Family doctor or doctor general practice is a specialist who has knowledge and practical skills from various medical fields(for example, pediatrics, surgery, gastroenterology, gynecology, internal medicine, etc.). That is why a family doctor can observe all family members, regardless of their gender and age. This is especially important in the case of “family” diseases that are inherited from parents to children.
Family doctor is essentially a universal specialist who can provide high-quality diagnostic and treatment assistance for adults and children. All efforts of the family doctor are aimed at preventing possible and treating existing diseases.
Family doctor– a multidisciplinary, highly qualified specialist who provides any primary health care from infancy to old age.
Family doctor- common practice in European countries. The specialist has been involved in family health for many years, is familiar with hereditary diseases, lifestyle and previous complaints of patients. If the results of laboratory diagnostic tests are available, more than early period much easier to provide prompt assistance when the patient contacts and make a diagnosis.

General practitioners (GPs) have knowledge of wide range diseases, and diagnose and treat patients of all ages.

Historical background: At one time all doctors were general practitioners: they performed surgical operations, treated infections, assisted in childbirth, and cared for people of all ages from birth to death. Then doctors began to specialize in one area of medicine. In other words, doctors associated with general medicine are specialists in family medicine, family practice and primary care.

Family medicine or general medical practice is actually a specialty that includes the knowledge and skills of many medical specialties. The patient and doctor usually maintain contact over many years. The care of a family doctor is personal and comprehensive, based on knowledge of the patient's relationships in the family and society. Family medicine emphasizes disease prevention and health promotion.

Family doctor in many European countries usually called a general practitioner. Its preparation allows in most cases to determine the nature of the disease and the measures necessary for its treatment. The responsibilities of a general practitioner include providing medical care regardless of her profile.

To do this, he needs to have skills and knowledge both in the field of therapy and in numerous related fields, including neurology, ophthalmology, dermatology, otorhinolaryngology, cardiology and others. According to indications, the family doctor refers the patient for consultation with specialized specialists or for hospitalization in a hospital.

Benefits of Family Medicine

The specific work of a general practitioner (family doctor) is in many ways more justified and beneficial for doctors and patients. This is primarily due to the fact that, in addition to therapeutic education, having knowledge of narrower medical specialties (otolaryngology, infections, nephrology, gastroenterology, cardiology) makes diagnosis faster.

In addition, by constantly observing the family, the doctor also knows the family history, which allows minimizing the examination time and allowing the disease to be recorded at the earliest early stages its development.

Responsibilities of a General Practitioner

Like other doctors, a family doctor must examine a patient, conduct a diagnosis, prescribe treatment, or send the patient for examination to a specialized clinic. Basically, family doctors practice visiting appointments, that is, they see patients at the patient’s home. In addition, family doctors can perform preventive examinations children, gynecological care, immunizations and prostate checks. Some family doctors assist in childbirth and provide care for newborns, while others perform minor surgeries or assist in major surgeries performed on their patients. The knowledge of a family doctor may vary depending on the region - for example, doctors practicing in rural areas, are more likely to have sufficient skills to assist with childbirth than urban doctors.

Thus, the responsibilities of a family doctor include:

Off-site receptions;
Preventive examinations of patients;
Diagnosis of diseases;
Prescription of treatment;
Referring the patient for examination if diagnosis cannot be carried out at home;
Monitoring family relationships;
Working in a team with other doctors, discussing and introducing other doctors to the practice;
Using observations of the treated family for accurate diagnosis;

To the circle job responsibilities General practitioner also includes:

Medical supervision and provision of qualified assistance if necessary using modern methods diagnosis, prevention and treatment. Also, in some cases, his responsibility includes the development of rehabilitation measures;
Obtaining reliable diagnostic information. Diagnosis should be carried out as quickly as possible short time to establish a diagnosis. Depending on the patient’s condition, the family doctor may make changes to the treatment plan and prescribe additional examinations;
Establishing diagnosis, and in some cases its confirmation, based on the collection of anamnesis, clinical observations and examinations and data from clinical and laboratory studies;
Assignment and control of necessary treatment , diagnostic procedures And rehabilitation measures. Also, a family doctor is often involved in conducting examinations related to temporary disability, and his responsibilities include preparing necessary documents for medical and social examination.

