How to choose a good doctor?

Some 20 years ago, such a question as the choice of a doctor did not arise in principle. All were served at the place of residence, had a district therapist, as well as specialists of narrow specialties who were part of the staff of this medical institution: a polyclinic, an outpatient clinic or a FAP (a feldsher-obstetric station in a rural area). With the advent of insurance medicine, in particular, compulsory insurance of all citizens, district continuity is preserved, but it has already become not so uncontested. The patient has the right to be attached to any medical institution in the locality where he lives, as well as to choose a doctor, both a therapist and other specialists. For example, earlier pregnant women were observed at the obstetrician-gynecologist of the antenatal clinic, to which the woman belonged at the place of residence. Moreover, the expectant mother could not choose a specialist: the areas of residence were divided according to the territorial basis between the working gynecologists in this antenatal clinic. This was due to the fact that the midwife carried out patronage of a pregnant woman, if there was such a need. Now a pregnant woman has the opportunity to register for pregnancy in any medical institution, including a commercial one, which has a license to conduct this type of medical activity, as well as choose a doctor of her choice.

So how do you determine which doctor is good and which is not? What to be guided by when choosing a specialist, and what to look for?

Legal requirements for medical professionals

First of all, the doctor must be a professional. It seems to be obvious, but it turns out not always. There are professions that necessarily require special education and permission to engage in a specific type of activity, issued after receiving such education. The absence of the latter is a reason for the ban on activities ^[1]. Vocational education is extremely important because if we fly by plane, travel by train or even by bus and taxi, we expect the pilot, machinist and driver to have a specialized education and the presence of documents confirming it; we will not fly a plane that is flown by a self-taught pilot, and we will not agree to ride with a taxi driver without a license. Medicine, just refers to one of these professional areas.

Perhaps the fact that a person has a higher medical education does not guarantee that he is an excellent specialist, but he will probably have more knowledge and skills than without education. It gives not only a lot of information, but, no less important, it teaches her to look in the right sources. Moreover, to engage in medical activities without an appropriate education is a crime. Now that many private commercial organizations have appeared on the medical services market, this problem has become most relevant. Therefore, if you decide to choose a specialist in a non-state institution, where the guarantee of having a specialized medical education is not provided by a special staff of personnel workers and administration, as in state institutions, then you need to familiarize yourself with all the documents in detail, starting with a diploma of graduation from a medical university, a diploma of internship or residency in this specialty, as well as a specialist certificate, which is issued for a period of 5 years. Unfortunately, in the medical field, up to the present day, there are a large number of charlatans and scammers who use pseudo-scientific and pseudo-medical knowledge, relying on the ignorance and gullibility of people.

The main “signs” of a good doctor, what are they?

Immediately following the understanding that a special, high-quality education is needed, the question arises of how to identify a doctor who not only has a large set of knowledge and skills in comparison with the layman, but who uses this knowledge, constantly replenishing and enriching his luggage in the professional field.

In the past few years, the idea of ​​evidence-based medicine has been actively promoted in Russia, which at first was considered something fashionable and extraordinary. Moreover, most of the medical community, which is accustomed to working according to the old traditions, either actively opposed this trend or simply ignored it. The resistance was caused by the fact that evidence-based medicine exposed the shortcomings and flaws of the health care system as a whole. Moreover, there are quite a lot of flaws in this area throughout the post-Soviet space, ranging from the organization of the work of health care systems, medical education and scientific activity, to the problems of treatment protocols, the use of ineffective and unproven drugs called “fuflomycins”, as well as problems of ethics and deontology. Doctors of the old formation, as arguments justifying such actions, cite personal clinical experience. However, evidence-based medicine is an experience only proven by clinical scientific research. So who is right, and how can the layman figure it out?

Science is not truth, but the process of finding it. It plays the role of a vector, base, foundation, indicating the direction of movement. Science can and knows how to correct itself like a living organism. Everything necessary is delayed, unnecessary is removed and displayed. To take into account and adhere to the principles of evidence-based medicine today is one of the important differences in the work of a good modern doctor. A doctor who prescribes unnecessary examinations and useless medicines, making non-existent diagnoses, will not help the patient, but will take valuable time, nerves and money. The ideal situation is when a specialist takes into account the uniqueness of each person and considers his physical health, taking into account the mental and psychological (mental) state.

