Functional responsibilities of the local general practitioner. Responsibilities of a local general practitioner Job description of a local general practitioner

Official responsibilities local general practitioner

1. To carry out outpatient reception of patients in accordance with the schedule approved by the administration of the polyclinic, regulating the flow of visitors by rational distribution of repeated patients.
2. Visit patients at home on the day of the call.
3. Provide timely diagnosis of diseases and qualified treatment of patients.
4. Provide emergency medical care to patients, regardless of their place of residence, in acute conditions, injuries, poisoning.
5. Conduct an examination of temporary incapacity for work in accordance with the current Regulation on it and promptly send patients to the KEK and MSEC in order to determine the ability to work, transfer to another job.
6. Timely hospitalize therapeutic patients with compulsory preliminary examination during planned hospitalization.
7. To consult patients with unclear forms of diseases with the head of the department, doctors of other specialties of the polyclinic and other health care institutions.
8. Use in their work modern methods of prevention, diagnosis and treatment of patients.
9. To carry out a set of measures for prophylactic medical examination of the population of the site in accordance with the list of nosological forms subject to dispensary observation by a general practitioner, with an analysis of the effectiveness and quality of prophylactic medical examination.
10. Provide organization and conduct preventive vaccinations population of the site.
11. Notify the management of the institution, cabinet infectious diseases polyclinics, the center of state sanitary and epidemiological supervision about all cases of infectious diseases or suspicions of them, food and occupational poisoning, violations of the sanitary and anti-epidemic regime by infectious patients at home.
12. Carry out preventive examinations in accordance with the established procedure and according to the schedule approved by the administration of the polyclinic.
13. Observe the principles of deontology in their work.
14. Monitor and direct the work nurse precinct.
15. To systematically improve their qualifications and the level of medical knowledge of the district nurse.
16. Conduct active and systematic sanitary and educational work among the population on healthy way life and prevention of diseases of the site.
17. Maintain medical records of outpatients, write prescriptions.
18. Ensure the correct maintenance of medical records by the district nurse.

Job responsibilities district nurse

1. Prepare workplaces before an outpatient appointment with a local therapist, controlling the availability of the necessary medical inventory, equipment, documentation, checking the serviceability of equipment and office equipment.
2. Prepare and submit to the registry self-registration sheets of patients, coupons for an appointment with a doctor for the current week.
3. Before the beginning of the reception from the storehouse, bring the medical records of outpatients selected by the registrars in accordance with the self-recording sheets.
4. Monitor the timely receipt of the results of laboratory and other tests and paste them into the medical records of Outpatients.
5. To regulate the flow of visitors by fixing the appropriate time in self-registration places for repeated patients and issuing coupons to them.
6. To help patients, as directed by a doctor, during an outpatient appointment to prepare for the examination.
7. Measure to patients as directed by the local general practitioner Blood pressure, conduct thermometry and other medical manipulations.
8. Inform the card store about all cases of transfer of medical records of outpatients to other offices in order to make an appropriate entry in the substitute card.
9. Explain to patients the methods and procedures for preparing for laboratory, instrumental and instrumental studies.
10. To study the life and working conditions of dispensary Patients on the instructions of the doctor, keep records of them, invite them to see a doctor.
11. Prepare preliminary materials for the preparation of the Report on clinical examination of the population of the site.
12. To carry out, in accordance with the doctor's prescription, at the site Medical manipulations, the collection of material for bacteriological Research.
13. Carry out, as directed by the doctor, repeated visits to Patients at home in order to check their compliance with the prescribed regimen and treatment.
14. Picking the necessary tools and medications A bag of a local general practitioner to provide medical care At home.
15. Carry out preventive vaccinations to the population under the guidance and supervision of a physician.
16. To carry out, in accordance with the plan, sanitary and educational work among the population.
17. Systematically improve their qualifications by studying the relevant literature, participating in conferences, seminars.
18. Make out under the supervision of a doctor medical records: referrals for consultation and to auxiliary offices, dispensary observation control cards, statistical coupons, spa cards, extracts from medical records of outpatients, referrals to MSEC, temporary disability sheets, emergency notifications of an infectious disease, food, acute occupational poisoning, unusual vaccination reactions, certificates of temporary disability, average work diary medical staff, a notebook for recording work at home for a district nurse, etc.

Job responsibilities of the registry employee

1. Meet patients at the reception, help navigate the services necessary for the patient.
2. Answer the calls of patients, provide them with the necessary information about the services of the clinic.
3.If necessary, give additional information, involve a consultant in the conversation.
4. Draw the attention of patients to the demonstration stands, give the necessary explanations.
5. To inform each patient about the possibilities of the complex of hospital services.
6. To fill out all the necessary documents for patients (medical card, etc.) in the prescribed form.
7. Maintain a card index of medical records in the prescribed form.
8 Refer patients who wish to use paid services hospitals, to a consultant doctor.
9. Say goodbye to the patient, give him all the necessary documents.

