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| Instructions for the position " Reflexologist", presented on the website, meets the requirements of the document - "DIRECTORY OF Qualification Characteristics of Workers' Professions. Issue 78. Healthcare. (As amended in accordance with orders of the Ministry of Health No. 131-O dated June 18, 2003, No. 277 dated May 25, 2007, No. 153 dated March 21, 2011, No. 121 dated February 14, 2012)", which was approved by order of the Ministry of Health of Ukraine of March 29, 2002 N 117. Agreed by the Ministry of Labor and Social Policy of Ukraine. The document status is "valid". |
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Qualification requirements
Complete higher education (specialist, master's degree) in the field of training "Medicine", specialty "General Medicine". Completing an internship in the specialty "Neurology" with subsequent specialization in "Reflexology". Availability of a medical specialist certificate. No work experience requirements.
Knows and applies in practice: current legislation on health protection and regulatory documents defining the activities of governing bodies and healthcare institutions, the organization of reflexology and laser therapy services, ambulance and emergency medical care; fundamentals of law in medicine; rights, duties and responsibilities of a reflexologist; fundamentals of normal and pathological anatomy and physiology of human organs and systems, water-electrolyte metabolism, acid-base balance; fundamentals of neurology, biochemistry, immunology, genetics and other medical disciplines; modern classification of diseases; main clinical symptoms and disease syndromes for which reflexology and laser therapy are used; principles of compatibility and consistency, purpose of procedures, general and functional examination methods; modern methods of reflex and laser therapy; indications and contraindications for spa treatment; rules and requirements for the equipment of the reflexology and laser therapy room; procedure technique; safety rules when working with equipment and devices; rules for processing medical documentation; modern literature on the specialty and methods of its generalization.
Characteristics of work, tasks and job responsibilities
It is guided by the current legislation of Ukraine on health care and regulations that determine the activities of governing bodies and health care institutions, the organization of the work of reflexology and laser therapy rooms in clinics and hospitals, medical units, and in specialized medical institutions. Provides reflexology assistance to patients. Monitors adverse reactions/effects of medications. Works closely with doctors of other specialties, organizes and conducts consultations with patients. Plans work and analyzes its results. Supervises the work of nursing staff. Adheres to the principles of medical deontology. Maintains medical documentation. Takes an active part in disseminating medical knowledge among the population. Constantly improves his professional level, introduces modern methods of reflexology and laser therapy.
The unsatisfactory state of the medical rehabilitation system and the lack of its necessary regulatory and legal framework in the country are noted in the Concept for the development of the healthcare system in the Russian Federation until 2020.
One of the components of rehabilitation medicine is reflexology and it is fully affected by the problem of imperfection and inconsistency of the regulatory framework. Individual documents from the system of legal support for the activities of a reflexologist often do not have a logical relationship with each other.
In particular, the equipment of a reflexology room is stipulated by two regulations:
Order M3 of the Russian Federation No. 38 dated 02/03/1999 “On measures for the further development of reflexology in the Russian Federation” (Appendix No. 10).
Order of the Ministry of Health of the Russian Federation No. 753 of December 1, 2005 “On equipping outpatient clinics and inpatient clinics in municipalities with diagnostic equipment” (Appendices No. 1,3,4);
At the same time, the table of equipment for the reflexology room, presented in Order M3 of the SR RF No. 753, is not identical to the similar report card in Order M3 of the Russian Federation No. 38.
State reflexology services are regulated by four current regulations:
Order No. 364 of December 10, 1997 “On the introduction of the specialty “Reflexotherapy” into the range of medical and pharmacist specialties”;
Order of the Ministry of Health of Russia No. 38 dated 03.02. 1999 “On measures for the further development of reflexology in the Russian Federation”;
Order of the Ministry of Health of Russia No. 210n dated April 23, 2009 “On the nomenclature of specialties of specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare of the Russian Federation”;
Order of the Ministry of Health of Russia No. 415n dated July 7, 2009 “On approval of qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare.”
The last two orders are not entirely consistent with the first and with the State Standard for postgraduate professional training of specialists with higher medical education in specialty No. 040109.02 “Reflexology” approved by the Ministry of Health (Moscow, 2000), which regulates the training of reflexotherapists in clinical residency, general advanced training courses, and certification cycles, cycles of thematic improvement.
In addition, these orders are difficult to compare with the regulatory document that regulates the profile of pathology that requires the intervention of a reflexologist: Order of the Ministry of Health of the Russian Federation No. 266 of April 13. 2007 “On approval of recommended lists of medical indications and contraindications for the use of reflexology in clinical practice.”
The lack of system in the formation of the regulatory framework creates a discrepancy between the profile of diseases recommended for treatment by reflexology methods and the profile of specialists who are charged with its implementation.
Order of the Ministry of Health of the Russian Federation No. 266 is one of the most significant regulations on reflexology adopted in recent years. He gives clear, ICD-10-compliant statements of indications for the use of reflexology. These include: gastric ulcer and duodenal ulcer not specified as acute or chronic (K25.9. K26.7), chronic non-calculous cholecystitis (K81.1), recurrent bronchitis (diagnosis used in pediatrics) (J40.0), chronic obstructive bronchitis (J44.8), bronchial asthma (J45), pulpitis (K04.0), non-suppurative otitis media (H65), endometriosis (N80), kraurosis of the vulva and vagina (N90.4 and N89.8), chronic prostatitis (N41.1), etc. The effectiveness of using reflexology for all of the listed diseases has been confirmed by numerous studies and is reflected in the extensive literature of recent decades, both domestic and foreign.
In addition to Order No. 266, the use of reflexology for various pathologies is also regulated by the Standards of sanatorium care for patients with diseases of the esophagus, stomach and duodenum, intestines (Order of the Ministry of Health of the Russian Federation No. 278 of November 23, 2004), patients with obesity and other types of excess nutrition, disorders metabolism of lipoproteins and other lipidemias (Order of the Ministry of Health of the Russian Federation No. 223 of November 22, 2004), patients with diseases of the liver, gall bladder, biliary tract and pancreas (Order of the Ministry of Health of the Russian Federation No. 277 of November 23, 2004), patients with ear diseases and mastoid process, upper respiratory tract (Order of the Ministry of Health of the Russian Federation No. 275 of November 23, 2004), patients with urolithiasis and other diseases of the urinary system (Order of the Ministry of Health of the Russian Federation No. 210 of November 22, 2004), etc.
Thus, the regulatory framework presents a spectrum of very diverse pathologies indicated for reflexology. In this regard, it is not clear why the conduct of reflexology in Order No. 415n is legally assigned primarily to a medical specialist who has a postgraduate professional education in the specialty “Neurology,” while Order No. 210 clearly requires specialization in neurology for all reflexotherapists.