When should you contact your family doctor?

If you experience these symptoms, you should consult your family doctor:

Increased body temperature
Fatigue, weakness
Any pain syndromes
Problems with the gastrointestinal tract
Excess weight

In most cases, when patients independently turn to a specialist as an initial appointment, their choice turns out to be wrong. Since the same symptoms can be characteristic of many diseases.

The best decision would be to contact your family doctor (general practitioner), who can correctly interpret your symptoms and prescribe necessary tests and treatment, and, if necessary, write a referral to a specialist.

The Ministry of Health informs: in Belarus in 2020 there will be no local therapists in clinics; they will be completely replaced by general practitioners. And medical officials will most likely keep their word. In 2017, about 40% of local doctors retrained as general practitioners (GPs). It is expected that in the capital in 2018, 60% of local therapists will become GPs, in 2019 - 75%, in 2020 - 100%. The question arises: why is this necessary? A correspondent from the Minsk-Novosti agency was looking for an answer.

- General medical practice is modern organization district police officer medical service, - said the chief therapist of the Ministry of Health of the Republic of Belarus Alexander Verbovikov. - In this connection, in city clinics the existing therapeutic departments will be renamed into general medical practice departments. This won't just be a sign change. This means retrofitting doctors' offices and bags with modern electronic tonometers and thermometers, portable electrocardiographs and other medical equipment. Each doctor will have a computer installed at his or her workplace, connected to the clinic’s database.(in the capital, almost all workplaces of local therapists are equipped with computers, in the regions - not yet. - Note auto). In computer - full information about the patient with his hospitalizations, prescribed treatment, medications taken. There are also the results of laboratory, instrumental, ultrasound, and radiographic studies.

GP has basic skills in ENT diseases

Three years ago, only six general practitioners worked in Minsk - at outpatient clinic No. 1 in Sukharevo, the villages of Sokol and Sosny. Now in the 39th city clinic there is a department of general medical practice of the Belarusian State Medical University. This is where the capital's local therapists undergo retraining.

A GP is a generalist doctor with basic knowledge in neurology, endocrinology, cardiology, surgery, and otorhinolaryngology. This doctor's bag contains a portable electrocardiograph, a neurological hammer, a glucometer, a portable otoscope, and an electronic tonometer.

- In Rus' there was a zemstvo doctor who knew how to do everything,- added Lyudmila Lugovets, head of the primary health care department of the Health Committee of the Minsk City Executive Committee. - Both as a neurologist could look at the patient, and as a cardiologist. What now? The patient complains to the doctor that his back hurts, he refers him to a neurologist, so he can sort it out.

They started expanding the powers of local therapists in the capital two years ago: they organized a series of seminars, practical classes, tests in neurology, endocrinology. Due to which patients with diabetes mellitus, for example, were completely transferred to local therapists. With basic knowledge of neurology, these doctors are also quite capable of providing consultation and medical assistance to patients. Only diagnostically complex patients are referred to neurologists and endocrinologists.

- We analyzed the work of general practitioners in the capital - the patients are very satisfied,- noted L. Lugovets. - During one visit, a person receives advice from several specialists in one person. If the case is complex and requires additional examination or examination by a specialist colleague, the doctor will write a referral. And doctors like to work in a new way, their self-esteem has increased.

Marina Dreyling: everything you need for work is at hand

...Marina Dreyling, general practitioner, 39th city clinical clinic, explained that she personally is interested in working.

“I don’t remember any patients complaining.” For us, local service doctors, this fact is especially important. There are no queues for me,- she said.

As for the workload, according to the standards in the city, one GP is assigned 1,700 patients, and in rural areas - 1,300. On average, one person is given 15 minutes to see each other.