OFFICIAL INSTRUCTIONS OF DOCTORS-SPECIALISTS
PRECINCT DOCTOR THERAPIST
1. General Provisions
1. This job description defines the job duties, rights and responsibilities of the district general practitioner.
2. Specialists who have a higher medical education in the specialty "General Medicine" or "Pediatrics" and a certificate of a specialist in the specialty "Therapy" are appointed to the post of a district therapist.
3. A district therapist in his activities is guided by legislation Russian Federation, regulatory legal acts of the federal executive body in the field of health care, executive bodies of the constituent entities of the Russian Federation and local self-government bodies, as well as the Regulations on the organization of the activities of the district therapist, approved by order of the Ministry of Health and Social Development of the Russian Federation of December 7, 2005 No. 765 "On the organization of the activity of the district therapist".
4. A district general practitioner carries out his activities to provide primary health care to the population in medical organizations, mainly of the municipal health system:
- polyclinics;
- outpatient clinics;
- inpatient polyclinic institutions of the municipal health care system;
- other treatment and prophylactic institutions providing primary health care to the population.
5. Remuneration for labor (financing of activities) of a district therapist is carried out in accordance with the legislation of the Russian Federation.
6. A district therapist must know the basics of the legislation of the Russian Federation on health care; regulatory documents governing the activities of healthcare institutions; the basics of organizing medical and prophylactic care in hospitals and outpatient clinics, ambulance and emergency medical care, disaster medicine service, sanitary and epidemiological service, drug supply to the population and health care facilities; theoretical foundations, principles and methods of medical examination; organizational and economic foundations of the activities of healthcare institutions and medical workers in the context of budgetary and insurance medicine; fundamentals of social hygiene, organization and economics of health care, medical ethics and deontology; legal aspects of medical practice; general principles and the main methods of clinical, instrumental and laboratory diagnostics of the functional state of organs and systems of the human body; etiology, pathogenesis, clinical symptoms, course features, principles complex treatment major diseases; rules for the provision of emergency medical care; bases of examination of temporary disability and medical and social examination; the basics of health education; internal labor regulations; rules and regulations of labor protection, safety, industrial sanitation and fire protection.
According to his specialty, a district therapist must know modern methods of prevention, diagnosis, treatment and rehabilitation; content and sections of therapy as an independent clinical discipline; tasks, organization, structure, staffing and equipment of the therapeutic service; current normative-legal and instructional-methodical documents in the specialty; rules for processing medical documentation; the procedure for the examination of temporary disability and medical and social examination; principles of planning and reporting of therapeutic services; methods and procedure for monitoring its activities.
7. A district general practitioner is appointed and dismissed by order of the chief physician of a medical facility in accordance with the current legislation of the Russian Federation.
8. The district physician-therapist is directly subordinate to the head of the department, and in his absence, to the head of the healthcare facility or his deputy.
2. Job responsibilities
Local doctor-therapist:
- forms a medical (therapeutic) area from the population attached to it;
- carries out sanitary and hygienic education, advises on the formation of a healthy lifestyle;
- carries out preventive actions to prevent and reduce morbidity, to identify early and latent forms of diseases, socially significant diseases and risk factors, organizes and runs schools of health;
- studies the needs of the population they serve in health-improving activities and develops a program for these activities;
- carries out dispensary observation patients, including those who have the right to receive a set of social services, in the prescribed manner;
- organizes and conducts diagnostics and treatment of various diseases and conditions, including rehabilitation treatment of patients in outpatient setting, day hospital and home hospital;
- provides emergency medical care to patients with acute illnesses, injuries, poisoning and other emergencies on an outpatient basis, day hospital and hospital at home;
- directs patients for consultations to specialists, including for inpatient and rehabilitation treatment for medical reasons;
- organizes and conducts anti-epidemic measures and immunoprophylaxis in the prescribed manner;
- conducts an examination of temporary incapacity for work in the prescribed manner and prepares documents for referral to medical and social expertise;
- issues a conclusion on the need to refer patients for medical reasons to sanatorium treatment;
- interacts with medical organizations of the state, municipal and private health systems, health insurance companies, and other organizations;
- organizes, jointly with the bodies of social protection of the population, medical and social assistance to certain categories of citizens: lonely, elderly, disabled, chronic patients in need of care;
- supervises the activities of paramedical personnel carrying out primary health care;
- maintains medical records in accordance with the established procedure, analyzes the health status of the attached population and the activities of the medical department;
- complies with the rules and principles of medical ethics and deontology;
- professionally and in a timely manner fulfills orders, orders and instructions of the management of a health care institution, as well as regulations on their professional activities;
- complies with the rules of internal regulations, fire safety and safety measures, sanitary and epidemiological regime;
- promptly takes measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors;
- systematically improves their qualifications.
3. Rights
The local therapist has the right:
1.to independently establish a diagnosis in the specialty based on clinical observations and examination, collection of anamnesis, data from clinical laboratory and instrumental research; determine the tactics of patient management in accordance with the established rules and standards; prescribe the instrumental, functional and laboratory diagnostics; carry out diagnostic, medical, rehabilitation and preventive procedures using approved diagnostic and treatment methods; involve, if necessary, doctors of other specialties for consultations, examination and treatment of patients;
2. to make proposals to the management of the institution to improve the treatment and diagnostic process, improve the work of administrative and economic and paraclinical services, the organization and conditions of their work;
3. control the work of subordinate employees (if any), give them orders within the framework of their official duties and demand their strict implementation, make proposals to the management of the institution to encourage them or impose penalties;
4. to request, receive and use information materials and regulatory documents necessary for the performance of their official duties;
5. to take part in scientific and practical conferences and meetings, which consider issues related to its work;
6. undergo certification in accordance with the established procedure with the right to obtain the appropriate qualification category;
7. to improve their qualifications at advanced training courses at least once every 5 years.
The local general practitioner enjoys all labor rights in accordance with Labor Code RF.
4. Responsibility
The local therapist is responsible for:
1.timely and high-quality performance of the duties assigned to him;
2. organization of their work, timely and qualified execution of orders, orders and instructions of the management, regulatory legal acts on their activities;
3. Compliance with internal regulations, fire safety and safety measures;
4. timely and high-quality registration of medical and other service documentation provided for by the current regulatory and legal documents;
5. provision of statistical and other information on their activities in accordance with the established procedure;
6. Ensuring compliance with executive discipline and the performance of their duties by employees subordinate to him (if any);
7. Prompt adoption of measures, including timely informing of the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the health care institution, its employees, patients and visitors.
For violation of labor discipline, legislative and regulatory legal acts, a local general practitioner may be brought to disciplinary, material, administrative and criminal liability in accordance with the current legislation, depending on the severity of the offense.
Research Institute of Public Health and Management
health care MMA them. I.M.Sechenov
M. A. TATARNIKOV
04.08.2006