In parallel with the development and dissemination of the principles of evidence-based medicine in the field of health and medical services, the so-called integrative medicine began to gain momentum. However, it is necessary to clearly understand its difference from alternative (alternative) medicine, when a person is canceled a full-fledged, evidence-based treatment, and replaced by another, sometimes rather dubious one. Integrative medicine is when, along with normal, full-fledged treatment, the patient is offered to additionally use some methods and methods that may not yet have scientific evidence of effectiveness, but are at least safe for health. It is unacceptable for a doctor to suggest “applying herbs” instead of surgery, but it is quite reasonable to recommend, along with the use of traditional therapy, for example, massage, meditation, psychotherapy for many diseases, the course of which is aggravated by stress.

When choosing a specialist, psychological comfort is also very important. If a doctor violates ethical standards, allows himself familiarity, familiarity, and sometimes rudeness towards the patient, this is unlikely to help establish communication, and sometimes even build a “wall of distrust” to such a specialist. If you are not comfortable in communicating with a doctor, you do not receive the necessary information, you do not have confidence, then with a high degree of probability we can assume the lack of success from the treatment.

It is especially important for the patient to receive emotional and psychological support when, for example, surgery is due. For a doctor, this may be an ordinary routine day, but for a patient it is very important and special. A person may not show excitement, but feel fear, because he trusts the doctor with his health, and sometimes his life. Sometimes the mood and expectations from the operation of the patient depend on the doctor’s facial expression and tone of voice, and it is important for him that the doctor reassures, explains, and at the same time speaks not in medical terms that may be incomprehensible, but in the simplest words.

What should and what should not: the doctor’s duties to the patient

Often, patients themselves mistakenly form an idea of ​​a good doctor, endowing him with some mythical and even absurd qualities. For example, many believe that a doctor should know everything and has no right to make mistakes. However, this is not possible for humans. Much of the knowledge acquired over years of study and practice is forgotten. There are rare people who have a phenomenal memory, but this is not a mandatory quality for a doctor. He must have the ability to acquire knowledge by choosing the right sources. It is a completely false assumption that the doctor who says: “I don’t know” is bad, or even worse, opens a directory or medical resource on the Internet. For most, he will instantly become a “bad doctor.” Often patients are waiting for answers to all questions, and sometimes they simply do not. Science does not know the causes of all diseases, such as atherosclerosis, hypertension, osteochondrosis, and many others. But the mechanisms and causes of their occurrence are known, which is often enough to successfully control these conditions.

A doctor should not be negligent in his work, be irresponsible, but as in any other profession, he can make mistakes and be mistaken, although, of course, the price of a mistake in medicine is extremely high. Some patients, believing that the doctor is obliged to know everything, hide information about themselves, their health, data from past examinations, explaining that a good doctor will determine everything anyway. But this is a dangerous delusion. Sometimes a careful collection of complaints and anamnesis gives the specialist 80% of the information, and the remaining 20% ​​is an objective examination and examination.

There is also a false belief that a good doctor is obliged to help anytime and anywhere. If we are talking about emergency assistance, when there is a threat to life, then yes, this is an indisputable fact. But if we are talking about planned care or a health situation where the patient’s life is not in danger, then the doctor has the right to end the working day on time, since he is an ordinary person, with his own needs, problems and desires.

The same erroneous expectations include the opinion that a good doctor will not work for the sake of money, strive to earn more and, in general, is obliged to consult for free. If the doctor works in a budgetary organization, then he receives a guaranteed salary, and it is his choice to agree to such payment for his work or not, even if, in the opinion of the specialist himself, it is biasedly small. But if you decide to be treated in a private clinic, where the doctor has a piece-rate payment or he rents an office, then as a professional who has certain knowledge, ambitions, who values ​​his time, he can charge a certain, rather high price for his appointment.

