Domestic medicine, among other things, is famous for its continuity. However, despite the presence of a department of history of medicine in every medical university in our country without exception, modern doctors know little about the luminaries of the medical profession - those thanks to whom, to one degree or another, they receive an education, and also have the opportunity to use various methods diagnosis and treatment of diseases. In other words, the profession is losing its nobility and intelligence, while it is common knowledge that from time immemorial in our country, a doctor, along with qualifications, had deep culture and general erudition. Fortunately, we have individual representatives of the medical community who are trying to revive this connection between generations in the clinical world, amazingly combining both the highest general culture and the professionalism of the bygone galaxy of doctors, as well as a non-trivial approach to one of the most conservative specialties, adapted to the current reality.
One of our country’s leading specialists in the field of internal medicine, head of the Department of Therapy, clinical pharmacology and ambulance medical care Moscow State Medical and Dental University named after. A.I. Evdokimov, professor, Honored Scientist of the Russian Federation Arkady VERTKIN.
- Arkady Lvovich, you are a hereditary doctor. Did this influence your choice of profession?
I was born in the city of Kislovodsk, where my father was the chief physician of a resort hospital where sick vacationers were treated. In this hospital, along with perfectly delivered healing process was absolutely amazing home furnishings. All medical staff clinics - from the head doctor to the nurse - lived as a single family with the patients. Since birth I have seen incredible medicine. The fact is that in the post-war years, many leading therapists in our country moved to Kislovodsk. This hospital was one of the bases Central Institute improvement of doctors. Who among the great doctors worked there!.. From morning to evening there were clinical examinations. 24 hours a day I listened to conversations about patients. My mother was also a doctor - she headed the department functional diagnostics at the resort clinic.
So already with early years I have formed my own ideology about what a good doctor is, especially a therapist. First of all, he must be born into a prosperous family. Homeless people will not make a therapist - the question is clear. In addition, from my point of view, without a good heart you cannot become a good internist. Not to mention the fact that you need to work hard, read constantly and have a good mentor, since without a teacher in the broad sense of the word there is nothing to do in medicine.
- Why?
Therapy, unlike others clinical specializations, - V highest degree logical discipline. This logic cannot be mastered without a teacher. Therapy is not a craft, not a listing of symptoms. This is absolute logic. The ability to think logically at the bedside develops to the greatest extent under the influence of an experienced mentor, caring and purposeful, who wants to leave behind a legacy in the form of well-prepared students who will continue his work. Of course, a lot comes with experience, but without a mentor you cannot become a real, highly qualified clinician. I am absolutely convinced of this.
-Who do you consider your main teacher in the profession?
First of all - his father. He was a brilliant therapist. His virtually error-free diagnosis was verified by autopsy results. There were practically no discrepancies. I was also lucky to meet upon my arrival in Moscow the current president of the All-Russian scientific society therapists, Academician of the Russian Academy of Sciences Anatoly Martynov, who gave me a lot professionally. In those years, he was an assistant professor in the department of Professor Vladimir Pomerantsev, whom I also consider one of my main mentors. Few people know about him, but he was amazing person and professional. He brilliantly mastered the methodology of diagnosis. His methodological recommendations did not require editing. He was a great Methodist.
- Recently, you have been publishing biographies of outstanding domestic therapists. What are the goals of this project?
Imagine that suddenly Pushkin was banned at the state level. So, I don’t know who is “cooler”: the great Russian doctors or Pushkin. Great Literature or great medicine, where the cultural component is at least the same - what is higher on the hierarchical ladder of values? I can't answer this question. Look at the portraits of these doctors - their faces, their clothes... These people dedicated their entire lives to medicine and patients. All their scientific works were based on propaedeutics - the basis of the principles in the clinic. Remained documentary evidence their communication with patients is a separate science. You won't see anything like this now.