The qualifications of healthcare specialists are also regulated by Order of the Ministry of Health and Social Development of Russia No. 541i dated July 23, 2010 “On approval of the Unified Qualification Directory of Positions of Managers, Specialists and Employees”, section “Qualification characteristics of positions of workers in the field of healthcare”. According to clause 1.6 of the Appendix to the specified regulatory document: “Persons who do not have the appropriate additional professional education or work experience established by the qualification requirements, but have sufficient practical experience and perform efficiently and in full the job responsibilities assigned to them, on the recommendation of the medical certification commission organizations, as an exception, can be appointed to appropriate positions, as well as persons with special training and the necessary work experience. The employer is taking measures for further professional training of the mentioned persons.” In relation to a doctor-reflexologist, this position of the order quite clearly requires that, in addition to specialization in reflexology, postgraduate professional education in the specialty “Neurology”, although it provides some temporary deferment (which can be used, but realistically only until the next licensing or accreditation).
At the same time, postgraduate training programs for doctors in neurology (specialization and improvement) are concentrated exclusively on neurological pathology, and do not include issues of pathogenesis, clinical picture and diagnosis of somatic and any other diseases, including those for which the use of reflexology is indicated. Thus, high-quality reflexology for patients suffering from non-neurological diseases requires the additional participation of a specialist in the profile of the disease. In addition to additional financial costs for the healthcare system, in outpatient practice this provision creates additional barriers for the patient: the need to regularly visit two doctors, possibly with different schedules and queues for appointments, which reduces the availability of treatment and patient compliance. The regularity of such visits is unlikely. As a result, an assessment of the dynamics of the condition of a patient with bronchial asthma or peptic ulcer disease, carried out during a course of reflexology only by a specialist - a neurologist, will inevitably be focused primarily on neurological criteria and the patient’s self-assessment, which does not reflect the interests of the patient himself and is not consistent with the relevant protocols for the management of patients (Order Ministry of Health of the Russian Federation No. 241 of November 22, 2004 “On approval of the standard of medical care for patients with gastric and duodenal ulcers”; Order of the Ministry of Health of the Russian Federation No. 678 of September 25, 2006 “On approval of the standard of medical care for patients with asthma”, etc.)
The optimal situation, in our opinion, would be a situation where the doctor performing reflexology treatment of somatic, gynecological, otolaryngological, traumatology and orthopedic patients would be a specialist in the appropriate profile and, during the treatment process, would examine patients in accordance with the provisions of the relevant standards. The same opinion was shared by one of the leading Russian specialists in the field of reflexology, Professor V.G. Vogralik. In this case, the patient should be examined to the extent necessary and sufficient to assess the dynamics of the condition in this pathology. However, in this case, the costs for the implementation of basic specialization in neurology for a reflexologist were not justified. The costs (financial and time) of mandatory residency in reflexology for therapists, orthopedists or pediatricians working with specialized patients also do not seem justified.
Inconsistency of standards results in irrational costs and reduced availability of specialized medical care.
We see a solution to the problem in different ways. Improving the quality, cost-effectiveness and accessibility of reflexology could be facilitated by adjusting the qualification requirements for a reflexologist, namely, by introducing into the paragraph of the regulatory document regarding reflexology a reference to Appendix 5 to the current Order of the Ministry of Health of Russia dated 02/03/1999 No. 38 “On measures for further development of reflexology in the Russian Federation" ("Regulations on the doctor of the office (department) of reflexology"): "A specialist with a higher medical education in the specialty "General Medicine" or "(Pediatrics), who has undergone postgraduate training (internship) is appointed to the position of doctor of the office (department) , residency) or specialization in reflexology in licensed educational institutions.”
The positive aspects of this solution: firstly, it allows you to link two existing regulatory documents. Secondly, it is possible for specialist doctors in different fields to acquire the additional specialty of reflexologist and apply the acquired knowledge in their field.
A similar approach, by the way, is implemented in Order of the Ministry of Health and Social Development of Russia No. 415n dated July 7, 2009 regarding the qualification characteristics of a physiotherapist.
Physiotherapy and reflexology appeared in the medical lexicon almost simultaneously: “physiotherapy” in 1905 in Belgium, and “reflexology” in 1912 in France. Already known by that time in European countries, including Russia, the methods of ancient Chinese medicine - acupuncture and moxibustion - could equally be attributed to both physiotherapy and reflexology. The modern arsenal of physiotherapy technologies, as well as reflexology, is widely used in almost all areas of clinical medicine. The methodologies and methods of both medical specialties mutually enrich each other. It never occurred to anyone to limit the ability of doctors to specialize in physical therapy to any one basic medical specialty. Why this should be done in relation to reflexology defies any logical explanation.
At the same time, the issue of studying reflexology as part of basic medical education is long overdue. This specialty must be studied at different stages of medical personnel training, starting from the third year, as well as as a separate discipline in the training program for fifth-year students, when the clinical thinking of future specialists begins to form. For doctors of the 21st century, mastery of reflexology and reflexology is especially important due to the ability to conduct an integrative assessment of the patient’s health, both in the initial state and in the process of correcting identified functional disorders not only of the damaged segment, but of the entire organism as a whole, while simultaneously assessing the adequacy and effectiveness ongoing therapeutic measures.
It should be noted that over the past 10-15 years, the standards regulating the professional activities of a reflexologist have changed several times. As a result, we have a cadre of reflexotherapist doctors who at one time received their specialty on the basis of previously existing regulations and do not fit into the current regulations. The problem of the consequences of repeated redrawing of standards was taken into account in note 4 of Order of the Ministry of Health of the Russian Federation No. 112n dated March 11, 2008. “On the nomenclature of specialties of specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare of the Russian Federation,” which was in force until April 2009. According to the note to this order, persons who have received the right to professional activity in their specialty, as well as those enrolled in postgraduate programs professional and additional vocational education in accordance with previously valid regulations, retain the right to professional activity and further education in accordance with the existing specialty. This note, apparently, should be included in the new regulatory documents.
Thus, the current situation with the regulatory support of reflexology does not contribute to improving its quality and accessibility, leads to ineffective costs, loss of experienced personnel and therefore requires correction. Further development of the legal framework for the activities of reflexology specialists should ensure continuity and interconnection of individual regulatory documents. The inclusion of this discipline in the compulsory training program for medical students will undoubtedly bear fruit in the near future.
Literature.
1. Vasilenko A.M. Integration of the principles of physiotherapy and reflexology into dynamic electrical neurostimulation technologies. // Collection of materials from the international symposium dedicated to the 10th anniversary of DENAS MS Corporation, Yekaterinburg. - 2008. p.