APPROVED:

[Job title]

_______________________________

_______________________________

[Name of company]

_______________________________

_______________________/[FULL NAME.]/

"______" _______________ 20___

JOB DESCRIPTION

District physician

1. General Provisions

1.1. This job description defines and regulates the powers, functional and job responsibilities, rights and responsibilities of the district general practitioner [Organization name in the genitive case] (hereinafter referred to as the Medical Organization).

1.2. A district general practitioner is appointed and dismissed in accordance with the procedure established by the current labor legislation by order of the head of the Medical Organization.

1.3. The district therapist belongs to the category of specialists and is subordinate to [the names of the positions of subordinates in the dative case].

1.4. The district general practitioner reports directly to the [name of the position of the immediate supervisor in the dative case] of the Medical Organization.

1.5. A person who has a higher professional education in one of the specialties "General Medicine", "Pediatrics" and postgraduate professional education (internship and (or) residency) in the specialty "Therapy" or professional retraining in the presence of postgraduate professional education is appointed to the position of a district therapist. in the specialty "General practice (family medicine)", a certificate of a specialist in the specialty "Therapy" without any requirements for work experience.

1.6. The local therapist is responsible for:

• effective execution of the work entrusted to him;
• compliance with the requirements of performing, labor and technological discipline;
• the safety of the documents (information) in his custody (which have become known to him) containing (constituting) the commercial secret of the Medical Organization.

1.7. The district doctor-therapist should know:

• The Constitution of the Russian Federation;
• laws and other regulatory legal acts of the Russian Federation in the field of healthcare;
• Fundamentals of legislation on public health protection;
• general issues of the organization of therapeutic care in the Russian Federation;
• the work of medical institutions, the organization of the ambulance and emergency care adults and children;
• organization of work of the polyclinic, continuity in its work with other institutions;
• organization of day hospital and home hospital;
• basic questions of normal and pathological anatomy, normal and pathological physiology, the relationship of the functional systems of the body and the levels of their regulation;
• basics of water-electrolyte metabolism, acid-base balance, possible types of their disorders and principles of treatment;
• the system of hematopoiesis and hemostasis, physiology and pathophysiology of the blood coagulation system, homeostasis indicators in health and disease;
• fundamentals of immunology and body reactivity;
• clinical symptoms and pathogenesis of the main therapeutic diseases in adults and children, their prevention, diagnosis and treatment, clinical symptoms of borderline states in therapeutic clinic;
• fundamentals of pharmacotherapy in the clinic of internal diseases, pharmacodynamics and pharmacokinetics of the main groups medicines, complications caused by the use of drugs, methods of their correction;
• the basics of non-drug therapy, physiotherapy, physiotherapy exercises and medical supervision, indications and contraindications for spa treatment;
• fundamentals of rational nutrition of healthy persons, principles of diet therapy for therapeutic patients;
• anti-epidemic measures in the event of a focus of infection;
• medical and social examination at internal diseases;
• dispensary observation of healthy and sick, prevention problems;
• forms and methods of sanitary and educational work;
• demographic and social characteristics of the site;
• principles of organization of the civil defense medical service;
• the connection between the disease and the profession.

1.8. A district therapist in his activities is guided by:

• local acts and organizational and administrative documents of the Medical Organization;
• internal labor regulations;
• occupational health and safety regulations, industrial sanitation and fire protection;
• instructions, orders, decisions and instructions of the immediate supervisor;
• this job description.

1.9. During the period of temporary absence of the district therapist, his duties are assigned to [the name of the position of the deputy].

2. Job responsibilities

The district doctor-therapist is obliged to carry out the following labor functions:

2.1. Identifies and monitors risk factors for the development of chronic non-communicable diseases.

2.2. Implements primary prevention in high-risk groups.

2.3. Performs a list of works and services for the diagnosis of the disease, assessment of the patient's condition and the clinical situation in accordance with the standard of medical care.

2.4. Carries out a list of works and services for the treatment of a disease, condition, clinical situation in accordance with the standard of medical care.

2.5. Provides symptomatic assistance to oncological patients of the IV clinical group in cooperation with an oncologist.

2.6. Carries out an examination of temporary disability of patients, submission to the medical commission, referral of patients with signs of persistent disability for examination for medical and social examination.

2.7. Issues conclusions on the need to refer a patient for medical reasons to a sanatorium-resort treatment, draws up a sanatorium-resort card.

2.8. Carries out organizational, methodological and practical work for medical examination of the population.

2.9. Organizes vaccination of the population in accordance with national calendar preventive vaccinations and for epidemic indications.