Take, for example, Maxim Petrovich Konchalovsky, Obraztsov, Strazhesko, Pasternatsky, Zimnitsky... Such people must be remembered. It is necessary to know about their lives, not to mention the personal contribution of each of them to medicine and science. Their works came from the mind and heart. All of them began their professional careers as pathologists - in the prosthesis department, while today's doctors have little knowledge of anatomy, not to mention the other shortcomings of modern education...
At some stage of their development, current doctors forgot about their great predecessors, which is unacceptable, in my opinion. These were widely, highly educated people - both in general and professionally. So you think: how can you choose a mentor for yourself nowadays, when the legacy of our the best doctors, to put it mildly, forgotten. Continuity has been lost.
Why don’t today’s students and young doctors have much respect for the older generation, unlike their brothers-in-arms of yesteryear?
Most modern professors have neither the need nor the time to work with young people. It’s much easier to “dismiss” young people than to devote a couple of hours of your time. When I was a resident, my mentors took care of me: they taught me, literally took me by the hand to see patients, advised me on this or that monograph, etc. How can a feeling of respect or piety not arise in such a situation? Everything is natural.
I’m used to this and try to devote more time to young doctors. It is necessary to understand that they are the ones who will soon replace us, and their qualifications are largely our merit or, as is often the case now, an omission. Previously, the word “clinic” meant “shrine.” Now this is not the case. Much has been devalued, but I am absolutely convinced that, despite all the obstacles, to this day young doctors have good opportunity find yourself a mentor - a guide to the clinical world.
Your wife, Natalya Viktorovna, heads the capital’s City Clinical Hospital No. 81, you actually manage the therapeutic activities of City Clinical Hospital No. 50. Who is in charge in the house?
We met more than 40 years ago. During those years, she worked as a radiologist and finished her work around 2 p.m. I was on duty at an ambulance at 1.5 rates, I was on duty at a clinic, I worked part-time decoding ECG. In short, the lion's share family budget I got it. However, I cannot say that I had the feeling that I was the head of the family due to the fact that I provided for the family. You know, we don’t have much time left until our golden wedding, and our family has maintained absolute equality all these years. We understand each other perfectly. We already have four grandchildren, so we have enough worries besides figuring out which of us is more important.
When you were 40 years old, the USSR collapsed and your life changed radically. How did you perceive this, being already a mature, formed personality?
If we take away the political component, then for me it was a turn in better side. This is undeniable. New income opportunities have emerged using your professionalism and intelligence: the main thing is to work hard, fruitfully and efficiently. In addition, borders have opened for residents of our country: it is possible to freely visit all countries of the world, including with the aim of improving their vocational training, not to mention trips for general development and have a nice time. I am not at all nostalgic for the Soviet era. I managed to fit into modern life.
- Due to what?
The secret of my success is simple: work, work and more work. It’s not stupid to sit in your desk chair, but to effectively use the knowledge you have for the benefit of patients, students and colleagues. Wealth, including material wealth, is the result of proper application and application mental abilities. My whole life is a constant overcoming of difficulties. From an early age. I experienced all the “charms” of that time - leveling, suppression of individuality, imposition of imaginary ideals, anti-Semitism, and not at the everyday level... Nevertheless, I did not give up and found my niche, taking a worthy place in life.
- How does Professor Vertkin spend his rare minutes of free time?
I have completely “masculine” hobbies: Lately I am fond of alpine skiing and tennis. In my youth, I received a master of sports in basketball and chess. I love preference. Until recently I played football regularly. I remain a football fan to this day.
- And which club are you worried about?
All my life I have loved extraordinary people. In my youth, I was a fan of the Moscow “Torpedo” - Streltsov, Ponamarev, Voronin, Ivanov... I especially liked “Sagittarius” - Eduard Streltsov, who could do incredible things on the field in a second. In chess, my idol was Mikhail Tal. His playing style was literally mesmerizing: endless sacrifices, intrigue, high tempo...
- Did you have any idols?
My father. His medical abilities and professional talent could not leave anyone indifferent. And he was an extraordinary and extraordinary person. For me, he was an example in almost everything, mainly in his profession.
- What is your main achievement??