For information

From January 24, 2018, outpatient clinic No. 1 in Sukharevo was reorganized into the general medical practice department of the 10th city clinic.

Photo by Sergei Sheleg

A general practitioner includes in his duties the treatment of a variety of diseases, which include:

atherosclerosis,
oncological pathologies,
metabolic syndrome,
excess weight,
obliterating diseases of the vessels of the lower extremities.

Its task is to identify the presence probable diseases, as well as the reasons for their occurrence. This also includes the selection preventive measures in order to prevent the risk of diseases to which there is a tendency, including genetic predisposition patient. It should be added that a general practitioner is not just a local doctor, but a specialist who takes part in all issues related to the treatment of certain diseases.

What diseases does a general practitioner treat?

Despite the “broad” name, a general practitioner does not treat all diseases, but monitors and attracts other doctors if his competence does not extend to the patient’s existing disease.

We have already said above that a general practitioner treats oncological pathologies, excess weight, atherosclerosis, and so on.

As for excess weight, therapy is aimed not only at compiling proper diet, and the determination of the factor that caused such a state is especially true since overweight- this is a possible disease, for example, abnormal metabolism, hormonal disorders, problems with thyroid gland, mental condition and much more.

When should you see a GP?

A general practitioner will help if you have all sorts of symptoms, even seemingly minor ones such as a feeling of heaviness or fatigue. Sometimes the provocateur of headaches, which at first glance seem causeless, can be a block in cervical vertebrae- he also has direct relation to vascular spasms that disrupt the flow of blood from the head.

changes in weight, despite the fact that diet and lifestyle have not changed. These signs are characteristic of various diseases, for example, to cancer or disorders of the nervous system,
slurred speech, fatigue, paralysis and numbness of the limbs may indicate an impending stroke,
black stool is a possible ulcer or tumor in the stomach or intestines. The change in stool color in this situation occurs due to internal bleeding, which in itself is a dangerous process,
meningitis is characterized by a headache that extends to the neck, accompanied by fever,
When a cerebral hemorrhage occurs, a debilitating headache occurs.

A general practitioner (family doctor) is a generalist who provides outpatient medical care of a therapeutic nature to members of the same family.

A general practitioner examines patients, treats, diagnoses: ECG, Holter, otoscopy, rhinoscopy, laryngoscopy, fundus visualization, measurement eye pressure, examination on a gynecological chair, removal sulfur plugs. The family doctor also makes diagnoses and provides treatment, although he often refers patients to specialized specialists.

A general practitioner (family doctor) treats:

Respiratory viral infections.
Metabolic disorders.
Atherosclerosis.
Sudden weight fluctuations.
Weakening of the immune system.
Migraine and other headaches.
Dyspeptic disorders.
Urethritis of various origins.
Dysbacteriosis.
Dysuria.
Poisoning and intoxication caused by various reasons.

The family doctor also helps family members when identifying symptoms of pre-stroke or pre-heart attack, and accompanies them until hospitalization. If an oncological process is suspected, the doctor transfers the patient to the oncology dispensary for follow-up. If tuberculosis is detected, carries out treatment and epidemiological measures, helps in social rehabilitation patient and family members. The doctor also monitors pregnant women and guides them to postpartum period, corrects breast-feeding and mother’s nutrition, advises on the care of newborns.

The profession of a general practitioner involves helping family members in all health matters - nutrition, exercise therapy for joint diseases, dental examination and referral to a dentist, bite correction, treatment of diseases together with specialized specialists: ENT, ophthalmologist, pediatrician, gynecologist, cardiologist, nephrologist, occupational pathologist , surgeon.

At the request of family members, with the consent of the chief physician of the Moscow Region (medical organization), accompanies them on travel, on vacation or treatment in a sanatorium.

In Russia, the first graduation of general practitioners took place in 1994.

Places of work

The position of general practitioner is available in clinics and day hospitals MO, in special offices of a general practitioner, in an ambulance, in antenatal clinics, first aid stations of industrial enterprises, large agricultural associations, sanatoriums and rest homes, hotel associations.