2.10. Draws up and sends to the institutions of Rospotrebnadzor an emergency notification when an infectious or occupational disease.

2.11. Organizes and conducts events on sanitary and hygienic education (health schools, schools for patients with socially significant non-communicable diseases and individuals at high risk of their occurrence).

2.12. Monitors and analyzes the main medical and statistical indicators of morbidity, disability and mortality in the serviced area in the prescribed manner.

2.13. Keeps accounting and reporting documentation of the established form.

In the event of an official necessity, a district general practitioner may be involved in the performance of his official duties overtime, in the manner prescribed by the provisions of federal labor legislation.

3. Rights

The local therapist has the right:

3.1. To give subordinate employees and services assignments, assignments on a range of issues included in his functional duties.

3.2. Control the execution of production tasks, the timely execution of individual orders and tasks by the services subordinate to him.

3.3. Request and receive the necessary materials and documents related to the activities of the district general practitioner, subordinate services and units.

3.4. Interact with other enterprises, organizations and institutions on production and other issues related to the competence of the district general practitioner.

3.5. Sign and endorse documents within their competence.

3.6. Submit to the head of the Medical Organization for consideration the idea of \u200b\u200bthe appointment, relocation and dismissal of employees of subordinate units; proposals to encourage them or to impose penalties on them.

3.7. Enjoy other rights established by the Labor Code of the Russian Federation and other legislative acts of the Russian Federation.

4. Responsibility and performance evaluation

4.1. The district doctor-therapist bears administrative, disciplinary and material (and in some cases stipulated by the legislation of the Russian Federation - and criminal) responsibility for:

4.1.1. Failure to comply or improper fulfillment of the official instructions of the immediate supervisor.

4.1.2. Failure to perform or improper performance of his labor functions and the tasks assigned to him.

4.1.3. Misuse of the granted official powers, as well as their use for personal purposes.

4.1.4. Inaccurate information about the status of the work assigned to him.

4.1.5. Failure to take measures to suppress identified violations of safety regulations, fire safety and other rules that pose a threat to the activities of the enterprise and its employees.

4.1.6. Failure to enforce labor discipline.

4.2. Assessment of the work of the district therapist is carried out:

4.2.1. Immediate supervisor - regularly, in the process of the employee's daily performance of his labor functions.

4.2.2. The attestation commission of the enterprise - periodically, but at least once every two years, based on the documented results of work for the evaluation period.

4.3. The main criterion for evaluating the work of a district therapist is the quality, completeness and timeliness of his performance of the tasks provided for in this instruction.

5. Working conditions

5.1. The mode of work of the district therapist is determined in accordance with the internal labor regulations established in the Medical Organization.

6. Authority to sign

6.1. To ensure his activities, the district general practitioner is given the right to sign organizational and administrative documents on issues attributed to his competence by this job description.

Acquainted with the instructions ___________ / ____________ / "____" _______ 20__

The main principle of organizing the work of the polyclinic is the district principle of providing medical care, which consists in the fact that the territory served by the polyclinic is divided into territorial areas, based on the population in the area of \u200b\u200b1700 people. A certain physician-therapist and a nurse are assigned to each site, who are called upon to provide medical and preventive assistance to the residents of their site.

The therapeutic department employs doctors - specialists: surgeon, neuropathologist, otolaryngologist and ophthalmologist. This method of work is called brigade, when these specialists serve patients in the clinic and at home from certain therapeutic areas.

The work of each department - brigade is organized in such a way that all its members work at the same hours. In these conditions, the role of the therapist increases in the process of providing medical care to the population. Unification into teams ensures an even distribution of the workload among doctors, their interchangeability, strengthening of continuity, the opportunity to exchange experience in patient management.

The main tasks of the district therapist:

Providing qualified therapeutic assistance to the population of the site at the reception in the clinic and at home;

Organization and direct implementation of preventive measures among the population of your site;

Reducing morbidity and mortality of the population in the assigned area.

Duties of the local general practitioner:

Timely therapeutic assistance to the population of the site in the clinic and at home;

Emergency medical care for patients in the event of acute conditions, injuries, poisoning;

Timely hospitalization of therapeutic patients with compulsory preliminary examination during planned hospitalization;

Patient consultations in the clinic;

Use in your work modern methods prevention, diagnosis and treatment of patients, including complex therapy and rehabilitation treatment;

Examination of temporary disability of patients;

Organization and implementation of complex measures for prophylactic medical examination of the adult population of the site;

Issuance of an opinion to residents of the site undergoing medical examinations and leaving abroad;

Organization and implementation of preventive vaccinations and deworming of the population of the site;

Early detection, diagnosis and treatment of infectious diseases, immediate signaling to the head of the therapeutic department and the doctor of the office of infectious diseases about all infectious diseases, food and occupational poisoning... Sending an emergency notification to the appropriate SES;

Systematic improvement of their qualifications and the level of medical knowledge of the district nurse;

Active and systematic conduct of sanitary and educational work among the population of the site, the fight against bad habits.

The work of the district general practitioner is carried out according to the schedule approved by the head of the department or the head of the institution. The schedule provides for fixed hours of outpatient reception of patients, home help, preventive and other work.

On average, a doctor works on an outpatient basis from 2.5 to 3.5 hours, and to provide assistance at home - from 3 to 4 hours; 0.5 hour allocated daily for sanitation work.

