåíèò íå çà ñíèæåíèå çàáîëåâàåìîñòè è òåì áîëåå íå çà ïîâûøåíèå "êà÷åñòâà æèçíè", à çà óñïåøíóþ èìèòàöèþ ýòîé äåÿòåëüíîñòè. Ðåàëüíî äîñòè÷ü ýòèõ öåëåé âñå îäíî íå â ìîèõ ñèëàõ, à ïîñòðîèòü "ïîòåìêèíñêóþ äåðåâíþ" ñ ßÌÐ íà ôàñàäå - ÿ ïðîñòî îáÿçàí äëÿ ñîáñòâåííîãî âûæèâàíèÿ. 5. Åñëè â îäíîé áîëüíèöå áóäåò ñòîëüêî æå êîåê, êàê â 10 (ìû - çà óêðóïíåíèå õîçÿéñòâà!), à ÿ îñòàíóñü ãëàâíûì âðà÷îì - òî ÿ çà òàêîé ïîäõîä. Ïðî çàðïëàòó - íå ñìåøèòå ìåíÿ. Êòî-æ äîõòóðó òàêóþ çàïëàòó ïîëîæèò? Ìîæåò ÿ è îãëóïèë îòâåòû - äëÿ ÿñíîñòè.  æèçíè íèêòî èç ðóêîâîäèòåëåé íà âîïðîñû ïðÿìî íå îòâå÷àåò. Ñëåäóþùàÿ ôðàçà â èõ ðå÷è äîëæíî ïðîòèâîðå÷èòü ïðåäøåñòâóþùåé, ÷òî áû íèêòî èç âûøåñòîÿùåãî íà÷àëüñòâà íå îáèäåëñÿ. Ñïîñîá âûæèâàíèÿ áåëêîâûõ òåë. |
#215
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Êñòàòè,
íàñêîëüêî ìíå èçâåñòíî â Ðîññèè, äàæå â ñòîëèöàõ - Ìîñêâå è Ïèòåðå, íåò íè îäíîé áîëüíèöû ðàáîòàþùåé ñòðîãî ïî çàïàäíûì ñòàíäàðòàì ñ çàïàäíûì æå ìåíäæìåíòîì è îáó÷åííûìè íà çàïàäå âðà÷àìè. Êàê ñïðàâåäëèâî îòìåòèë Àëåêñàíäð, òàêóþ áîëüíèöó ìîæíî íàéòè Êàðà÷è èëè Áàíãêîêå, íî íå çäåñü... Èíâåñòîðû  Ðîññèè íå çíàþ êóäà äåâàòü äåíüãè (íåôòÿíûõ ñêâàæèí íà âñåõ íå õâàòàåò), íî çà òàêîé, êàçàëîñü áû, ëåæàùèé íà ïîâåðõíîñòè ïðîåêò íå áåðóòüñÿ. Ïî÷åìó? |
#216
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Êîëëåãè. Ñíà÷àëà íåìíîãî ïîôûðêàþ íàñ÷åò ñêðèíèíãà. Íàâåðíîå Alex_MD äàâíî íå áûë â Ðîññèè. Îí ìíå íàïîìíèë ïðîôåññîðà è Ðèìà, êîòîðûé â ïðîøëîì ãîäó ó÷èë íàñ, ÷òî îäíàêî íàäî îáñëåäîâàòü áåðåìåííûõ èç ãðóïï ðèñêà ïî ãåïàòèòó íà àíòèòåëà ê HCV. Ìû âåæëèâî óëûáàëèñü, à ÿ íåäîóìåâàë â íàøåé îáëàñòè ýòî ñ 1994 ãîäà. Íàïðèìåð, ñêðèíèíã íà ÂÓÈ ó íàñ â îáëàñòè ïðîâîäèëñÿ â 1995-97 ãîäó, ðåçóëüòàòû ïîçâîëèëè î÷åíü ìíîãî ñäåëàòü. Íó ýòî òàê, ýìîöèè.