History of the profession

The first family doctors in Russia and the West were all practicing doctors. In Russia they were also called zemsky. However, the development of medicine has led to the emergence of narrow specializations in order to maintain the quality of service to the population. Some doctors began to deal only with the treatment of children, others - women, and still others - performed exclusively surgical interventions.

Within the narrow focus of treatment, there were different types diseases. This led to the emergence of professional associations of physicians that evaluate the knowledge and skills of their colleagues and issue them the appropriate permission to work in one direction or another. This is how the specialist certificate came about. The prestige of subspecialty training grew, and general practitioners were forgotten.

This forced the American A. Willard to create a committee to support the prestige of the family doctor profession (1966). This date is considered the birthday of official family medicine, which was based on an individual approach to patients. The concept of the family doctor changes the role of the doctor in healing process. The task of the general practitioner is to monitor family members from birth to death. Today, family doctors rank second in number after general practitioners.

In the Russian Federation, the first graduation of general practitioners took place in 1994. Since 2014, the task has been set to retrain all outpatient therapists in this specialty. The future of outpatient medicine belongs to family doctors with their self-sufficiency and efficiency.

Thanks to the specialty, medical care in rural areas has become more accessible.

Responsibilities of a General Practitioner

The main responsibilities of a general practitioner are as follows:

Reception and treatment of patients (outpatient and at home).
Providing continuous primary health care to the family.
Disease prevention and rehabilitation of family members.
Analysis of the health status of family members, monitoring of clinical examination, supervision during pregnancy.
Referral to sanatorium-resort treatment.
Preparation of documentation, issuance of sick leave, preparation of documents for medical examination.

Requirements for a general practitioner

Basic requirements for a general practitioner include:

Higher medical education, a valid accreditation certificate for general medical practice (family medicine).
Knowledge of emergency, emergency and resuscitation methods.
PC knowledge.
Personal qualities: sociability, friendliness, attentiveness.

How to become a general practitioner

To become a general practitioner, you must:

Graduate from a university or medical school with a degree in General Medicine or Pediatrics.
Receive an accreditation sheet. To do this, you need to pass an exam and successfully pass an interview with an expert commission.
After this, you can work with patients on an outpatient basis (for example, a therapist or pediatrician).
To obtain a narrow specialization, you can enroll in a residency (2 years of study) in the specialty “General Medical Practice (Family Medicine).” Paid is easier, because The competition is small and for admission you only need 50 certification points. For free You can get into residency in two ways: through a competition on a general basis or through a targeted referral from the chief physician of a medical organization in which the specialist is already working.

Every year, doctors are required to score 50 certification points. To do this, you can take advanced training courses (36 points), attend scientific and practical conferences (the number of points depends on the event, but usually about 10 points), publish scientific works, write books, defend dissertations. If you have collected enough points, you can continue working. If you don’t get points, you will either have to stop medical practice, or solve this problem in “non-standard” ways.

The experience, skill and quality of the doctor’s work are usually assessed qualification categories, which can be obtained by protecting research work. During the defense, the commission evaluates the doctor’s skills in the field of diagnosis, treatment, prevention, as well as the relevance of his knowledge.

What are the qualification categories:

second – over 3 years of experience;
first – more than 7 years of experience;
Higher - more than 10 years of experience.

The qualification category allows you to occupy high positions in medical institutions, gives the right to a salary increase, gives status in the professional environment and high trust from patients. Even more respect can be achieved by speaking at conferences, symposiums and creating science articles and work.

A doctor has the right not to qualify, but this will hinder his career and professional growth.

General practitioner salary

The general income range is as follows: general practitioners earn from 23,000 to 140,000 rubles per month. General practitioners are most in demand in the Moscow and Leningrad region. We found the minimum salary in Kamensk-Uralsk: 23,000 rubles per month; the maximum - in one of the clinics in Moscow: 140,000 rubles monthly.