2. Vasilenko A.M., Osipova N.N., Shatkina G.V. Lectures on reflexology: Textbook. - M.: Su Jok Academy Publishing House, 2002.-374 p.
3. Vogralik V.G. Vogralik M.V. Acupuncture: Basics of traditional oriental and puncture adaptation-energizing therapy of qi-gong. - M.: GOU VUNMTs M3 RF, 2001.
4. Ponomarenko G.N., Turkovsky I.I. Biophysical foundations of physiotherapy: Textbook. - M.: Medicine, 2006. - 172 p.
5. Grigoriadi N.V., Yablochkina T.N. The place of reflexology in modern medicine. New aspects of indications and contraindications for the use of reflexology in clinical practice (based on the Order of the Ministry of Health and Social Development of the Russian Federation No. 266 of April 13, 2007) // Doctor and pharmacy of the XXI century. - 2008.-9.-s. 12-14.
6. Breuner, S.C. Complementary Medicine in Pediatric: A Review of Acupuncture, Homeopathy, Massage, and Chiropractic Therapies. Pediatric and Adolescent Health Care. 2002, T. 32, N 10, p. 351-366.
7. Diehl, D. L. Acupuncture for gastrointestinal and hepatobiliary disorders //J. Altern. Comp. Med. - 1999. - N.5. - p.27-45.
Editor's comment.
Article by Doctor of Medical Sciences A.G. Polyakova and Ph.D. E.I. Maziloy continues and develops the discussion of this topic that took place back in 2002. The beginning was made by the following letter, published in No. 3 (3) of the magazine “Reflexotherapy” for 2002.
On the place of reflexology in the range of medical specialties.
Open letter to the first deputy
Minister of Health of the Russian Federation A.I. Vyalkov.
Dear Anatoly Ivanovich!
The decision of the Board of the Ministry of Health of the Russian Federation, held on March 20-21, 2001, provided for a revision of the nomenclature of medical specialties in 2002 (Medical Newspaper No. 1, January, 2002, P. 13). The issue of nomenclature is one of the most fundamental in all areas of knowledge and any human activity. The revision of the nomenclature is intended to help ensure the progress of the industry as a whole and the optimal development of its individual areas. The identification of a particular area of medical activity as a specialty should be based on certain criteria and objective realities of medical science and practice.
At present, the question of universal criteria for the formation of a nomenclature of medical specialties remains open. Most often, specialties are distinguished according to the criterion of the affected system; in other cases, the criteria of the predominant method of treatment, the main pathogenic factor, the most relevant goal of providing medical care or its stage are used. At the same time, some types of medical activities are awarded the title of primary specialty, others - additional, many remain in the rank of methods. At the same time, again, there are no objective criteria for classifying a particular medical activity, technology or method into the appropriate category.
The following formulation of the criterion for a medical specialty can be proposed for discussion: an area of medical activity characterized by a relatively specific holistic system of diagnosis and treatment, effective at various stages of medical care.
Along with obvious advantages, medical specialization also has negative consequences. Narrowly professional clinical thinking sometimes prevents the doctor from seeing the patient in all the diversity of his internal and external relationships. The principle of “treating the patient, not the disease” often fails to be implemented in practice. Patient management, despite the declared comprehensive approach, is often carried out sequentially.
The progress of medicine, like any other science, requires optimal balance between analytical and synthetic methods of cognition. Stefan Zweig owns the following words: “One can feel among the smartest and most humane doctors a longing for the old universalism, a desire to find ways from closed, localized pathology to constitutional therapy, awareness not only of individual diseases, but also of the person’s personality. Having explored the body down to the molecule, creative curiosity turns its gaze again towards the wholeness of the disease, different in each case.” Indeed, the attention of the progressive public has always been attracted by directions based on a holistic approach to man and his diseases in inextricable unity with the environment. This is how psychosomatics arose in European medicine and psychotherapists appeared.
The holistic approach is clearly evident in traditional Eastern medicine, in particular acupuncture. Gradually, a broader area of medicine, which in 1912 received the name “reflexotherapy,” which initially did not contain any restrictive instructions regarding the modality of therapeutic effects and the participation of certain sensory systems, turned out to be “monopolized” by acupuncture. Now we are restoring reflexology (RT) to its original, broader understanding, defining it as a therapeutic and preventive system based on assessing the parameters of peripheral reflexogenic zones and influencing them in order to regulate the functional systems of the body.
RT is characterized by the presence of a specific holistic system of diagnosis and treatment. Its effectiveness at various stages of medical care is proven both by the centuries-old “survivability” of the method and by modern data from clinical and experimental studies. Thus, RT meets the criterion of a medical specialty. According to the above definition, music, aroma, light and color therapy are returning to the fold of RT. Multifaceted research and clinical practice have provided RT with a modern scientific base. RT is recognized as a universal method aimed at regulating stress reactions and adaptation in all the diversity of their physiological and clinical manifestations.
In 1997, by order of the Ministry of Health of the Russian Federation No. 364 dated December 10, 1997, the Republic of Tatarstan was included in the nomenclature of medical and pharmacist specialties, and the regulations on the reflexologist, his qualification characteristics and certification procedure were approved. In 1999, by order of the Ministry of Health of the Russian Federation No. 38 dated 03.02 “On measures for the further development of reflexology in the Russian Federation”, regulations on the office and department of the RT and staffing standards for their personnel were determined.
Order M3 of the Russian Federation No. 337 dated August 27, 1999, according to which only doctors with a specialization in neurology have the right to receive a RT certificate, caused severe damage to the development of the RT service. It has been convincingly proven that RT is effectively used in many areas of clinical medicine, including those far from neurology.
However, the misfortunes of the Republic of Tatarstan did not end there. On 06/05/2002, order No. 186 was signed to amend Appendix No. 1 to Order No. 290 of the Ministry of Health of Russia dated 07/26/2001, which introduces paragraph 84 - Chief specialist in traditional medicine, and traditional medicine itself means “reflexotherapy, manual therapy, herbal medicine” , homeopathy, etc.”
The last of the cited orders introduced additional misunderstanding into the organization of the RT service. According to the current nomenclature, RT belongs to neurology, according to order No. 186 - to traditional medicine, which is generally absent in the nomenclature of medical specialties.
The belonging of RT to neurology is formallysignificantly limits the scope of its use and the receipt of appropriate training by doctors. Doctors - representatives of many areas of clinical medicine, in which RT has been used for a long time and very effectively, are forced to first obtain specialization in neurology. Thus, the 4-month training provided for by the unified postgraduate training program in RT should be preceded by a 5-month specialization in neurology. Please note that training is carried out on a full-time basis, away from work. Now let's ask the chief physician of any medical institution - is he ready to let his employee go for 9 months so that he receives a reflexologist certificate? - The answer will almost certainly be negative.