Òåïåðü î ñèñòåìå çäðàâîîõðàíåíèÿ. Íà ìîé âçãëÿä, ñåé÷àñ ìû èìååì óðîäà- ïëîä ñêðåùèâàíèÿ Ñîâåòñêîé ñèñòåìû (âðîäå, êîãäà-òî ïðèçíàííîé ëó÷øåé â ìèðå, â 1982 ãîäó) è ñèñòåìû îáÿçàòåëüíîãî ìåäèöèíñêîãî ñòðàõîâàíèÿ (ïðåñëîâóòûå ÒÔÎÌÑ). ×òî íàì îáåùàëè ââîäÿ â ïðèêàçíîì ïîðÿäêå ñòðàõîâàíèå? Êó÷ó äåíåã áîëüíèöàì è âðà÷àì. À ÷òî, èìååì? Ôîíäû àêêóìóëèðóþò ñðåäñòâà, à ïëàòÿò ñî ñêðèïîì. Çàðïëàòà ñåêðåòàðøè â ÒÔÎÌÑ â 3 ðàçà âûøå çàðïëàòû õèðóðãà. ×àñòíûå ñòðàõîâûå êîìïàíèè, òîæå æóëèêè, ïëàòÿò òàê æå ñî ñêðèïîì. Îáðàçîâàíèþ ÷àñòíûõ êëèíèê ÷èíÿò ïðåïÿòñòâèÿ. Äîõîäèò äî òîãî, ÷òî â ëèöåíçèðîâàíèè ñóùåñòâóåò ñèñòåìà äâîéíûõ ñòàíäàðòîâ -ãîñêëèíèêè èìåþò ïîáëàæêè, à "÷àñòíèêîâ" ïëþùàò, êàê áîìæ ïëþùèò æåñòÿíêó èç ïîä ïèâà. Ïèøó ýòî âñå íà îñíîâàíèè ñâîåãî îïûòà. |
#217
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Ñðàçó õî÷ó ðàçâåÿòü ïîïóëÿðíûé ìèô î òîì, ÷òî íàøà ñèñòåìà áûëà â êàêîì-òî òàì ãîäó ïðèçíàíó ëó÷øåé. Äåéñòâèòåëüíî â îäíîì èç äîêëàäîâ ÂÎÇ èìåëà ìåñòî ôðàçà, ÷òî ñîâåòñòêàÿ ñèñòåìà Ñåìàøêî ÿâëÿåòñÿ ñàìîé ýôôåêòèâíîé ÄËß ÐÀÇÂÈÂÀÞÙÈÕÑß ÑÒÐÀÍ. Îá ýòîé âòîðîé ÷àñòè âûñêàçûâàíèÿ êàê-òî óìàë÷èâàþò. Ñèñòåìà áûëà ïðèçíàíà ýôôåêòèâíîé äëÿ áîðüáû ñ èíôåêöèîííûìè çàáîëåâàíèÿìè, äëÿ ÷åãî îíà â îáùåì è ñîçäàâàëàñü. Äëÿ áîðüáû ñ íåèíôåêöèîííûìè çàáîëåâàíèÿ ñèñòåìà íå ãîäèòñÿ.
Íèæå ïðèâîæó âûäåðæêó èç äîêëàäà ÂÎÇ 2000 ãîäà ïî ðîññèéñêîé ñèñòåìå çäðàâîîõðàíåíèÿ Russian Federation The period until 1991 At the end of the nineteenth century, life expectancy in Russia was 32 years, compared to 47 years in France and the United States. By 1938 the gap had increased: life expectancy was 43 years in Russia, while in France it had reached 59 years and in the United States over 63 years. In the course of roughly the next 15 years, however, Russia made huge strides and succeeded in closing much of the gap. By 1965, life expectancy for males was 64.3, 67.5 and 66.8 for Russia, France and the United States respectively, and 73.4, 74.7 and 73.7 in the case of females (6). However this progress was not maintained in later years. The factors behind these developments will be outlined below. Following the establishment of the “Semashko” model in 1918, Russia made massive strides in arresting the spread of infectious diseases. Drastic epidemic control measures were implemented, particularly in the cases of tuberculosis, typhoid fever, typhus, malaria and cholera. These involved community prevention approaches, routine check-ups, improvements in urban sanitation and hygiene, quarantines, etc. (For an account of health system conditions related to health status development see the section below Historical background). Progress in controlling infectious diseases continued to be made throughout the entire Soviet period, with crude mortality rates from infectious diseases falling from 87 per 100 000 in 1960 to 21 in 1980 and 12 in 1991 (representing a fall of 86%) (7). Yet these successes were not reflected in improvements in the overall health status of the population. Whereas life expectancy in Soviet Russia (and the entire Soviet Union) showed continuous improvement until the 1960s, it subsequently stabilized, presaging a growing gap with western nations that were to experience continuously increasing life expectancies. By about 1990-91, male life expectancy was roughly at the same levels or lower than in the 1960s (63.8 years in 1990 compared to 63.0 years in 1959 and 64.3 in 1965), while female life expectancy had improved only slightly over the 30-year