An important section of the work of the district doctor is the reception of patients in the polyclinic. Each visit to a sick doctor should be exhaustive and complete. Reappointments should be based on medical indications.

During the entire period of observation of the patient in the polyclinic, a "medical card of an outpatient patient" is kept. All examination data, diagnoses, treatment, consultations, dismissal from work and other information must be entered into the "outpatient medical record" on the same day.

Big role plays medical care of patients at home. On average, the time spent by a local doctor when providing assistance at home should be 30-40 minutes. After examining the patient at home on call, the district doctor subsequently visits the patient as necessary on his own initiative. Active home visits are planned by the doctor himself, depending on the patient's state of health. When providing assistance with the organization of a "hospital at home", the doctor must ensure that the patient takes all the necessary measures: laboratory and other studies, medical procedures, etc.

IN modern conditions day hospitals in outpatient clinics became widespread. In day hospitals, patients have the opportunity to comprehensive survey and treatment. In addition, it is a more economical form of treatment compared to a 24-hour hospital.

The local doctor at his site is not only the attending physician-therapist, but also the organizer of all medical and preventive care for the population.

Medical therapeutic area- the most important link in the system of medical care, and the district therapist is the leading figure in the area and in the system of public health protection. The size of the adult population of the therapeutic area is currently 1700 on average, and 1600 for the workshop (in a number of industries, depending on the working conditions in the workshop, up to 2000 and less than 1000).

District doctoris not only a clinician, it is a healthcare organizer at the primary health care stage. The district doctor needs knowledge of the basics of public health and health care, clinical medicine, sociology and family psychology. The district doctor should be a researcher of the health status of the population of his area and the factors affecting it, should improve his activities, introduce new methods of diagnosis and treatment, elements of the scientific organization of labor.

A good local doctor is essentially a general practitioner.

In accordance with the regulation "On the general practitioner of the local polyclinic (outpatient clinic)", the local therapist is obliged to provide:

Timely qualified therapeutic assistance to the population of the site in the polyclinic (outpatient clinic) and at home;

Emergency medical care for patients regardless of their place of residence in case of direct treatment in the event of acute conditions, injuries, poisoning;

Timely hospitalization of therapeutic patients with mandatory preliminary examination during planned hospitalization;

Consultation of patients, if necessary, together with the head of the therapeutic department, doctors of other specialties of the polyclinic (outpatient clinic) and other health care institutions;

The use of modern methods of prevention, diagnosis and treatment of patients, including complex therapy and rehabilitation treatment ( medications, diet therapy, physiotherapy exercises, massage, physiotherapy, etc.);

Examination of temporary disability of patients in accordance with the current regulation on the examination of temporary disability;

Organization and implementation of a set of measures for prophylactic medical examination of the adult population of the site (identification, registration, dynamic observation, medical and recreational activities), analysis of the effectiveness and quality of prophylactic medical examination;

Organization and implementation of preventive vaccinations and deworming of the population of the site;

Early detection, diagnosis and treatment of infectious diseases, immediate reporting to the head of the therapeutic department and the doctor of the office of infectious diseases about all cases of infectious diseases or patients suspected of being infected, about food and occupational poisoning, about all cases of non-compliance with anti-epidemic requirements by infectious patients, referral to the appropriate department of the SES emergency notification of an infectious disease;

Systematic improvement of their qualifications and the level of medical knowledge of the district nurse;

Active and systematic implementation of medical and educational work among the population of the site, the fight against harmful habits.

The local therapist works according to the schedule approved by the head of the department, which provides for fixed hours of outpatient admission to patients, home help, preventive and other work. The distribution of the time for receiving and helping at home depends on the size and composition of the population of the site, on the prevailing attendance, etc.

Home health care- one of the main activities of the polyclinic. Medical assistance at home is provided around the clock: from 9 am to 7 pm - by a local doctor, the rest of the time in urgent cases - by an ambulance and emergency doctor.

When making a house call, the patient's condition is found out, and in case of emergency, the doctor on duty (in the absence or employment of a local doctor) goes to the patient immediately. In urgent cases requiring hospitalization, an ambulance is called. The call data is logged. Follow-up visits by the doctor to the patient at home are called active if they are made at the initiative of the doctor, without calling the patient. The doctor ensures the conduct of clinical and diagnostic studies, the performance of medical procedures by the nurse, consults the patient with doctors of other specialties.

48. Application of the dispensary method in the work of medical institutions.

Preventive work consists, first of all, in the widespread use by doctors of outpatient clinics, especially district therapists, dispensary method.This is an active method of dynamic monitoring of the health status of certain contingents (healthy and sick) of the population with the aim of early detection of diseases, registration and comprehensive treatment of patients, taking measures to improve working and living conditions, to prevent the occurrence and spread of diseases, to form a healthy lifestyle ...

Distinctive feature medical care provided in polyclinics is an organic combination of curative and preventive work in the activities of all doctors of this institution.

3 main directions in a preventive doctor:

a) sanitary and educational work- when communicating with each patient, he should be explained the principles of healthy lifestyle and the regime for a specific disease, the basics of rational and therapeutic nutrition, the harm of smoking and alcohol abuse and other sanitary and hygienic aspects; the doctor also conducts lectures in the clinic and at enterprises, issues health bulletins and other information materials, etc.

b) vaccination work- carried out under the guidance of immunologists, infectious disease specialists and district therapists of the polyclinic (in last years there was an urgent need for a universal vaccination of the adult population against diphtheria)

in) clinical examination (dispensary method)Is a method of active dynamic monitoring of the state of health of the population, aimed at improving health and increasing working capacity, ensuring proper physical development and preventing diseases by carrying out a complex of medical, recreational and preventive measures. In the dispensary method of work of the medical institution, the preventive orientation of the ZO is most fully expressed.