It is also not justified to classify RT as so-called traditional medicine. According to the definition adopted by WHO, traditional medicine is a body of knowledge and skills (whether or not they have received a logical explanation) applied in the process of prevention, diagnosis and treatment of physical, mental and social health disorders and based solely on practice and observations transmitted from generation to generation in oral or written form. Even in classical acupuncture, diagnostic and treatment algorithms are based on general scientific Chinese methodology, and not “solely on practice and observation.” Moreover, modern RT does not meet the criteria of traditional medicine formulated by WHO, the sanogenetic mechanisms of which are interpreted from the standpoint of the latest achievements of fundamental and biomedical sciences, and the methodological arsenal includes the latest information technologies.
A lot depends on which section of the nomenclature RT falls into - from the personnel training system, everyday issues of organizing the relevant service and the work of specialists, to the prospects for further development of the area. The above definition allows us to consider RT as an independent medical specialty, similar to the specialty of a family doctor. However, the revision of the nomenclature provides for a reduction in the total number of specialties, and not its increase.
RT is effectively used at various stages of medical care, but is most widely and reasonably used in prevention and rehabilitation. In most health care institutions, reflexologists most often work in rehabilitation departments. The largest number of master's and doctoral dissertations devoted to RT are considered by the Academic Council at the Russian Scientific Center for Regenerative Medicine, Resortology, Physiotherapy and Physical Therapy.
When preparing the final edition of the nomenclature of medical specialties, we ask you to resolve the issue of the place of RT in it, taking into account the given circumstances and arguments.
Sincerely.
Chief Editor
magazine "Reflexotherapy"
A.Vasilenko
* * *
Since there was no response to this appeal, the Medical Newspaper published another, more detailed letter in the April (No. 4) issue - an invitation to a discussion on this topic.
Nomenclature of medical specialties: the place of reflexology - an invitation to discussion.
One of the most important conditions for the progress of medicine, like any other science, is the optimal balance between analytical and synthetic methods of cognition. Stefan Zweig owns the following words: “One can feel among the smartest and most humane doctors a longing for the old universalism, a desire to find ways from closed, localized pathology to constitutional therapy... Having explored the body down to the molecule, creative curiosity again turns its gaze towards the integrity of various diseases in every case." The specialization of doctors is a natural consequence of the success of the analytical approach in medicine. As knowledge about etiopathogenesis, the variety of forms of clinical manifestations of any pathology deepens, and therapeutic and preventive methods of combating it improve, new medical specialties are emerging. This natural process is correspondingly reflected in the nomenclature of medical workers.
Despite the obvious advantages, medical specialization may conflict with the interests of the patient. Narrowly professional clinical thinking sometimes prevents the doctor from seeing the patient in all the diversity of his internal and external relationships. The principle of “treating the patient, not the disease” often fails to be implemented in practice. Therefore, the attention of the progressive public has always been attracted by directions based on a holistic approach to man and his diseases, not only in the inextricable unity of all his internal relationships, but also in all the diversity of his interaction with the environment.
Let us turn to the current nomenclature of medical specialties. What principles underlie its formation - the designation of one or another medical activity as a specialty? Some specialties are formed according to the criterion of the affected system (dermatology, neurology,..). In other cases, criteria for the preferred method of treatment are used (surgery, physiotherapy,..); main pathogenic factor (traumatology, infectious diseases,...); stage or most relevant goal of medical care (resuscitation, rehabilitation...). Some types of medical activities are included in the nomenclature as the main specialty, while others are classified as “requiring additional specialization.” Many types of medical activities are not included in the nomenclature, remaining in the rank of treatment and prophylactic methods. Almost until 1998, the latter included reflexology (RT).
By order of the Ministry of Health of the Russian Federation No. 364 of December 10, 199? The city of the Republic of Tatarstan was introduced into the nomenclature of medical and pharmacist specialties, regulations on a reflexologist, his qualification characteristics and certification procedure were approved. In 1999, by order of the Ministry of Health of the Russian Federation No. 38 dated February 3, “On measures for the further development of reflexology in the Russian Federation,” the provisions for the office and department of the RT and staffing standards for their personnel were determined. However, in August of the same year, in accordance with the order of the Ministry of Health of the Russian Federation No. 337 dated August 27, 1999, the Republic of Tatarstan was classified as one of the specialties requiring additional training of neurologists.
Following the formal logic of this order, only neurologists can legally provide certified reflexology care in all areas of clinical medicine, where there is a wide range of indications for it. Where can you find so many neurologists, and even those with a specialization in RT, to treat many diseases of internal organs, gynecological diseases and provide obstetric care using RT methods, use them as an anesthetic aid and dozens of other areas far from neurology? A self-respecting neurologist will never undertake these tasks. Given the relatively small proportion of neurologists in the general medical cohort, the availability of RT appears to be sharply limited. At the same time, thousands of non-neurologist doctors who devoted themselves to RT found themselves formally excluded from their specialty. The nomenclature should contribute to the progress of the industry as a whole and its individual components. Does Order No. 337 meet this mission?
The rationality of any classification is determined by the clarity and universality of the principles on which it is based. The current nomenclature is based primarily on the medical “disease-centric” paradigm, focused on eliminating the actual pathological process. Healthcare in the truest sense of the word corresponds to a “health-centric) paradigm, the basis of which is the preservation and enhancement of health, preventive and rehabilitative orientation. Medical specialties representing the health-centric paradigm are represented much more modestly in the modern nomenclature. The predominance of specialties based on a disease-centric paradigm reflects an analytical approach to the human sciences. The health-centric paradigm is more based on an integrative - holistic approach to the study of man in all the diversity and inseparability of his biological and social fusions and their manifestations.
Without calling for the abandonment of previously established principles for the formation of nomenclature, by way of discussion, the following formulation of the criterion for a medical specialty is proposed: an area of medical activity based on a certain paradigm, characterized by a relatively specific holistic system of diagnosis and treatment, effective at various stages of medical care. Most of the medical specialties included in the existing nomenclature meet the above criterion; does RT meet it?
Initially, RT was understood as any therapeutic effect that causes the activation of nervous reflex mechanisms. This was reflected in the first domestic encyclopedic definition of RT: “a therapeutic system that uses reflex relationships created in the human body during its centuries-old evolution to influence the pathological process” (A.R. Kirichinsky, BME, 1962, v. 28, p. 564). Subsequently, the understanding of RT was narrowed to the boundaries of the somatosensory analyzer: “a healing system based on reflex relationships formed in the process of phylo- and ontogenesis, implemented through the central nervous system through irritation of the receptor apparatus of the skin, mucous membranes and underlying tissues to influence the functional systems of the body” ( V.S. Goydenko, BME, 1984, v. 22. p. 244), and then limited itself to only the impact on acupuncture points: “a set of therapeutic techniques based on the influence of various, mainly physical, factors on certain point areas of the body surface - acupuncture points” (D.M. Tabeeva, KME, 1989, vol. 2. P. 603).