period (71.5 years in 1959, 73.4 years in 1965, and 74.3 in 1990). The variation in death rates after 1965 was particularly unfavourable in Russia’s male population (8). By the beginning of the 1980s the gender gap in life expectancy was about 12 years, which is largest of all countries in the world (9). Infant mortality stood in 1971 at 22.9 per 1000, having fallen to less than one tenth of pre-revolutionary Russian figures and roughly one quarter of those of 1950 (although the use of the Soviet definition of a live birth prior to the mid 1990s means that these figures are about 20% lower than they would have been using the WHO definition) (10). However in subsequent years they began to climb, reaching 24.7 in 1972 and 27.4 in 1974. At that time, with the appearance of declining health status indices and widening gaps with the west, the Soviet authorities decided to stop publishing data. The diverging paths of Russia and other industrialized nations with respect to health status from the 1960s onward has been attributed to the failure of the Russian health care system to successfully respond to the epidemiological transition. In a sense, the very factors making for the successes of the early years in curbing the spread of infectious diseases were responsible for the inability to effectively cope with noncommunicable diseases that were becoming increasingly important. The Soviet health care system was based heavily on prevention, consisting of extensive screening measures and check-ups, although with little evidence for their effectiveness, which together with the introduction of antibiotics after the Second World War, contributed to major reductions in infectious diseases. This system of prevention, with its primarily medical orientation, did not evolve into one of population-based health promotion measures necessary for dealing with the new patterns of morbidity (due to noncommunicable diseases). While those in power were aware that an epidemiological transition was occurring, they responded by treating cardiovascular and other noncommunicable diseases as “social diseases”5 requiring a medical solution (7). Êàê âèäíî èç ïðèâåäåííîé ñòàòèñòèêè ïðîáëåìû ó íàñ íà÷àëèñü åùå â 60 ãîäàõ. |
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 íàñòîÿùåå âðåìÿ â ìèðå ñëîæèëîñü íåñêîëüêî ñèñòåì çäðàâîîõðàíåíèÿ
1. ×àñòíàÿ ñ ýëåìåíòàìè äîáðîâîëüíîãî ñòðàõîâàíèÿ (õàðàêòåðíà äëÿ ðàçâèâàþùèõñÿ ñòðàí è ÑØÀ) 2. Êîíòèíåíòàëüíàÿ ìîäåëü (Ãåðìàíèÿ, Àâñòðèÿ, Øâåéöàðèÿ) 3. Ãîñóäàðñòâåííàÿ ñèñòåìà (Âåëèêîáðèòàíèÿ) 4. Ñêàíäèíàâñêàÿ (íåêàÿ ñìåñü êîíòèíåíòàëüíîé è ãîñóäàðñòâåííîé) 5. Àâñòðàëèéñêàÿ (ïðîèçâîäíàÿ áðèòàíñêîé ñ ÷àñòíûì ïåðâè÷íûì çâåíîì è ãîñóäàðñòâåííûì ãîñïèòàëüíûì)  íàñòîÿùåå âðåìÿ Ðîññèÿ åùå íå îïðåäåëèëàñü ñ òåì, â êàêóþ ñòîðîíó îíà õî÷åò äâèãàòüñÿ. Ýêîíîìè÷åñêîå ñïîíòàííîå ñïîëçàíèå ïðîèñõîäèò â ñòîðîíó ÷àñòíîé ñèñòåìû (ðàçâèâàþùèåñÿ ñòðàíû, ÑØÀ). Óñêîðèòü ýòîò ïðîöåññ äîëåí ðîñò ðåàëüíûõ äîõîäîâ íàñåëåíèÿ è öåíû íà íåôòü. |
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Äîáðîâîëüíîå ñòðàõîâàíèå è ÷àñòíóþ ñèñòåìó ó íàñ íàñåëåíèå íå ïîòÿíåò... ß íå ðàçáèðàþñü â ñèñòåìàõ çäðàâîîõðàíåíèÿ... ÈÌÕÎ, îíà äîëæíà áûòü â Ðîññèè îò÷àñòè ãîñóäàðñòâåííîé... Òîëüêî êàæäûé åå ýëåìåíò ýòîé ñèñòåìû äîëæåí áûòü çàèíòåðåñîâàí â ðàçâèòèè... íàïðèìåð, âðà÷ äîëæåí áûòü çàèíòåðåñîâàí â çäîðîâüå ñâîèõ áîëüíûõ, ãëàâíûé âðà÷ â áëàãîïîëó÷èè ñâîèõ ïîä÷èíåííûõ, ïðåçèäåíò - .... íå ÷èíîâíèêàõ è ñ÷åòàõ è èìèòàöèè äåÿòåëüíîñòè... Ìîæåò áûòü ÿ ãîâîðþ ïðèìèòèâíî...