Contingents subject to clinical examinationinclude both healthy and sick people.

1st group (healthy) includes:

Persons who, due to their physiological characteristics, require systematic monitoring of their health (children, adolescents, pregnant women);

Persons exposed to adverse factors of the working environment;

The decreed contingents (food workers, communal service workers, workers of public and passenger transport, personnel of children and medical institutions, etc.);

Special contingents (persons affected by the Chernobyl disaster);

Disabled people and participants of the Great Patriotic War and contingents equated to them.

Clinical examination healthyis aimed at maintaining health and working capacity, identifying risk factors for the development of diseases and their elimination, preventing the occurrence of diseases and injuries through the implementation of preventive and recreational measures.

Group 2 (patients) includes:

Sick chronic diseases;

Reconvalescents after some acute diseases;

Patients with congenital (genetic) diseases and malformations.

Clinical examination sickprovides for early detection of diseases and elimination of the causes that contribute to their occurrence; prevention of exacerbations, relapses, complications; preservation of working capacity and active longevity; reducing morbidity, disability and mortality by providing comprehensively qualified curative care, carrying out health-improving and rehabilitation measures.

Dispensary tasks:

• identification of persons with risk factors and patients with early stages diseases by conducting annual preventive examinations of compulsory contingents and, if possible, other groups of the population;
• active observation and rehabilitation of patients and persons with risk factors;
• examination, treatment and rehabilitation of patients according to the appealability, dynamic monitoring of them;
• creation of automated information systems and data banks for dispensary registration of the population.

Stages of medical examination:

1st stage. Registration, survey of the population and selection of contingents for registration in dispensary registration.

a) registration of the population by district by conducting a census by a paramedical worker

b) a survey of the population in order to assess the state of health, identify risk factors, and early detection of patients.

The identification of patients is carried out during preventive examinations of the population, when patients apply for medical care in health care facilities and at home, with active calls to a doctor, as well as during special examinations about contact with an infectious patient.

Distinguish 3 types of preventive examinations.

1) preliminary- is carried out for persons entering work or study in order to determine the suitability (suitability) of workers and employees for the work they have chosen and to identify diseases that may be contraindications for working in this profession.

2) periodic- is carried out to persons in a planned manner at a specified time to certain groups of the population and with the current appeal for medical care in medical institutions.

To contingents subject to mandatory periodic inspections, relate:

Workers of industrial enterprises with harmful and dangerous working conditions;

Workers in leading professions in agricultural production;

Ordered contingents;

Children and adolescents, youths of pre-conscription age;

Students of vocational schools, technical schools, university students;

Pregnant women;

Disabled people and participants of the Great Patriotic War and contingents equated to them;

Persons affected by the Chernobyl disaster.

For the rest of the population, the physician must use every visit of the patient to the medical facility for a preventive examination.

3) target- is carried out for the early detection of patients with certain diseases (tuberculosis, malignant neoplasms etc.)

The main forms of preventive examinations are

and. individual- carried out:

According to the appeal of the population to the medical institution (for a certificate, in order to issue a sanatorium-resort card, in connection with the disease);

With an active call of persons served by the polyclinic for dispensary examination in the polyclinic;

When doctors visit patients with chronic diseases at home;

Among persons being treated in a hospital;

When examining persons who were in contact with an infectious patient.

This is the main form of medical examinations of the unorganized population.

b. massive- are held, as a rule, among organized groups of the population: children of preschool and school institutions, youths of pre-conscription age, students of secondary specialized institutions and students of universities, workers and employees of enterprises, institutions. Mass preventive examinations, as a rule, are complex and combine periodic and targeted.

Inspections of organized teams are carried out on the basis of agreed schedules and are regulated by the relevant orders of the Ministry of Health.

The data of medical examinations and the results of the examinations carried out are recorded in the medical records("Medical card of an outpatient patient", "Individual card of a pregnant and postpartum woman", "History of a child's development").

Based on the results of the examination, a conclusion is given on the state of health and observation group:

a) group "healthy" (D1)- these are persons who do not make complaints and who have no health abnormalities in the history and on examination.

b) the group "practical healthy" (D2) -persons with a history of chronic diseases without exacerbations for several years, persons with borderline conditions and risk factors, often and long-term ill, convalescents after acute diseases.

c) group "chronic patients" (D3):

Persons with a compensated course of the disease with rare exacerbations, short-term disability, which does not interfere with the performance of normal work activities;

Patients with a subcompensated course of the disease, who have frequent annual exacerbations, prolonged disability and its limitation;

Patients with a decompensated course of the disease, having persistent pathological changes, irreversible processes leading to permanent disability and disability.

If a disease is detected in the examined person, the doctor fills in a statistical coupon (form 025/2-y); makes entries about the state of health in the medical record of the outpatient (form 025 / y). Persons referred to the third health group are taken into dispensary registration by a district doctor or a specialist doctor. When the patient is taken to the dispensary registration, the patient starts dispensary observation control card (f. 030 / y), which is kept by the doctor who carries out dispensary observation of the patient. The control chart indicates: the name of the doctor, the date of registration and removal from the register, the reason for withdrawal, the disease for which he was taken under dispensary observation, the number of the patient's outpatient card, his last name, first name, patronymic, age, gender, address, place of work, doctor's attendance, records of changes in the initial diagnosis, concomitant diseases, a set of medical and preventive measures.