The opposite belief that the price of a good specialist will necessarily cost fabulous money is also incorrect. A doctor can consult both free of charge and expensively, more often it is determined by common sense and certain external conditions. But it’s not a fact that a specialist whose consultation costs 50 thousand rubles is better than the one whose consultation costs a thousand. Often the overpriced price tag is put by the “promoted” integrative and alternative doctors who have gained mass fame in the era of media and Internet trends.

Another deceptive expectation from a doctor who is good in the opinion of patients is the availability of guarantees from him for recovery. But just a sane doctor will not make such promises. After all, even if he correctly diagnoses, prescribes an effective and safe treatment, it is difficult to predict how the body of a particular patient will respond to therapy. Guarantees are easily given by various “charlatans”.

Elementary skills that a good specialist should have

It is very important for a practicing doctor to know the propaedeutics of internal diseases and objective examination.

In the era of technological progress, when a huge number of research methods appeared, many doctors simply stopped using such simple and at the same time important techniques as external examination, palpation, percussion, auscultation.

For a dermatologist, for example, it is very important to undress and examine the patient, his skin, and using a fairly simple device – a dermatoscope. It is with its help that one can accurately suspect such a formidable disease as melanoma.

Palpation (palpation) can determine the position, shape, consistency, mobility, topographic ratio and soreness of the internal organs.

With percussion (tapping) of certain parts of the body, based on the analysis of the sounds received, it is possible, for example, to determine the size of the liver or suspect a disease in the lungs without ultrasound.

Auscultation (listening to the sounds produced by the heart and lungs) using a special device – a phonendoscope, allows you to identify many diseases, including pneumonia or heart disease.

Modern research methods such as ECG, Echo-KG, ultrasound, MRI, CT, X-ray and many others become an excellent help in diagnosis, but sometimes they may not be necessary or not all and not immediately needed.

When to Contact a Specialist

In the post-Soviet space, unfortunately, a tradition has developed in medicine, when it was customary to send a patient to “narrow specialists” for any reason. Echoes of this are manifested even now, when a patient, in order to solve his health problems, simultaneously turns to doctors of various specialties, each of which prescribes some kind of treatment. For example, for the treatment of hypertension – to a cardiologist, cystitis – to a urologist, anemia – to a hematologist, etc. Very often, such combined treatment includes a huge number of drugs, sometimes even incompatible with each other. But since each “narrow” specialist solves some of his specific health problems, the rest remain unaccounted for, and the treatment is sometimes absurd. And, of course, not the patient himself is to blame for this, but such a vicious system. It is much more correct and effective if the patient is managed by one doctor who knows all the nuances of his illness, related problems, living conditions, that is, his entire history.

In fact, a competent therapist or pediatrician (in children) can perfectly cope with most problems, resorting to the help of their colleagues of narrow specialties in difficult cases when more specialized diagnostics are required. Ideally, when the treatment is led by a family doctor or general practitioner. If your therapist or pediatrician prescribes treatment related to related specialties (cardiology, gastroenterology, endocrinology, nephrology, etc.), this may mean that you have come across a very competent specialist. Do not think that therapists and pediatricians can and should treat only the common cold. In Western countries, many diseases are treated by a family doctor, for example, otitis media and sinusitis, and not by an otorhinolaryngologist (ENT doctor), as is customary in our country.

Unfortunately, in our country there are practically no family doctors or general practitioners, and therefore, if you come across a competent therapist or pediatrician, hold on to him and appreciate him.

Conclusion

Based on the foregoing, how to find and choose a good doctor, a specialist in a particular field of medicine? It is difficult to give a definite answer to this question. Personal experience, recommendations from friends, word of mouth, as well as an understanding of what you need and can expect from a competent and professional doctor will help in this very difficult task. Now that the Internet is available, there is a great opportunity to get information about clinics and doctors on the net, where you can read reviews about the work of a particular specialist. And this greatly facilitates the task of finding a good doctor of the right specialty.

Sources of