First of all, this is a marriage of over 40 years. I also can’t help but notice that my grandchildren turn out quite well (smiles). This is also an achievement. Moreover, I believe that I have prepared great amount doctors, and our clinic sounds at the federal level, approaching the classics of the national medical school.
-Are you a happy person?
Absolutely. Happiness is a biochemical reaction that occurs when the so-called “hormones of happiness” are released into the blood, which appears when a person is in harmony with the world around him and himself: success in personal life and in the professional field, favorite hobbies, good vacation, even tasty food… Considering that I have all the components of this, I consider myself absolutely lucky.
Conducted the conversation
Dmitry VOLODARSKY,
MG columnist.
Born in 1951 in Kislovodsk into a family of employees. A. L. Vertkin is a doctor of the highest category, for 12 years in parallel with his work at the department he headed therapeutic department in 50 city clinical hospital. A.L. Vertkin is a member of the Scientific Medical Council of the Moscow State Medical University, a member of the methodological commission of the Ministry of Health of the Russian Federation on clinical pharmacology, the editorial board of the journals “International Medical Journal”, “Concilium”, “Doctor Ru.”, “Russian Medical Journal”, editor-in-chief of the journals “Emergency” therapy" and reviewed by the Higher Attestation Commission "Emergency Doctor", Head of the National Scientific and Practical Society of Emergency Medical Care and the Interdisciplinary Organization of Specialists for the Study of Age-Related Involution, member of the Presidium of the All-Russian Scientific Society of Therapists.
After graduating from MMSI (now MGMSU) from 1974 to 1976. studied in clinical residency, and from 1976 to 1979. — in graduate school at the Department of Hospital Therapy of the same institute. From 1979 to 1989 - assistant and associate professor of the department of internal diseases, from 1989 to 1990 - professor of the same department, from 1990 to 1997. - head Department of Clinical Pharmacology, from 1997 to 2001 - Head of the Department of Clinical Pharmacology and Internal Diseases of Moscow State Medical University, from 2001 - Head. Department of Clinical Pharmacology, Pharmacotherapy and Emergency Medical Care, and since 2010 - Head. Department of Therapy, Clinical Pharmacology and Emergency Medicine. In 1980 he defended his candidate's dissertation, and in 1990 - his doctorate. Author of more than 900 scientific works, 15 monographs and textbooks, 35 methodological recommendations, 6 inventions. Under his leadership, 14 doctoral and 102 candidate dissertations were defended. In 1990, A.L. Vertkin was awarded the Prize of the Council of Ministers of the USSR for the development and introduction into the clinic of a method of radioisotope study of the heart, and in 1998 for research on treatment peptic ulcer stomach and duodenum - Moscow City Hall Prize. In 1999 he was awarded the “850th Anniversary of Moscow” medal, in 2001 and 2005. — diploma “Scientist-Educator of the Year” and Certificates of Honor from the Minister of Health of the Russian Federation.
In 2001, A.L. Vertkin was awarded the title “Honored Scientist of the Russian Federation.”
Under the leadership of A.L. Vertkin, more than 20 major international forums on current problems of medicine were organized.
A.L. Vertkin is married. Wife - Vertkina Natalya Viktorovna - doctor medical sciences, chief physician City Clinical Hospital No. 81 of the Moscow Government Health Department. Son - Vertkin Maxim Arkadievich, Ph.D., doctor.