Carrying out a preventive examination without subsequent medical and health-improving and preventive measures does not make sense. Therefore, for each dispensary, a dispensary observation plan is drawn up, which is noted in the dispensary observation control card and in the outpatient's medical card.

2nd stage. Dynamic monitoring of the health status of dispensaries and the implementation of preventive and therapeutic measures.

Dynamic observation of a dispensary is carried out differentiated by health groups:

a) observation of healthy people (group 1) - carried out in the form of periodic medical examinations. Obligatory contingents of the population undergo annual examinations according to the plan in a timely manner. For the rest of the population, the physician should make the most of any patient attendance at medical institution... In relation to this group of the population, recreational and preventive measures are carried out aimed at preventing diseases, promoting health, improving working and living conditions, as well as promoting healthy lifestyles.

b) observation of persons assigned to group 2 (practically healthy) is aimed at eliminating or reducing risk factors for the development of diseases, correcting hygienic behavior, increasing the compensatory capabilities and resistance of the body. Observing patients who have undergone acute diseases is aimed at preventing the development of complications and chronicity of the process. The frequency and duration of observation depends on the nosological form, the nature of the process, possible consequences (after an acute sore throat, the duration of clinical examination is 1 month). Dispensary observation by a general practitioner is subject to patients with acute diseaseswith a high risk of chronicity and development of severe complications: acute pneumonia, acute tonsillitis, infectious hepatitis, acute glomerulonephritis and others.

c) observation of persons assigned to group 3 (chronic patients) is carried out on the basis of a plan of medical and recreational activities, which provides for the number of dispensary visits to a doctor; consultations of specialist doctors; diagnostic studies; drug and anti-relapse treatment; physiotherapy procedures; physiotherapy exercises; diet food, Spa treatment; sanitation of foci of infection; planned hospitalization; rehabilitation measures; rational employment, etc.

Dispensary group of patients with chronic diseasespatients subject to dispensary observation by general practitioners are patients with following diseases: chronical bronchitis, bronchial asthma, bronchiectasis, lung abscess, hypertonic disease, NDC, IBS, peptic ulcer stomach and duodenal ulcer, chronic gastritis with secretory insufficiency, chronic hepatitis, cirrhosis of the liver, chronic cholecystitis and gallstone disease, chronic colitis and enterocolitis, ulcerative colitis, urolithiasis disease, chronic glomerulonephritis, chronic pyelonephritis, osteoarthritis, rheumatism, rheumatoid arthritis, often and long-term ill. If there are doctors of narrow specialties in the polyclinic, specialized patients, depending on the age and stage of compensation, can be under dispensary supervision by these specialists.

A group of dispensary patients subject to dispensary observation by a surgeon,are patients with phlebitis and thrombophlebitis, varicose veins veins lower limbs, post-resection syndromes, chronic osteomyelitis, endarteritis, trophic ulcers, etc.

In the course of dynamic observation, the planned activities during the year are carried out, adjusted, supplemented. At the end of the year, a staged epicrisis is filled in for each dispensary, which reflects the following points: the initial state of the patient; medical and recreational activities carried out; dynamics of the course of the disease; final assessment of health status (improvement, deterioration, no changes). The epicrisis is reviewed and signed by the head of the department. For convenience, many health care facilities use special forms of the "plan-epicrisis of dispensary observation", which are pasted into the medical record and can significantly reduce the time spent on paperwork.

3rd stage. Annual analysis of the state of dispensary work in health care facilities, assessment of its effectiveness and development of measures to improve it (see question 51).

Statistical analysis of dispensary work is carried out based on the calculation of three groups of indicators:

Indicators characterizing the organization and volume of medical examination;

Indicators of the quality of clinical examination (activity of medical supervision);

Indicators of the effectiveness of clinical examination.

A) indicators of the volume of medical examination

1. Coverage of dispensary observation of patients with this nosological form:

2. The structure of patients registered with dispensaries:

B) indicators of the quality of medical examination

1. Timeliness of coverage of newly diagnosed patients with dispensary observation:

2. Activity of making visits to the doctor:

3. Percentage of hospitalized dispensary patients:

Similarly, the activity of performing other medical, diagnostic and health-improving measures among the dispensary is calculated (diet, sanatorium treatment, anti-relapse treatment, etc.)

C) indicators of the effectiveness of clinical examination

1. Changes in the state of health of the dispensaries (with improvement, with deterioration, without changes)

2. The proportion of patients who have had an exacerbation of the disease for which dispensary observation is carried out.

3. Morbidity with temporary disability of dispensary (in cases and days):

4. Primary disability among dispensary:

5. Mortality of prophylactic patients.

1. This job description defines the job duties, rights and responsibilities of the district general practitioner.

2. Specialists who have higher professional education in one of the specialties "General Medicine", "Pediatrics" and postgraduate professional education (internship and (or) residency) in the specialty "Therapy" or professional retraining in the presence of postgraduate professional education in the specialty "General medical practice (family medicine)", a certificate of a specialist in the specialty "Therapy" without any requirements for work experience.

3. A precinct general practitioner in his activities is guided by the legislation of the Russian Federation, regulatory legal acts of the federal executive body in the field of health care, executive bodies of the constituent entities of the Russian Federation and local governments, as well as the regulation on the organization of the activity of a district therapist.

