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«In many situations, such as discussing the vaccination schedule, discussing the diet, test results, advice on breastfeeding, teleportation is the only optimal form of contact with a doctor. Inviting an infant to the clinic during the 3rd wave of the pandemic to discuss the vaccination schedule, it is a crime after all! » – with these words Maciej Pawłowski, MD, PhD, pediatrician and primary health care physician, comments on the recent changes in the rules of providing telepaths.
- From March 15, new rules for the provision of teleporting have been in force, introduced by the ordinance of the minister of health
- Teleportada ceased to be the standard. Doctors are now required to personally see newly enrolled patients at the clinic, patients with chronic disease after deterioration of health, people suspected of having cancer, and those who do not consent to teleportation
- In the form of teleportation – which aroused a lot of controversy among primary care physicians and paediatricians – children under 6 years of age cannot be consulted.
- The ban on teleporting has a “hiccup” and has a negative impact on access to healthcare for children in Poland, and this is not the point – comments the pediatrician, Maciej Pawłowski, MD, Ph.D.
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‘I am a pediatrician, I would like to express my opinion on the new “regulation” of Minister Niedzielski. Some time ago in In the Journal of Laws, an ordinance on the provision of tele-advice by GPs was published.
Not only in my opinion it is a typical “trash” that limits the rights of patients, although this regulation was probably written in good faith, so that there would be no clinic where 100 percent visits are teleports because such a situation is bad.
- Significant limitations in teleportation. Changes for patients
1. In Poland, the regulation is an act of the lowest order, it is lower than the constitution and statutes. Article 42 of the Act on the Medical Profession says that “a physician decides about the health of a specific person after prior, personal examination or examination via teleinformation systems or communication systems, as well as after analyzing the available medical documentation of that person”
“I don’t need to see the patient to examine him”
How, then, does this new regulation have to do with the act? The Act gives the possibility of adjudicating on the state of health, e.g. on the basis of medical documentation. For example, for example, the parents of a 5-year-old child that I know provide the clinic with the result of computed tomography, I call the parents, fill in the missing information, if there is any and I can decide whether there is a need for additional tests, etc. I do not have to physically examine the child or him « see ”on the day of delivering the result, because I don’t need it. Unfortunately, this is not possible in the regulation, which is absurd.
2. The Constitution of the Republic of Poland, and more specifically article 68 says: Everyone has the right to health protection. Citizens, regardless of their financial situation, public authorities ensure equal access to healthcare services financed from public funds. The terms and scope of the provision of services are specified in the Act. Public authorities are obliged to provide special health care to children, pregnant women, people with disabilities and the elderly.
Thus, the conditions of benefits are specified in the Act, in this case Art. 42 of the Act on the Medical Profession, and not an “ordinance”. There is such a thing in Polish law as a “regulation with the force of a law”, but we do not have a state of emergency, so there are no grounds for issuing such a legal act.
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Physician: An in-person appointment order is a care limitation
“Provision of special care” referred to in the Act should therefore be understood as any form of contact: personal, telephone, e-mail, video call, home visit, etc.
In certain social groups, ordering a personal visit only, excluding teleportation, may violate the constitution. Why? Because instead of leading to “providing them with special care”, it will limit it.
If the child’s parents want to consult the result of a test they have performed in another city, and there is no primary health care physician in their area. If the mother of a child I know would like an e-referral to an allergist, I could issue it on the day of reporting so that she can make an appointment that same day. If we force her to come to the appointment with the child in person, she must quit her job, she will come in 3 days and only then will she be able to look for an allergist. This is delaying diagnosis and limiting benefits !!!!
«Inviting an infant to the clinic in the 3rd wave of the pandemic is a crime |»
Of course, we are not talking about pathological situations where a highly febrile 2-year-old child was “treated” only with telepaths and then died, which is a bad situation. But even worse is the ban on teleporting for children. In many situations, such as discussing the vaccination schedule, discussing the diet, test results, and advice on breastfeeding, these are the only optimal forms of contact. Inviting an infant to the clinic during the 3rd wave of the pandemic to discuss the vaccination calendar, it is a crime after all !! Unfortunately, such legal “monsters” come from Minister Niedzielski.
If we read this ordinance literally, a 20-year-old will have better care, because such a person can benefit from both teleporting and a personal visit, and a 5-year-old child cannot. This is bureaucratic stupidity, possibly unconstitutional.
It is necessary to change the provisions in accordance with the Polish constitution, extending the right of children to special care, and thus to quick consultations, in any form.
The ban on teleporting has a “hiccup” effect and has a negative impact on access to healthcare for children in Poland, which is not the point. The optimal version is a personal visit to the child, if there is a need for an absolute physical examination. But it is not always the case. If someone comes for advice about his mental state, does he have to be auscultated with a stethoscope?
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Direct contact with the patient. What does that actually mean?
3. The “Regulation” of Minister Niedzielski talks about visiting in direct contact with the patient. This also raises my doubts, because what is direct contact? After all, during every personal visit, I am not obliged to physically examine the patient, because not every problem requires it. In addition, for the needs of the epidemic, it was defined what “close” contact with a patient is: direct physical contact, exposure to cough, contact longer than 15 minutes, at a distance of less than 2 meters, etc. Not every visit requires spending more than 15 minutes. Depending on the problem, this could be, for example, 10 minutes or 20 minutes.
4. The “Regulation” provides for the first-time visit to a primary care physician, indicated in the declaration of choice. What if the patient reports to doctor X and the nearest possible date is to doctor Y? Does he have to wait for a personal visit or can he have teleportation?
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5. What is the difference between a cold in a 5-year-old child and a cold in a 7-year-old child? Why does a 5-year-old with the same cold need a personal visit and a 7-year-old with teleportation? To come to the clinic with a child, a parent often has to leave work, which may result in the fact that in the 7th summer he gets a consultation faster than a 5-year-old. I don’t think that’s what it is about.
There are many more such doubts.
I assume that the authors of this “regulation” wanted to increase the availability of patients to medical services, including personal visits to primary health care, which was a good intention. Unfortunately, it is quite the opposite. Wouldn’t it be better to let doctors treat them in accordance with medical knowledge and standards, including experience in working in primary care, and consult them in advance? As the regulation introduces an official who has no idea about working in POZ, this is what it is, i.e. worse than it was.
Maciej Pawłowski, MD, PhD (PWZ 2862886)
A specialist in pediatrics