The average salary of a general practitioner is 55,000 rubles per month.

Where to get training

Besides higher education There are a number of short-term training programs on the market, typically lasting from a week to a year.

Medical University innovation and development invites you to take distance courses for retraining or advanced training in the direction of "" to receive a diploma or state certificate. Training lasts from 16 to 2700 hours, depending on the program and your level of training.

In the near future, Muscovites, apparently, will be left without local therapists. Their places will be taken by general practitioners (GPs), or, as they are also called, family doctors. However, these will not be new doctors, but for the most part the same local doctors, only retrained. Moreover, they were given little time to master additional skills - a maximum of six months. As they say, off the ship to the ball, which will begin on April 1. It is by this date that the capital’s clinics must provide the work of general practitioners. We found out whether the “old guard” will be able to meet the new requirements and how the reform threatens patients.

General doctor

Whatever they say about local doctors, several generations of Soviet and Russian citizens grew up with the confidence that a familiar doctor sits in the clinic, who takes our medical history, is always ready to prescribe the on-duty “Otsegomitsin”, and in case of doubt, send us to a specialist specialist. Now his place will be taken by a doctor with an unclear name and a bunch of new responsibilities. The 1992 Order defines a GP as a specialist broadly oriented in the main medical specialties and able to provide assistance for the most common diseases and emergencies.

Lenta.ru has at its disposal a list of tools and devices that GP offices should be equipped with in accordance with the instructions of the Moscow Department of Health dated February 2017. This is a tourniquet to stop bleeding, a manual device for artificial ventilation lungs, surgical scissors, ophthalmoscope (for checking vision), rhinoscope (for examining the nasal cavity), a table for drawing blood and intravenous infusions, Esmarch's irrigator. In general, the new doctor must be a jack of all trades - give an enema, draw blood, and do simple surgical intervention carry out, and even resuscitation.

Photo: Anatoly Zhdanov / Kommersant

Express course

To master all the intricacies of family medicine, the district physician has six months. The retraining program consists of educational modules on internal medicine, neurology, ENT diseases, surgery, skin and infectious diseases. Training that involves both full-time and correspondence form, is divided into theory and practice. The regular program is designed for 864 hours (study period is six months), but there is also a shortened one - 504 hours (about four months).

In the capital, a pilot retraining project was launched back in 2014. Its main goal was to train a general practitioner in the shortest possible time, Tatyana Mukhtasarova, first deputy head of the capital’s health department, said in an interview with Moscow. In 2014, 113 specialists were trained. In 2015, their number exceeded a thousand, but the capital’s clinics need more than 4.5 thousand general practitioners.

According to Lenta.ru’s interlocutor, a Moscow doctor who has already completed the training course, the time allotted for retraining is clearly not enough. More specifically, there is little practice. “For example, I didn’t feel that I could completely replace the lore,” he said honestly. “In addition, a GP will not be able to precisely operate on appendicitis and ingrown toenails; surgery classes were more theoretical.” Although in the program posted on the First Honey website, such manipulation as removing an ingrown nail is included in the list of skills.

In Russia, an experiment in training general practitioners began back in 1987, but the emergence of these specialists was hampered by problems with determining their legal status. Only in 1992 did a corresponding position appear in the list of specialties. By 2000, about a thousand GPs were trained in the country, by 2005 - almost four thousand.

For what?

According to Mukhtasarova, experience foreign countries shows that when a GP position is introduced, 80 percent of patients begin and end treatment with one doctor. Accordingly, the workload of narrow specialists is reduced.

Currently, she noted, Muscovites most often turn to local police officers for help. Those, she is convinced, in most cases refer a person to specialists for diagnosis and treatment, “whose visits may take long time and most often comes down to preventive consulting assistance.” The workload of specialized doctors is increasing, and the district police officer has the responsibility of a dispatcher distributing patients. The representative of the department is sure that neither the patient nor the doctor likes this approach.