Vertkin, Arkady Lvovich
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Vertkin Arkady Lvovich- born in 1951 in Kislovodsk into a family of employees. After graduating from MMSI (now MGMSU) from 1974 to 1976. studied in clinical residency, and from 1976 to 1979. - in graduate school at the Department of Hospital Therapy of the same institute. From 1979 to 1989 - assistant and associate professor of the department of internal diseases, from 1989 to 1990 - professor of the same department, from 1990 to 1997. - manager Department of Clinical Pharmacology, from 1997 to 2001 - Head of the Department of Clinical Pharmacology and Internal Diseases of Moscow State Medical University, from 2001 - Head. Department of Clinical Pharmacology, Pharmacotherapy and Emergency Medical Care, and since 2010 - Head. Department of Therapy, Clinical Pharmacology and Emergency Medicine. In 1980 he defended his candidate's dissertation, and in 1990 - his doctorate. He is the author of more than 900 scientific papers, 15 monographs and textbooks, 35 methodological recommendations, 6 inventions. Under his leadership, 14 doctoral and 102 candidate dissertations were defended. In 1990, A.L. Vertkin was awarded the Prize of the Council of Ministers of the USSR for the development and introduction into the clinic of a method of radioisotope study of the heart, and in 1998, for research on the treatment of gastric and duodenal ulcers, he was awarded the Moscow City Hall Prize. In 1999 he was awarded the “850th Anniversary of Moscow” medal, in 2001 and 2005. - diploma “Scientist-Educator of the Year” and Certificates of Honor from the Minister of Health of the Russian Federation.
In 2001, A.L. Vertkin was awarded the title “Honored Scientist of the Russian Federation.” A.L. Vertkin is a doctor of the highest category; for 12 years, in parallel with his work at the department, he headed the therapeutic department at the 50th city clinical hospital. A.L. Vertkin is a member of the Scientific Medical Council of the Moscow State Medical University, a member of the methodological commission of the Ministry of Health of the Russian Federation on clinical pharmacology, the editorial board of the journals “International Medical Journal”, “Concilium”, “Doctor Ru.”, “Russian Medical Journal”, editor-in-chief of the journals “Emergency” therapy" and reviewed by the Higher Attestation Commission "Emergency Doctor", Head of the National Scientific and Practical Society of Emergency Medical Care and the Interdisciplinary Organization of Specialists for the Study of Age-Related Involution, member of the Presidium of the All-Russian Scientific Society of Therapists. Under the leadership of A.L. Vertkin, more than 20 major international forums on current problems of medicine were organized. A.L. Vertkin is married. Wife - Natalya Viktorovna Vertkina - Doctor of Medical Sciences, chief physician of the city clinical hospital No. 81 of the Moscow Government Health Department. Son - Vertkin Maxim Arkadievich, Ph.D., doctor.
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Arkady Lvovich Vertkin:
“I know how to be a good therapist.”
Medicine is a special type of activity, and quite specific. Working with patients every day, you will not achieve great career heights, you will not become rich like Croesus, and you will not get an “easy life.” On the other hand, as Seneca said, for a person who does not know which harbor he is heading to, no wind will be favorable. What is the goal of a therapist? Doctor of Medical Sciences, Professor, Doctor highest category, Honored Scientist of the Russian Federation, head of the National Scientific and Practical Society of Emergency Medical Care, member of the presidium of the Russian Scientific Medical Society of Therapists, head of the Department of Therapy, Clinical Pharmacology and Emergency Medical Care of the Moscow State Medical and Dental University Arkady Lvovich Vertkin believes that we should strive to be not just a general practitioner, but a good therapist. And he even has a recipe for how to become one.
Arkady Lvovich, what does it take to become a good therapist?
First, be born into a prosperous family. All great, outstanding domestic therapists had a completely unique pedigree. For example, Maxim Petrovich Konchalovsky, an outstanding Russian therapist - what a family he comes from! To say “difficult” is to say nothing, because there were artists, writers, poets in it... Maxim Petrovich’s brother was Pyotr Petrovich Konchalovsky, a famous artist. Both brothers were very successful, each in their own field.
The second condition - it is mandatory - is a good education: both university and postgraduate. Today, unfortunately, therapy has ceased to be the main “brand” in medical education. If earlier the departments of therapy were leading in any medical university, they were fundamental, they represented a medical base, but now educational and professional values have shifted a little. Many narrow specialties profiled
departments, but no matter how narrow a specialist a doctor becomes, he cannot do without a good therapeutic base.
You mean internal illnesses?