Thus, the initially broader semantic meaning of RT has been significantly narrowed. In accordance with the cited definitions, RT appears to be more of a therapeutic method than a medical specialty. This contradicts both the original essence of classical acupuncture, an integral part of which is its own diagnostic system, and the broader modern understanding of RT.
The limited understanding of RT appears to be due to the dominance of the concept of nervism since the early 19th century, which led to the term “reflex” acquiring a primarily neurophysiological meaning. It is appropriate, however, to remember that in a broader biological and philosophical sense, the category of reflection (reflex) is applicable not only to any form of relationship between an organism and the environment, but in general to all forms of existence of matter, because they are its basic property. Understanding reflex activity, and, consequently, RT should not be limited only to neural regulatory mechanisms.
Today's ideas about the essence of RT are based on the theory of functional systems, the modern interpretation of which is unthinkable without biophysical and information approaches. An integral part of RT is a variety of specific reflex diagnostic methods. These circumstances prompt us to turn to an initially broader understanding of RT and define it as a treatment and prophylactic system based on assessing the parameters of peripheral reflexogenic zones and influencing them in order to regulate the functional systems of the body. Unlike the previous ones, this definition introduces the presence of a relatively specific holistic system of diagnosis and treatment into the understanding of RT. It does not limit the understanding of RT to a neurophysiological framework, any type of receptor, a specific analyzer system, or modality of treatment. Music, color and aromatherapy are returning to the arsenal using the RT method. The most fully studied and popular area of traditional Chinese medicine - acupuncture, although it seems to be the most extensive, is still a particular method of RT. At the same time, classical mechanical and thermal methods of stimulating acupuncture points are increasingly giving way to factors of low and ultra-low intensity, which contain not so much energy as informational effects on the body.
Numerous diverse studies have made it possible to find an adequate modern interpretation of the main methodological principles of traditional acupuncture. Thus, the concept of “vital energy qi”, the canonical topography of acupuncture channels and points are explained from the positions of classical and quantum mechanics, modern ideas about the electron-ion-quantum level of biochemical reactions that ensure bioelectromagnetic homeostasis. Consideration of the phenomenology of acupuncture channels and points at the electron-ion-quantum level does not at all contradict the reflex theory, if we are not limited to its simplified neurophysiological interpretation.
Generalization of the results of studies conducted on various experimental models and in the clinic allows us to conclude that the therapeutic and prophylactic effects of RT develop due to the involvement of adaptive reactions of various levels. Adaptive reactions initiated by influences on acupuncture points are manifested in optimizing the functions of almost all body systems; however, the pain sensitivity control system plays a central coordinating role. This makes the use of RT highly effective for a variety of pain syndromes.
The pain sensitivity control system is an evolutionarily ancient homeostatic mechanism, occupying a leading place in the hierarchy of later formed mechanisms for maintaining the constancy of the internal environment of the body and its adaptive reactions. Changes in the functional state of this system cause changes in the response of other systems that ensure adaptation of the body not only under the influence of directly damaging (nociceptive) physical factors, but also under other stressful, potentially pathogenic loads.
Reflex diagnostic methods make it possible to identify functionally insufficient adaptation systems. Actually, therapeutic methods, replenishing the deficiency of these systems, make it possible to limit the pathogenic effect of stress, contribute to the elimination of existing pathogenetic mechanisms and the formation of sanogenetic functional systems. The stress-limiting and adaptogenic effects of RT provide a wide range of indications for its use for therapeutic and prophylactic purposes in almost all areas of clinical medicine and at all stages of medical care. This is reflected, in particular, in the content of the quarterly scientific and practical journal “Reflexotherapy”, published since 2002, the range of publications of which goes far beyond neurology. The current RT is a scientifically based, dynamically developing system, including several dozen diagnostic, treatment and prophylactic methods, the totality of which meets the requirements for the medical specialty.
Neither the modern theoretical basis, nor the established practice, nor the prospects for further development give grounds to consider RT as the exclusive prerogative of neurology. This far-fetched restriction does not exist in any country where RT methods are used in one or another regulation. Representatives of all areas of healthcare where there are indications for its use should have the opportunity to receive specialization in RT. Moreover, the current unified program of specialization in RT includes a significant amount of information, both on the general fundamentals of neurology and on the specifics of using RT in the clinic of nervous diseases.
The possibility of appropriate specialization for paramedical workers should also be discussed. A number of methods of reflex diagnostics and therapy, although they require certain preparation, are not at all more complicated than, for example, ECG recording, intravenous injections, or some physiotherapeutic procedures. The legislation of a number of Western European countries and American states allows persons who do not have a higher medical education, but who have undergone appropriate (usually two years) training, to practice acupuncture and some similar types of medical activities.
In conclusion, I would like to hope that the Russian Ministry of Health will continue the tradition of a careful and attentive attitude to the current state and prospects for the development of the RT service, the beginning of which dates back to 1956. It is necessary to provide opportunities for specialization for doctors working in those areas of clinical medicine where RT has long established itself as an effective, safe and economically attractive holistic approach that promotes the necessary integration of disease- and health-centric paradigms in today's medicine and the healthcare of the future.
Head of the Department of Reflexology
and manual therapy MGMSU,
Chief Editor
magazine "Reflexotherapy",
Doctor of Medical Sciences, Prof. A. M. Vasilenko.
* * *
From the Ministry of Health, it, like the first, remained unanswered, but caused dozens of responses from specialists who were not indifferent to the fate of the Republic of Tatarstan (Medical Newspaper No. 12, 2003). Here are some excerpts from them.
Responses to the article by Prof. A.M. Vasilenko “nomenclature of medical specialties: the place of reflexology - an invitation to discussion”, published in VG No. 4 (43), April, 2003.
In an address by Professor A.M. Vasilenko to the Ministry of Health of the Russian Federation raised the pressing issue of the situation with the medical specialty “reflexotherapy” in the country and the difficulties faced by practitioners in obtaining a certificate in this specialty. Without going into a lengthy discussion, I would like to note that in recent years, medical science has expanded its understanding of the mechanisms of the positive therapeutic effects of reflexology, just as the practice itself has provided numerous examples of its successful use in various fields of medicine.