The future family doctor did not agree with Mukhtasarova. For a long time now, everything has not been happening as the official described, he objected, the patient cannot simply be redirected - this always requires justification. The local therapist can do this after conducting a series of studies, noticing the problem and realizing that he lacks the qualifications to prescribe treatment.

Kirill Braga / RIA Novosti

A big difference

The difference in the actions of district police officers and GPs can be shown using examples from existing work experience. A woman came to the appointment complaining of a lump in her breast. Upon palpation, a round, painless formation is determined. In this case, the district police officer will send you to a surgeon or gynecologist, while the GP will immediately send the patient for a mammogram, and if a tumor is detected, to an oncologist. Another situation is a man complaining of headaches, ringing in the ears, unsteadiness of gait, deterioration of hearing and memory. The therapist passes it on to the neurologist. The family doctor himself refers the patient to duplex scanning arteries and for tests. The study determines a critical narrowing of the internal carotid artery, responsible for the blood supply to the brain. A man goes to a consultation with a vascular surgeon to decide on surgery. After consultation and passing all the tests, the GP sends him for hospitalization.

By the way, the opportunity to call a GP to your home in Moscow is not yet provided. However, the local therapist now only conducts outpatient appointment. Home care is provided by other doctors, and nothing will change for them with the advent of family doctors (as well as for pediatricians, who are essentially pediatric general practitioners).

As for the experience of Western countries where they successfully operate family doctors, then, for example, in France there are no clinics. There are freely practicing general doctors who are chosen at their discretion. They keep a medical history and write out referrals to specialists - also freely practicing doctors. Unlike the USA, in France a GP can be called to your home. In the States, according to a local resident, family doctors are mostly treated with colds or “minor ailments,” but with anything serious they go straight to the hospital.

By the way, family doctors in Russia appeared earlier than district doctors - in the 17th century. They served nobility. With the abolition of serfdom in 1861, as the Moscow Medicine magazine writes, the institute of zemstvo doctors began to emerge, who helped all groups of the population. At first, the doctor traveled to paramedic stations in the county, while he himself lived in the city. Soon this system of medical care was replaced by a stationary one: rural hospitals began to be built and local territorial services were created. After October revolution organizational forms, developed by zemstvo medicine, were generally preserved and over time transformed into the familiar system of local therapists, which at the conference and in 1978 was recognized as the most effective.

Photo: Viktor Korotaev / Kommersant

Pros, cons, questions

A metropolitan doctor with whom Lenta.ru spoke expressed fears that the standards for a GP will remain the same as for a district police officer, and the range of responsibilities will increase. It is difficult to imagine what will happen in the end, he noted. Now, in an eight-hour working day, the local police officer sees about 30 patients. The time allotted according to the regulations for seeing one person is 12 minutes (of course, patients are different, and it is not always possible to maintain this norm). There is no nurse. Still the doctor sees positive side The innovation is that on weekends the GP will be able to take on some of the tasks of a specialist and not have to send the patient to another medical institution where there is a specialized doctor on duty.

“The appointment time will increase to 15-20 minutes, and the nurse will be there,” reassures Lenta.ru’s source in the management of one of the Moscow clinics. He, for his part, complained about the difficulty of finding premises for a GP: a general practitioner’s office should have a manipulation room (for mini-operations) and a procedure room. According to him, due to organizational difficulties, GPs and district police officers will work in parallel for some time.

It turns out that from April 1, general practitioners will appear in clinics who are not fully confident in their abilities - which is not surprising, given the timing of training. There is a fear that former therapists will not be able to replace specialized specialists to the extent that they are counted on. Accordingly, the quality of medical care may decrease.

In medical circles in Moscow, there is concern about the possible reduction of specialized specialists due to the emergence of GPs. There are already fewer of them due to the consolidation of clinics and hospitals. However, the Department of Health denies such consequences.

But if in the capital general practitioners have yet to prove their worth, then in rural areas this practice must be effectively implemented. In areas where the help of highly specialized doctors is not always available, family doctors will certainly be in demand.