Such a frank conversation could hardly have happened to a stranger. True, the interlocutor of Sputnik, a narrow specialist with 30 years of experience, asked not to be named. You will understand why when you read an interview with Sputnik correspondent Tamara Zenina.
… We talked about medicine outside the hospital walls. Perhaps that is why my friend, whom I have known for a quarter of a century, was talkative and extremely honest.
Photo: from the personal archive of R. Yakubtsevich
Dr. Mednauk: a fine line between tradition and corruption in medicine
– For 30 years I have worked in many state and commercial medical institutions and I can say that there are pluses and minuses everywhere.
– Everyone knows that the main plus of commercial centers is the level of salary.
– Yes, it is more there than in state structures. And if you get settled well, then at times. Of course, specialization is important, work on yourself. Today, there is little demand for doctors, who simply received a specialty and do nothing else.
A good doctor is constantly trying to improve their skills. He monitors the best practices of colleagues, reads many scientific articles and reports, for which he must know a foreign language, because not everything is in translation.
Additional skills are required. For example, now almost every specialist should be able to do ultrasound, etc. Also, surcharges doctors receive for surgery. If you simply consult, there will be no big salary.
Sputnik / Victor Tolochko
Very many doctors combine work in state medicine and in private
– Can a doctor in Belarus today earn $ 500 "desired"?
– Maybe. In state institutions, for example, in the hospital, if there are high-tech operations, these are the same oncologists, transplantologists, they have good salaries by our standards.
In the clinic at the rate, having a good category, clean turns 400-450 dollars.
In commercial centers, a doctor can earn twice as much. Many of my colleagues try to combine work in public and private hospitals.
Sputnik / Vera Dashkevich
Doctor about distribution: it’s not true that salaries are higher in a big city
At the same time in the clinic, you get paid for coming to work, and in a commercial center, the salary depends on how many patients you have received.
– Nevertheless, you do not go completely to private medicine.
– Work in private centers is a kind of ceiling. In America, there is even a symbol of unpromising work – a school bus driver. A doctor in our private center is a kind of "bus driver". He has no professional growth. He just makes money.
But I can not help but note the moments that I like.
A patient who goes to the doctor for money knows why he came: he has something to hurt, there is some problem, he goes for help.
Sometimes a person goes to the state clinic because he "needs to go."
CC0 / pixabay / engin_akyurt
The doctor can only help by prescribing the right treatment. Man recovers himself
Someone comes, because "the neighbor had a similar," "the wife sent," someone said something, in short, he does not always understand why he came. Sometimes it seems that a person came just to start a conflict.
– Do the centers have rules of conduct with patients, for example, the doctor should be friendly, not rude, etc.?
Note of the doctor in Russian stumped users of social networks
– In some there is something like that.
– Patients think that in private centers doctors are required to prescribe as many expensive procedures as possible …
– I worked in dozens of different centers, officially nowhere is nothing like that. But there is a subtext. You are told: the goal of any commercial organization is to make a profit, and we are a commercial organization, now go and work (laughs).
– It turns out, still require?
– No, we assign what is written in the protocol. There is written enough. But if in the state clinic the patient can come to the reception five times for free, and you will assign him first one test, then another, then “and let's do another test” …
In a private patient, you have to pay for each next visit. Therefore, I immediately call the whole list of procedures that are required, and stipulate what is more important and what can wait. But if the patient says that he is able to do everything, I appoint everything. Next time it will help me and him.
In my practice there was a case when I unflatteringly expressed to the patient about a single procedure that was done in the center. I justified its uselessness and even pointed out possible harm.
CC0 / pixabay / engin_akyurt
In many countries, people enter into litigation, but they are judging not with a specific doctor, but with an institution. They distribute responsibility
They called me to the authorities and said: you may have your own opinion, you may not even assign this procedure, but please, do not tell it to the patients (laughs).
– Why do doctors leave private centers?
– I left several times due to lower wages. But in recent years, such centers do not allow themselves. If ten years ago, doctors competed with each other to get a job at the medical center, today the centers are fighting for specialists.
Sputnik / Sergey Pushkin
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– Equipment – indisputable plus commercial centers. What we work in public clinics, as a rule, was purchased in 2007-2010.
Previously they asked which new device to buy, and now they ask what to fix. What suffers most? All medical and diagnostic manipulations that require high-tech equipment, for example, ultrasound. Technologies are constantly improving, and equipment wears out.
There is such a thing – the examination of health care. When some equipment enters the country, it is certified. The certificate is given for five years. I even checked: the devices we work on are no longer listed in the registry. According to the rules you can not work on them, but they all work.
– What do you think about patients who compare the actions of doctors on the Internet?
– I myself am not ashamed to look on the Internet for some kind of scientific work on a specialized website. As for patients, today 80% come "prepared" and say: I have already read, I know everything. Sometimes they even give an assessment, they say, you said everything correctly, it was written there (laughs). This is a normal phenomenon of our time.
Sputnik / Vera Dashkevich
In public clinics, where a few minutes are allotted to the patient, and you still have to fill a pile of papers, the doctor always has no
– Is it true that pharmacists pay doctors to prescribe certain medications?
– I do not get paid (laughs), give pens and notebooks. Representatives of pharmaceutical companies really come a lot, I nod to everyone, but I nominate what I consider necessary. They can also invite to any conference with dinner in a restaurant. If I am interested in the topic, I listen to a lecture and leave, because I do not consider myself undernourished (laughs).
– About the "small cemetery that every doctor has." Have you had situations you regret?
– There were situations when I did not make a diagnosis in time. It was when, partly through my fault, the help was incorrectly organized.