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Alexei òóò åñòü èíòåðåñíàÿ âåùü. Äåëî íå òîëüêî â ìàòåðèàëüíûõ âîçìîæíîñòÿõ íàñåëåíèÿ.
Ôàêòè÷åñêè ñèñòåìà ñòîìàòîëîãè÷åñêîé ïîìîùè ó íàñ ïëàòíàÿ íà 70-80% è çíàåòå âåäü íàñåëåíèå òÿíåò.  íàøåé ïëàòíîé, àêàäåìè÷åñêîé, ñòîìàòîëîãè÷åñêîé êëèíèêå ïðîòåçèðóþòñÿ è áàáóøêè è äåäóøêè, è íè÷åãî íå âîçìóùàþòñÿ. Ïîòîìó ÷òî îáùåñòâåííîå ìíåíèå ïðèíÿëî ýòîò ôåíîìåí. Ñòîìàòîëîãó ïðèíÿòîïëàòèòü. À âçÿòü ðàáîòó ïåäèàòðà, - íèêòî íå ãîòîâ ïëàòèòü çà çäîðîâüå ðåáåíêà, êîíñòèòóöèÿ è âñå. Õîòÿ è òàì è òàì ðàáîòàþò âðà÷è è âðîäå ëþáàÿ ïîìîùü ó íàñ ãàðàíòèðîâàíà ãîñóäàðñòâîì. Ïîòðåáèòåëüñêîå îòíîøåíèå ê ìåäèöèíå ãðàæäàí âîò, ÷òî íóæíî ìåíÿòü. À òî ÷àñòî ñòàëêèâàåøüñÿ ñ òàêèì ôåíîìåíîì - ÿ êóðþ, ïüþ, òðàõàþ êîãî ïîïàëî à òû äîõòóð îáÿçàí ìåíÿ âûëå÷èòü, à ÿ åùå ïîäóìàþ âûïîëíÿòü èëè íåò òâîè ðåêîìåíäàöèè, òåáå çà ýòî áþäæåò ïëàòèò. Íàñ÷åò íàñåëåíèå íå ïîòÿíåò.Ýòî âåùü îòíîñèòåëüíàÿ. Íå çíàþ êàê â äðóãèõ ãîðîäàõ, íî ó íàñ çà ïîñëåäíèå 2 ãîäà ÷èñëî ìàøèí â ãîðîäå óâåëè÷èëîñü â 1,8 ðàçà -ïîêóïàþò ãðàæäàíå (áàíäèòîâ ñòîëüêî ó íàñ íåò) Ìåíÿòü íàäî ñèñòåìó îáùåñòâåííîãî îòíîøåíèÿ ê ìåäèöèíå-íèêòî íèêîìó íå îáÿçàí. Âðà÷ íå äîëæåí áåãàòü çà ïàöèåíòîì è óãîâàðèâàòü åãî ïîëå÷èòñÿ (åñòåñòâåííî êðîìå îáùåñòâåííî îïàñíûõ áîëåçíåé). |
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Öèòàòà:
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Âîò! È òóò âûïëûâàþ ÿ, ðàñïèñíàÿ, ñî ñâîåé ëþáèìîé òåìîé. Âåñü ñîâåòñêèé ïåðèîä öâåë ïàòåðíàëèçì, è ïàöèåíòû ïðèâûêëè, ÷òî îòäàòü ñâîþ ñâîáîäó âûáîðà âðà÷ó âçàìåí ïîëíîé áåçîòâåòñòâåííîñòè - ýòî ïðèÿòíî. À òåïåðü ìû èì îáðàòíî èõ ñâîáîäó òîëêàåì, à îíè óïèðàþòñÿ - íåóäîáíî ýòî... Âñþ ñîçíàòåëüíóþ æèçíü åãî (ïàöèåíòà) âîñïèòûâàëè, ÷òî âðà÷ - öàðü è áîã, êîòîðûé â îòâåòå çà âñå, ïîýòîìó æåëàòåëüíî åãî ñëóøàòüñÿ. À òåïåðü âðà÷ ïî÷åìó-òî îòâå÷àòü ìíîãî çà ÷òî íå æåëàåò, áîëüøå òîãî, ïèõàåò îòâåòñòâåííîñòü çà ñîáëþäåíèå ðåæèìà, ïðèåì ïðåïàðàòîâ è, ñòðàøíî ñêàçàòü!, îòâåòñòâåííîñòü çà ïðèíÿòèå ìåòîäà ëå÷åíèÿ... "Íå õî÷ó! Íå áóäó! Ãäå â êîíñòèòóöèè íàïèñàíî, ÷òî ÿ âîò ýòî âñå äîëæåí è îáÿçàí!!!! Õî÷ó îáðàòíî â äåòñêèé ñàä!". À òóò åùå äîêòîð ñòàðîé ñîâåòñêîé øêîëû ïîääàêèâàåò: "Ïðàëüíà! ß ëó÷øå çíàþ!!!".