Thus, it is considered proven that the therapeutic effect of RT cannot be explained solely from the standpoint of the classical reflex theory. Numerous data convincingly support the participation of endocrine mechanisms, as well as various parts of immune regulation when influencing biologically active points. Such a broad participation of various endogenous factors that restore disturbed homeostasis according to the most important principle of life - the principle of self-regulation, predetermines the success of RT in cases of various pathological manifestations in humans. Currently, the positive effects of RT are described not only in neurology, but also in the clinics of internal medicine, obstetrics and gynecology, urology, borderline mental disorders, etc.
In this regard, Order of the Ministry of Health of the Russian Federation No. 337 dated August 27, 1999, limiting the issuance of RT certificates exclusively to neurologists, is an undoubted obstacle to the use of RT in practical healthcare.
Noting the positive effects of RT in various diseases, we by no means consider RT a panacea and do not try to oppose RT to other medical specialties. Moreover, evidence is increasingly accumulating about the even greater effectiveness of RT if it is used both with methods of academic and other methods of traditional medicine.
From here it is clear that the more medical workers master the specialty of RT and use it creatively in treating patients, the better the success of our practical healthcare will be.
Head of the department
non-drug treatments
and clinical physiology
MM A im. THEM. Sechenov,
Doctor of Medical Sciences, Academician of the Russian Academy of Medical Sciences,
Professor V.G. Zilov
Opinion of the parent institute.
The issue of changing the order of the Russian Ministry of Health No. 337 has been long overdue. Developed and approved with the good goal of reducing the excessively bloated Nomenclature of medical and pharmacist specialties, this order turned out to be ill-conceived and largely inconsistent. The lack of clear criteria defining a medical specialty, in-depth study, and definition of privacy when discussing an order led to the infringement of the rights of a number of specialists.
It is noteworthy that the long-awaited discussion on this issue began on the pages of the “Medical Gazette”, the organ of the largest public professional medical organization. It is the Russian Medical Association, in our deep conviction, that, based on a broad study of the opinions of specialists, should develop and submit to the Russian Ministry of Health a draft new order that would reflect, on the one hand, the objective global trend towards a reduction in the number of specialties, and on the other, would avoid that subjectivity and inconsistency that characterize Order No. 337.
As for reflexology as a medical specialty, in our opinion, it cannot be strictly tied to any one basic specialty. In this regard, I would like to draw attention to the fact that at a recent scientific and practical conference held by the Russian Ministry of Health, respected Professor A.N. Razumov presented a draft of a new medical basic specialty “regenerative medicine”, to which reflexology is added as an additional specialty requiring in-depth study. In this case, reflexology will fall, as they say, “from the frying pan into the fire,” since both the scope of activity and the scope of training of specialists will be even more limited.
We are convinced that a representative of any medical specialty (therapy, surgery, obstetrics and gynecology, neurology, pediatrics, etc.) should have the right to receive a certificate of a reflexologist after appropriate training.
Director of the Institute of Reflexology
Federal Scientific Clinical
experimental center
traditional methods
diagnostics and treatment of the Ministry of Health of the Russian Federation
Doctor of Medical Sciences HER. Mazerov
One should not divide the indivisible - the opinion of therapists about the place of reflexology in the range of medical specialties.
Order of the Ministry of Health of the Russian Federation No. 364 of December 10, 1997 on the introduction of reflexology (RT) into the range of medical and pharmacist specialties was a natural consequence of many years of work by doctors and researchers in various specialties, which proved that RT is effective and safe, and is used in almost all areas of clinical medicine . The most attractive thing about RT is that its sanogenetic mechanisms are based on the regulation of natural adaptation processes at various levels. The stress-limiting and adaptogenic effect of RT ensures the feasibility and effectiveness of its use for the treatment and prevention of most widespread diseases.
Let's look at the list of indications for RT. Taking as 100% all nosological forms for which RT is indicated, it is easy to calculate that the first place among the indications is diseases of internal organs - 21.7%. Second place is occupied by pediatrics - 15%, third - obstetrics and gynecology - 10.6%, fourth - borderline conditions and psychiatry, fifth - diseases of the musculoskeletal system - 8%, and only sixth (7.5%) - diseases of the nervous system. Gastroenterology alone surpasses neurology in the number of nosological forms for which RT is indicated - 17 and 15, respectively. RT is indicated for 14 diseases of the bronchopulmonary system, at least seven diseases of the cardiovascular system and five different endocrinological diseases.
Already on the basis of this formal analysis, it becomes obvious that considering RT as a specialty additional to neurology, as provided for by Order of the Ministry of Health No. 337 of August 27, 1999, is completely unjustified. According to modern research, nervous mechanisms are far from the only ones, and, according to a number of authors, not the main ones in the implementation of the therapeutic effects of RT. Many years of our own experience in the clinic of internal medicine shows that the use of RT makes it possible to more effectively treat many complex diseases that are tolerant to pharmacotherapy, and to avoid drug burden on patients and many complications. Thus, neither from the standpoint of pathogenesis and sanogenesis, nor from the point of view of real clinical practice, the classification of RT as neurology cannot be considered appropriate.
Any classification, including the nomenclature of medical specialties, is a kind of convention that reflects current epistemological positions and practice. The current theoretical level of development of RT, world and own practice convinces that representatives of various fields of clinical medicine should be proficient in a rich arsenal of methods of modern RT.
What prevents doctors of different specialties from being certified in the specialty “reflexotherapy” as well? - Knowing the scope of the 4-month unified RT training program, which contains basic modern information on the etiopathogenesis and clinical picture of various diseases where RT is indicated, we can confidently answer - nothing! If this does not fit into the existing structure of the nomenclature, then it needs to be changed, and not try to artificially limit the use of RT within the framework of any one specialty.
At the same time, in no case should RT be allowed to lose its status as an independent specialty, the criteria of which it fully meets. It is necessary to maintain residency and other forms of postgraduate education in the Republic of Tatarstan. Considering the current situation and future prospects for the development of RT, there are reasons to think about including it as an appropriate course in basic medical education. As the 5-year experience of our University shows, the number of students wishing to take the elective course “Fundamentals of reflex, manual and information medicine” is increasing every year.
Today's RT, intensively developing on the basis of the latest achievements of fundamental sciences, using the latest achievements of microelectronics and information technology, is a vast area of modern healthcare, based on ideas about the integrity of man in all manifestations of his existence, relationships with nature and society, optimally meeting the principle of “treat not the disease, but the patient.” Attempts to “tie” RT to any of the existing specialties, or to introduce it into the vague boundaries of “traditional medicine” (Order of the Ministry of Health of the Russian Federation No. 186 of 06/05/02), or in any other way to deprive it of the status of an independent medical specialty, are fraught a number of negative consequences, primarily in the form of limiting its availability for hundreds of thousands of patients in need and large contingents of people in whom it is advisable to use it for preventive and rehabilitation purposes.