Doctors are not ideal people. I will say more, the doctor can not be responsible for the final result, he may want to help. The patient himself is getting well. No need to overestimate our capabilities.
Believe me, no doctor wants to cripple or kill anyone. And it is not always clear to me when, in cases with a tragic outcome in the comments, everyone shouts only one thing: crucify! Society must be prepared for the fact that the doctor may be wrong.
Sputnik / Alexey Malgavko
Sometimes a person goes to the state clinic not because his state of health requires it, but because he "needs to go"
– But the mistake of the doctor can cost life!
“Maybe because the doctor is not God.” The course of the disease may be typical, it may be atypical. There is such a thing as “pathomorphosis”, when a disease can be said to become practically unrecognizable for various reasons. For example, a patient drank some pills you don’t know about.
– Is the doctor who is unable to assist in a timely manner to blame?
– It all depends on the situation. In many countries, people enter into litigation, but they are judging not with a specific doctor, but with an institution. They allocate responsibility. Our doctors always make it extreme.
Immediately fire, plant … Do you really think that this doctor did not punish himself? What is he not going through?
Do you remember, there was a case in a private center, when the anesthesiologist received a sentence for not actually working the device? And the case when the patient was dropped from the gurney? My personal opinion is: it happened because the construction of the gurneys is disgusting.
Sputnik / Alexander Kryazhev
The design of the gurneys sometimes causes concern even among the physicians themselves
I myself once was taken for an operation, and it was really scary to lie. I thought: if now they accidentally find out on what threshold, these two little sisters simply will not keep me!
– How did your colleagues perceive the Matter of the Doctors?
– It affected many people, someone studied with someone, someone worked or just came across work …
Sputnik Roman Shantar
Amnesty may affect some of those convicted in the "medical case"
It is not clear to me why, if a businessman is detained, he compensates for the damage — and he is released, and everyone is confiscated at the doctor, and they are also put on decent terms. I think this is unfair.
– Have you ever been offered money for something?
– Of course, for the sick.
– Honestly – did?
– Honestly, no! They provoked, even demanded, but I always said: “This is not our business, sorry” (smiles).
– Do you consider chocolates a bribe?
– Now everyone is equated to a bribe – chocolates, sweets. I believe that this is nonsense – to consider corruption a chocolate bar. This is humiliating, in my opinion.
In search of "I express": where and why Belarusians emigrate
– Lot. Abroad doctors with surgical specialties are especially in demand: surgeons, anesthesiologists, etc.
In Germany, for example, any specialists are welcome. And it's easier to get there. You pass the language to level B2-C1 and are looking for vacancies on the Internet. There are many offers directly from employers.
You don’t even need a work permit right away. They take it without him, but with the condition that you pass the FSP for a certain period of time – the language exam in your specialty and you will receive a temporary permit.
At this exam there is an actor simulating a certain disease. For example, he may suddenly start behaving inadequately, poking the doctor in the leg, doing something else, and the commission looks at how you react to it. They just teach them conflict resolution methodologies, but we practically don’t.
Sputnik / Sergey Guneev
Abroad doctors with surgical specialties are especially in demand.
– Do doctors come back?
– Returned from the UAE or Saudi Arabia, where they work under contracts. My friends went to Angola, earned money, returned, bought an apartment.
The level of earnings abroad depends on various factors. For the same Saudi Arabia, the availability of residency and work experience after its completion. They also recognize academic degrees.
Doctors will take each patient for five minutes more.
The salary is promised 4-6 thousand dollars, taxes are small there, housing, as a rule, is offered to such contracts from hospitals.
In Germany, you actually go to the post of intern. But his starting salary is about 5 thousand euros, minus taxes, about 2.5 will remain. This is even without a residency.
And there is not like ours, when the salary decreases every year. For example, my salary has decreased twice since 2010.
There, the intern for five years working as an assistant salary rises to 6 thousand euros. Further more. My classmate left 25 years ago. Now she has a salary of 10-15 thousand euros. In America, wages are much higher. But there you actually start from scratch.
– You say "sick topic." And everyone serves the departure of the doctors as an emergency
– And you do not see the problem?
– In the medical environment, this is different. We have long ceased to regret the fact that we remain without specialists. We just rejoice for people who can find themselves in the specialty and abroad.
Why are many annoyed by how much our doctors can earn abroad? You calmly relate to programmers who also leave and earn money.
Almost all my friends who have left send money here to their relatives, even they buy real estate. Is it bad for the country's economy?
Many graduates of medical universities immediately dream to get into the pharmaceutical company
– This is bad for patients who remain without expert help.
– Then you need to create conditions so that those who leave, gain experience there and return. Not only Belarusians and Ukrainians go to the same Germany. Doctors go there, for example, from Saudi Arabia, precisely for experience, in order to return to their homeland.
– What specific conditions are needed?
– First, we need to make our diploma recognized, we must teach the specifics of providing assistance in other countries. So that our doctors could come with their documents to any place, work and bring the acquired experience and knowledge back to a country with a decent salary and working conditions. Conditions – this is the second, and we talked about this above.
But doctors, after all, do not just leave the country abroad; some simply leave the profession. Recently communicated with fifth year students. In a group of 12 people, only two want to work as doctors. The rest are immediately ready to go to the pharmacological company or even out of medicine.
– Have you ever wanted to go to a pharmaceutical company?
– No, I do not like to sell pills, I like to treat people.
– Do you know the language, you are a good doctor, what stops you from moving?
– It is always better to live in your own country. But I want change, new experience, impressions. In my case, the decision has not yet been made …
. (tagsToTranslate) emigration (t) general practitioner (t) medical error (t) doctor (t) profession (t) medicine
Chief EditorTags: case, conversation, doctor, doctorsquot, frank, quotThe, touched