First of all, but not only - this is physiology, and anatomy, and pathological physiology, and pathological anatomy. I will say more - all our outstanding internists at the beginning of their professional path They also worked in the dissection department as pathologists. Now it’s somehow inconvenient to even talk about this; not a single therapist will first work as a pathologist. The role of autopsy is also leveled out, but without an autopsy it is impossible to get a complete picture. The patient was treated, he died, but from what it is unknown, so maybe he was treated for something completely different from what he needed? The discrepancy between clinical and pathological diagnoses is far from a rare case.
There is another nuance in medical education. The future specialist needs to be lucky with his teacher. The great Russian doctor Fyodor Petrovich
Haaz very accurately said: “A teacher is not the one who teaches, but the one from whom they learn.” This means that the teacher must work with students according to the principle “do as I do.”
Today the number of doctors of medical sciences, professors, and academicians is huge. How can a young specialist decide on the choice of a teacher?
Choose a teacher who works in an emergency clinic with a prosthesis, who is not afraid of work and who learns from his mistakes. It doesn’t matter where this clinic is located: in Moscow, St. Petersburg or in the region. The main thing is that the student has a desire to learn and has someone to learn from. By the way, speaking about universities, I completely lost sight of the fact that now admission is based on the results of the Unified State Exam (USE). Now enroll in medical school or university can be done by any young person who, just yesterday, may not have even thought about becoming a doctor!
Arkady Lvovich, but the desire to become a doctor can arise suddenly... The fact that a person at school did not dream of working in a hospital does not mean that he has no chance of becoming a good therapist, right?
Everyone has a chance, it’s another matter whether our system allows for it medical education. Don’t you think it’s strange that every university teaches propaedeutics of internal diseases, internal diseases, therapy, but our biggest “failure” is outpatient practice? This practice includes working in a clinic and in an ambulance. I don’t mention the hospital, because everything is much better there: facilities, equipment, the opportunity to consult with colleagues from other specialties, professors, etc. And the emergency doctor must immediately and unilaterally decide the most difficult questions, and the fate and life of the patient depends on his actions. Making a diagnosis and taking it where needed is one scenario; making a diagnosis and taking it where it is not needed is a completely different scenario. But making a mistake and sending you to a third health care facility is a completely separate matter. And behind all this there is life and counting for minutes, for seconds. An emergency doctor is who needs to be trained first!
What about the doctor at the clinic?
Naturally. A huge number of people go to the clinic, and qualified personnel should be concentrated there. Polyclinic doctors also work under time pressure, and you need to be a very educated doctor to see in such conditions that
happens to the patient, make a diagnosis and understand how to treat, while highlighting priorities and dividing tasks according to ranking. But at the university there is practically no teaching of the basics of working as an emergency doctor, and teaching the basics of outpatient practice is more like an introduction. With rare exceptions, of course: for example, at the Moscow State Medical and Dental University, two departments are engaged in teaching emergency medicine, and polyclinic therapy is taught in a separate department, but I consider this insufficient, each department needs to pay attention to prehospital care.
“I advocate professionally oriented students as early as the 3rd or 4th year medical universities. Departments can organize days open doors, and venerable specialists will talk about their work. This will help the future doctor decide on his choice of specialty.”
Perhaps this is where the law of creation of demand by supply comes into force? Perhaps not many medical school graduates want to become therapists?
The prestige of the therapeutic specialty really needs to be raised, and for this it is necessary to tell students about it and gather them for meetings to determine their future profession. In winter, I took a state exam among students, asked 30-35 people, and not one wanted to be a therapist. Moreover, everyone has their own motivation. This motivation needs to be increased, plus give as complete an idea as possible about this profession. And ambulances should ideally be staffed by therapists with good skills and knowledge in the field of resuscitation. Such a specialist will be able to understand the patient’s condition and provide assistance if required, as well as direct him to the right medical facility.
Arkady Lvovich, we digress from your “recipe” for a good therapist. What other components of success do you consider important?