Head of scientific-educational-practical
Center "New Technologies in Medicine"
Academician of the Russian Academy of Medical Sciences, Professor L.E. Martynov.
Professor of the Department of Therapy No. 1 FPDO
MGMSU A.G. Evdokimov and V.L. Olkhin
Head Department of Therapy No. 2 FPDO
MGMSU Professor L. L. Kirichenko
Professor of the Department of Internal Affairs
diseases No. 3 MSMSU, Head. Course
occupational diseases A.M. Popkova
Associate Professor of the Department of Reflexology
and manual therapy, Moscow State Medical University,
Cardiologist with a 35-year-old
medical experience, Ph.D. Yu.P. Makarov
To the editor-in-chief of the Medical Newspaper, Professor G. A. Komarov.
Dear Georgy Alekseevich!
We are sending material for the “Discussion” regarding the article by Professor A.M. Vasilenko “Nomenclature of medical specialties. The place of reflexology is an invitation to discussion.” We fully share the concern of Alexey Mikhailovich, one of our country’s leading specialists in the field of reflexology, about the situation in which the specialty “reflexotherapy” found itself in connection with the publication of Order No. 337 of the Ministry of Health of the Russian Federation dated August 27, 1999.
The scope of application in medical practice of this specialty is clearly formulated in the order of the Ministry of Health of the Russian Federation No. 364 of December 10, 1997:
Appendix 2. 1.1. Doctor - reflexologist - specialist with higher education in the specialty “General Medicine” or “Pediatrics” ...” and further in Appendix 3, clause 3.1. Reflexology is designated as a “comprehensive clinical discipline in its own right.” Historically, over 47 years of existence in the country of reflexology, the practice has developed to use this type of diagnosis and treatment for a wide range of diseases within the framework of specialties included in the heading “General Medicine” and “Pediatrics”. This provision is enshrined in the order of the USSR Ministry of Health No. 106 dated March 10, 1959 “On indications and contraindications for the use of acupuncture”, as well as “Methodological recommendations” of the USSR Ministry of Health dated 1980 under the same name. Our practice and scientific research since 1957 (laboratory and research group of acupuncture, all-Union scientific and methodological center and department of reflexology at the Leningrad State Institute of Education and Science, then St. Petersburg MAPO) are evidence of the possibilities of reflexology and therapy not only for diseases of the nervous system, but and in the clinic of internal medicine (pulmonology, gastroenterology), allergology, obstetrics and gynecology, orthopedics and traumatology. The clinical application of reflexology is confirmed by fundamental scientific research, reflected in a large number of doctoral and candidate dissertations, the number of which has reached 300.
Against the backdrop of all the efforts and organizational measures of the Ministry of Health of the Russian Federation (including order No. 38 of 02/03/99 “On measures for the further development of reflexology in the Russian Federation”), order No. 337 of 08/27/99 destabilized the reflexology service throughout the country, reducing the specialty “Reflexotherapy” to the rank of “specialty requiring in-depth training.” Thus, in one fell swoop, a huge army of other specialists (therapists, allergists, obstetricians-gynecologists, pediatricians, etc.) was “cut off” from reflexology and deprived of medical care to thousands of thousands of patients who require effective drug-free care, which is reflexology. Doctors of the specialties listed above are put in a dead-end position: for example, a general practitioner, obstetrician-gynecologist, allergist must master neurology from scratch and pass an exam for a neurologist certificate (!!!). and then specialize in reflexology. Completing such a task is unrealistic. Thus, we support the point of view of our colleague and consider the optimal solution to be to give (or more correctly: restore) “reflexology” the status of an independent specialty.
Member of the Academic Medical Council, section “Traditional Medicine”, chief specialist in reflexology of the Health Committee of the Administration of St. Petersburg, professor of the department of reflexology of the St. Petersburg MAPO, doctor of medical sciences, professor A.T. Kachan.
Head Department of Reflexology St. Petersburg MAPO
Doctor of Medical Sciences, Professor N.N. Bogdanov
Narcologist's point of view.
In recent years, reflexology (RT) has been increasingly used in various fields of medicine. Much experience has been accumulated in the successful use of RT in narcology (V.A. Durinyan, V.P. Kokhanov, 1961; V.L. Lakusta, 1993, etc.). Modern methods of pharmacotherapy for drug addiction remain problematic. The use of medications often has its limitations and contraindications. It is not uncommon for our patients to develop dependence on medications.
It is often necessary to refuse to prescribe drug therapy due to the occurrence of toxic effects or side effects of the drugs. Therefore, along with the improvement of old treatment methods, the search for new and combined treatment methods in narcology is constantly being carried out.
Since the time that narcology was identified as an independent clinical discipline, RT has firmly occupied its “niche” in the complex treatment of addiction diseases. A large number of studies have been carried out to study the effect of RT on the activity of various body systems of patients dependent on alcohol (during the period of abstinence). This influences the neurotransmitter systems (adrenaline, norepinephrine, serotonin, acetylcholine, cholinesterase, hormones, histamine), including the state of the hypothalamic-pituitary-adrenal system. Much attention in the world literature is paid to the participation of opioid receptors and their ligands (enkephalins and endorphins) in the implementation of the effects of RT in the treatment of alcoholism. Therefore, the RT method is considered by many authors not only as a method of physiological non-drug treatment of alcoholism, but also as a way to study the pathogenetic mechanisms of this disease (Kokhapov V.P., 1992). Mention should also be made of the high results of treatment of tobacco smoking, where RT as the main method is effectively used in many countries of the world (Rudnev S.G.).
In modern medical institutions for drug treatment, RT is an integral part of a comprehensive treatment program. The use of RT is reflected in the standards (protocol models) for providing assistance to drug treatment patients. Treatment of our patients is carried out in several stages: detoxification, treatment of post-withdrawal state, rehabilitation period. RT is used in combination with the main treatment at a certain stage or throughout the entire treatment period, which is determined in each case individually. In some cases, especially during the rehabilitation period, RT is used as monotherapy (microneedling). Reflex diagnostic methods are also effectively used to diagnose and evaluate the effectiveness of treatment in narcology. The use of reflex diagnostics and therapy in narcology makes it possible to reduce the doses of medications used, strengthen psychotherapeutic contact with the patient and achieve more stable and high-quality remission.
Depriving narcologists of the opportunity to specialize (or improve their qualifications) in the Republic of Tatarstan primarily has a negative impact on the interests of our patients. It is difficult to imagine the presence of a neurologist on the staff of every drug treatment department or dispensary. But in our opinion, only the attending physician, who has complete information about the nature of the disease in a given patient and has emotional contact with the patient, can achieve a significant effect when using RT. We hope for the triumph of common sense and a more differentiated approach to resolving this issue.