4. A district general practitioner carries out his activities to provide primary health care to the population in medical organizations, mainly of the municipal health system:

Polyclinics;

Outpatient clinics;

Inpatient polyclinic institutions of the municipal health care system;

Other hospitals providing primary health care to the population.

5. Remuneration for labor (financing of activities) of a local therapist is carried out in accordance with the legislation of the Russian Federation.

6. The district doctor-therapist must know: the Constitution of the Russian Federation; laws and other regulatory legal acts of the Russian Federation in the field of healthcare; Fundamentals of legislation on public health protection; general issues of the organization of therapeutic care in the Russian Federation; the work of medical and preventive institutions, the organization of the work of ambulance and emergency care for adults and children; organization of work of the polyclinic, continuity in its work with other institutions; organization of day hospital and home hospital; the main issues of normal and pathological anatomy, normal and pathological physiology, the relationship of the functional systems of the body and the levels of their regulation; basics of water-electrolyte metabolism, acid-base balance, possible types of their disorders and principles of treatment; the system of hematopoiesis and hemostasis, physiology and pathophysiology of the blood coagulation system, homeostasis indicators in health and disease; basics of immunology and body reactivity; clinical symptoms and pathogenesis of the main therapeutic diseases in adults and children, their prevention, diagnosis and treatment, clinical symptoms of borderline states in a therapeutic clinic; fundamentals of pharmacotherapy in the clinic of internal diseases, pharmacodynamics and pharmacokinetics of the main groups of drugs, complications caused by the use of drugs, methods of their correction; the basics of non-drug therapy, physiotherapy, physiotherapy exercises and medical supervision, indications and contraindications for spa treatment; fundamentals of rational nutrition of healthy persons, principles of diet therapy for therapeutic patients; anti-epidemic measures in the event of a focus of infection; medical and social expertise in internal diseases; dispensary observation of healthy and sick, prevention problems; forms and methods of sanitary and educational work; demographic and social characteristics of the site; principles of organization of the civil defense medical service; the connection between the disease and the profession

7. A district general practitioner is appointed and dismissed by order of the head medical organization in accordance with the current legislation of the Russian Federation.

8. The district general practitioner is directly subordinate to the head of the department, and in his absence to the head of the medical organization or his deputy.

2. Job responsibilities

Identifies and monitors risk factors for the development of chronic non-communicable diseases. Provides primary prevention in high-risk groups. Carries out a list of works and services for the diagnosis of the disease, assessment of the patient's condition and the clinical situation in accordance with the standard of medical care. Carries out a list of works and services for the treatment of a disease, condition, clinical situation in accordance with the standard of medical care. Provides symptomatic assistance to oncological patients of the IV clinical group in interaction with an oncologist. Carries out an examination of temporary disability of patients, submission to a medical commission, referral of patients with signs of persistent disability for examination for medical and social examination. Issues conclusions on the need to refer a patient for medical reasons to a spa treatment, draws up a sanatorium card. Carries out organizational, methodological and practical work on the medical examination of the population. Organizes vaccination of the population in accordance with the national calendar of preventive vaccinations and according to epidemic indications. Draws up and sends to the institutions of Rospotrebnadzor an emergency notification when an infectious or occupational disease is detected. Organizes and conducts activities on sanitary and hygienic education (health schools, schools for patients with socially significant non-communicable diseases and persons with a high risk of their occurrence). Monitors and analyzes the main medical and statistical indicators of morbidity, disability and mortality in the serviced area in the prescribed manner. Keeps accounting and reporting documentation of the established form.

3. Rights

The local therapist has the right:

1. independently establish a diagnosis in a specialty based on clinical observations and examination, collection of anamnesis, data of clinical laboratory and instrumental studies; determine the tactics of patient management in accordance with the established rules and standards; prescribe the methods of instrumental, functional and laboratory diagnostics necessary for a comprehensive examination of the patient; carry out diagnostic, medical, rehabilitation and preventive procedures using approved diagnostic and treatment methods; if necessary, involve, in the prescribed manner, doctors of other specialties for consultations, examination and treatment of patients;
2. make proposals to the management to improve the treatment and diagnostic process, improve the work of administrative and economic and paraclinical services, the organization and conditions of their work;
3. control, within the framework of its competence, the work of middle and junior medical personnel, give them orders and demand their strict implementation, make proposals to the management on their encouragement or imposition of penalties;
4. to request, receive and use information materials and regulatory documents necessary for the performance of their official duties;
5. take part in scientific and practical conferences and meetings at which issues related to its work are considered;
6. undergo certification in the prescribed manner with the right to receive the appropriate qualification category;
7. improve their qualifications at refresher courses at least once every 5 years.

The district doctor-therapist enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The local therapist is responsible for:

1. timely and high-quality implementation of the duties assigned to him;
2. timely and qualified execution of orders, orders and instructions of the management, regulatory legal acts on their activities;
3. compliance with internal regulations, fire safety and safety measures;
4. timely and high-quality registration of medical and other service documentation provided for by the current regulatory and legal documents;
5. provision of statistical and other information on their activities in accordance with the established procedure;
6. observance of performance discipline and performance of official duties by employees subordinate to him (if any);
7. promptly taking measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of a medical organization, its employees, patients and visitors.

For violation of labor discipline, legislative and normative legal acts, a district therapist may be brought to disciplinary, material, administrative and criminal liability in accordance with the current legislation, depending on the severity of the offense.