Perhaps, kind heart. It is necessary in any work, but especially for a therapist. We often have to deal with patients in serious condition, there are polar nosologies: in our department there are patients who have problems with the heart, legs, mental disorders, diabetes etc.
The therapist, like no one else, must be aware of the peculiarities current moment in Russia. It’s a good idea to know which patients are visiting
an internal medicine clinic in Paris (we love and respect both the Parisians and this clinic), but we are not in Paris. Social portrait Russian patient completely different.
Oh write it, please.
Often this is a patient with one or another comorbid pathology. For example, this is often a person who smokes. Smoking is a disease. Nicotine and other harmful components tobacco smoke form a complex multiorgan pathology. Is not lung cancer, as our patients think and, having made sure that they do not have cancer, they cheerfully light another cigarette. This is a comorbid condition. Many of our compatriots, as they say, “drink.” And if earlier drinking man was a patient with cirrhosis of the liver, today we simply do not live to see this disease: we have to observe encephalopathy, cardiopathy, etc. - here is another comorbid problem. There are people who don't drink and don't smoke, but many of them are overweight. Moreover, obesity is also a complex comorbid pathology.
Bad habits, the use of surrogates not only causes the development of comorbid pathology - they provoke the pathomorphism of diseases. I think if a doctor who practiced at the beginning of the last century were placed in a modern clinic and shown our patients, he would be confused. Everything has changed - symptoms, outcomes, treatment, prognosis.
Example from the practice of A.L. Vertkina
On the day of the interview, a patient with severe angioedema was admitted to the clinic. She regularly dyes her hair at home and did it again the day before. I was very surprised allergic symptoms! And the fact that she drinks strong drinks every day alcoholic drinks, in particular vodka, which he buys in various retail outlets, she was not alarmed. As a result, it turned out that the performance indicators of the liver, pancreas and, in general, almost all organs and systems showed deviations from the norm. Plus encephalopathy. Allergy arose because the immune system This patient was severely damaged by severe multiple organ pathology caused by alcohol consumption, including surrogates.
What if a person does not smoke, drink alcohol or overeat?
The physician should be wary of hormonal disorders, which
also change the condition of many organs and systems. Let's say hypogonadism. In men over 40-45 years old, testosterone levels in the blood decrease by 1-2% every year. This is normal physiological process, which, however, creates the preconditions for the development of a number of pathologies, such as diabetes, obesity, erectile dysfunction, etc. Menopause in women it also often contributes to the formation of a complex of diseases. In addition, we must not forget about the existence of drug addiction, about the presence among our patients large quantity visiting people who either bring us specific diseases, or cannot adapt, and this negatively affects their health.
You brought out another rule for a good therapist - attention to detail.
And in order to become a good therapist, you need to know and remember the history of your specialty. We must not forget our “Pushkins in Medicine”; we need to read old books. Pay attention to the language in which they are written, how the anamnesis and complaints are collected - this will still be useful to the doctor today. You can’t talk about Pasternatsky’s symptom without knowing who Feodor Ignatievich Pasternatsky is. And he, by the way, is a famous therapist, the founder of balneology in our country, the author of wonderful books on therapy and balneology. There are very useful and informative books around the world that tell you what technological breakthroughs in medicine have been made recently and explain what they mean practical use for a doctor. But there are no such amazing clinical books anywhere else except in our country.
How to make them available to the wider medical community?
There are no problems with publication: almost everyone uses the Internet, but with search. I travel to cities and villages where there are still doctors who have similar books. This is just as important as highlighting the continuity of the stages of the treatment process. Let’s call this scheme conventionally “from pharmacist to doctor’s prescription.” The realities of Russian modernity do not detract from, but, on the contrary, emphasize the role of specialists at each level. A pharmacist is the fourth attending physician after an emergency physician, a doctor in a clinic, and a specialist in a hospital. I am sure that Russian clinics, hospitals and pharmacies employ competent people who love their profession. In medicine and pharmaceuticals, it is absolutely impossible to live without love for your work, and I have already spoken about this. I wish you not to lose your professional passion and strive to help people.
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