È êóäà íàì, ìîëîäûì è ïðîãðåññèâíûì â ýòîé ñòðàíå ïîäàòüñÿ, êîãäà êëèåíòóðà ïðåäïî÷èòàåò ñäàòü äåíüãè ãîñóäàðñòâó è íè çà ÷òî íå îòâå÷àòü, à òîëüêî ñòåíàòü íà òåìó "Êòî âèíîâàò"?
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Lead, follow, or get out of the way. — Thomas Paine |
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Öèòàòà:
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Äà, åñëè áûòü åùå áîëåå òî÷íûìè, òî òàì ãäå Âû ñåé÷àñ ðàáîòàåòå, óâàæàåìûé Âëàäëåí, ïàòåðíàëèçì åñòü? À êîãäà îí îòòóäà èñïàðèëñÿ? À óâàæàåìûé Àëåêñ_ìä ïîäåëèòñÿ âîñïîìèíàíèÿìè î òîì, êîãäà ïàòåðíàëèçì èñ÷åç â Àìåðèêå... Ó íàñ æå âñåãäà "ñîáñòâåííàÿ ãîðäîñòü" è ïàòåðíàëèçì íå åñòü ÷èñòî ìåäèöèíñêàÿ ïðèâèëåãèÿ... Ýòî îáðàç æèçíè... Ïîýòîìó, âåðíóâøèñü ñ íåáåñ íà ãðåøíóþ çåìëþ, íàäî áû ïðèäóìàòü: à êàê ñîâìåñòèòü óâàæåíèå ê ñåáå è ïàðòíåðó ïî âçàèìîäåéñòâèþ (â äàííîé ñèòóàöèè - ïàöèåíòó) ñ âåëèêîðóññêîé ëþáîâüþ ê àâòîðèòàðèçìó...
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Lead, follow, or get out of the way. — Thomas Paine |
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Óâàæàåìûé Àëåêñàíäð!
Ñïàñèáî çà ïîäðîáíîå îáúÿñíåíèå. Íî, ÷òî òàêîå ñêðèíèÍã ÿ çíàë è äî ýòîãî, à ÷òî òàêîå ñêðèíèã íå çíàþ äî ñèõ ïîð. Óæ èçâèíèòå çà ýòó ëåãêóþ èçäåâêó. ×òî êàñàåòñÿ òîãî, êóäà äåíüãè äåâàòü, òî ÿ Âàøè òåçèñû íå îñïàðèâàþ, áîëåå òîãî, ïîääåðæèâàþ. Îäíàêî 10% îòêàòà (Âû, êñòàòè, çíàåòå ÷òî ýòî?) îò 5Ì îò÷åòëèâî âëèÿþò íà èõ ðàñïðåäåëåíèå.  íàøåì êîðïóñå ÒÐÈ ÊÒ, 1 ÌÑÊÒ è 1 ÌÐÒ. Äâå ðåíòãåíîïåðàöèîííûõ(Ïðè ýòîì êîëè÷åñòâî àíãèîïëàñòèê - ìåíåå 200 â ãîä). Íó, áîãàòûå ìû... È åùå ïðî àááðåâèàòóðû. Ñåãîäíÿ â âûïèñêå âñòðåòèë ÒÌËÐ. Åëå äîãàäàëñÿ ÷òî ýòî òðàíñìèîêàðäèàëüíàÿ ëàçåðíàÿ ðåâàñêóëÿðèçàöèÿ. ß âîîáùå ïðîòèâíèê àááðåâèàòóð, êðîìå îáùåèçâåñòíûõ, òèïà ÝÊÃ. À òî ïèøóò ÆÏ íå ï. Ò.å. "æåë÷íûé ïóçûðü íå ïàëüïèðóåòñÿ". |