Psychiatrist-narcologist -
reflexologist of the 17th narcological clinic
Moscow hospital G.I. Romashchenko
The common fate of reflexology and manual therapy.
The coincidence of the dates of “birth” and “death” “12/10/1997-08/27/1999” of reflexology and manual therapy, as independent medical specialties, is obviously not accidental. Everything that Prof. writes. A.M. Vasilenko regarding the inappropriateness of limiting the use of reflexology to the framework of neurology can equally be extrapolated to manual therapy.
Our own medical experience, as well as an impressive number of observations from colleagues, quite convincingly indicate the advisability of using manual therapy in the clinic of internal medicine, obstetrics and gynecology, and other areas of clinical medicine that are quite far removed from neurology. Therefore, Order of the Ministry of Health of the Russian Federation No. 337 of August 27, 1999, which “places” manual therapy in the Procrustean bed of neurology or traumatology and orthopedics, significantly limits the possibilities of its use by doctors of other specialties.
232 doctors from Moscow, Moscow, Kaluga, Kostroma and Yaroslavl regions who attended the final conference of the Moscow Professional Association of Manual Therapists, held on October 26, 2002, unanimously voted for the decision, one of the points of which reads:
“To date, data have been obtained on the possibility of using manual therapy in the treatment of not only musculoskeletal disorders, but also a number of diseases of internal organs. This suggests increased use of manual therapy by various specialists. The current order to train specialists only from neurologists and traumatologists slows down the implementation of new developments in the clinic of internal diseases. The existing specialist training program (560 training hours) can be mastered by doctors who have received a specialty in general medicine or pediatrics, which will allow for a wider introduction of the achievements of manual medicine in the treatment and prevention of diseases in adults and children, which can become an integral part of a large-scale program for improving the health of the nation.”
A similar decision regarding reflexology was made by participants in the Congress on Traditional Medicine, which was held on September 27-29, 2000 in Elista. So, there is every reason to believe that the opinions of the majority of specialists in the field of reflexology and manual therapy on the issue under discussion coincide. Many doctors who have mastered reflexology become motivated to master manual therapy and vice versa. This is due to the commonality of a number of their sanogenetic mechanisms and mutual potentiating effects, which provide significantly more pronounced and sustainable therapeutic effects. Medical kinesiology is actively developing, combining the approaches of reflexology, manual therapy and physical therapy. Information medicine methods are increasingly being introduced into practice, the range of diagnostic, treatment and preventive capabilities of which also goes far beyond neurology.
The rapid development of the listed non-pharmacological approaches in modern medicine obviously requires appropriate reflection in the nomenclature of medical specialties. Practically and theoretically integrating on the basis of a health-centric paradigm, these approaches, which are different at first glance, form a single direction that does not fit into the current structure of the nomenclature of medical specialties. This is probably why they are often combined under the collective names of “alternative,” “complementary,” or “integrative” medicine.
Perhaps the most logical combination of them into a single specialty would be restorative medicine. The issue of introducing the latter into the nomenclature of medical specialties, as far as we know, is currently being considered by the Ministry of Health of the Russian Federation. The recovery stage is already provided for in any medical activity, so reflexology, manual therapy, homeopathy and other innovative medical technologies will not remain the exclusive domain of neurologists. The effectiveness of their integrated use is confirmed by the experience of the All-Army Rehabilitation Center, operating on the basis of the 6th Central Military Clinical Hospital of the Russian Defense Ministry. The argument about classifying them as restorative medicine is also supported by the practice of specialized scientific councils operating under the Russian Scientific Center for Regenerative Medicine and Balneology of the Ministry of Health of the Russian Federation.
In conclusion, we appeal to the Ministry of Health of the Russian Federation with a request, in one way or another, to remove artificial barriers to the possibility of obtaining specialization in reflexology and manual therapy for representatives of all those medical specialties where they have indications for use.
Head of manual therapy courses
and reflexology Department of Medical
rehabilitation and physical methods
treatment at the State Institute
advanced training for doctors of the Ministry of Defense of the Russian Federation Chairman
Council of the Moscow Professional
Association of Manual Therapists, Doctor of Medical Sciences,
Professor A.T. Neborsky
Head of the Manual Center
Therapy of the Russian Scientific Center
Regenerative medicine and balneology
Ministry of Health of the Russian Federation, President of Moscow
Professional Association of Manual
Therapists, Ph.D. A.E. Samorukov
Save Baby Reflexology!
According to the Ministry of Health of the Russian Federation, from 1990 to 1999, childhood morbidity for all groups of diseases increased by an average of 20%. Excluding known socio-economic factors, the increase in morbidity is due to an increase in the proportion of maladaptation diseases associated with environmental conditions, unjustifiably wide and intensive use of pharmacotherapy, leading to allergization of children and adults. Getting used to the constant consumption of medications from the period of intrauterine development, children, as V.P. Kaznacheeva become immunological “juniors”.
Against this background, it is especially important to use reflexology (RT) as widely as possible, which is based on the directed regulation of natural mechanisms of adaptation and sanogenesis. Reflex diagnostic methods make it possible to identify early (preclinical) manifestations of maladaptation and determine the most vulnerable body systems from the point of view of the possible development of pathology. Actually, therapeutic methods provide an individualized holistic approach to solving issues of prevention, treatment and rehabilitation, meeting the principle of “treating the patient, not the disease.” RT, in which medical procedures are carried out by a doctor, unlike most other medical specialties, provides greater opportunities for the necessary psychological interaction with the child and his parents. RT, aimed both at increasing the child’s general nonspecific resistance to various pathogenic influences and at treating specific diseases, can significantly limit the harmful effects on the body, which is in a state of environmental, psychological and medicinal stress.
With the current financial support for healthcare, the increasing cost of medical services, especially specialized medical care, and increasing prices of pharmaceuticals, the problem of maintaining health, preventing and early detection of diseases using economically affordable methods is of particular importance. RT does not require expensive equipment; it is affordable both for any medical institution and for the general population. The effectiveness of RT is not inferior to, and often exceeds, the level of effectiveness of pharmacotherapy, can replace a whole range of medications, has a very limited range of contraindications, and has virtually no side effects.
Based on these premises, one would expect a further increase in the number of pediatricians who speak RT and an expansion of the network of RT offices and departments in children's healthcare facilities. In fact, this does not happen, and the opposite trend is often observed. Thus, in 1993, the RT office was liquidated, which had been operating for 14 years in the advisory clinic of Children's City Hospital No. 13 named after. N.F. Filatova. In January 2001, after four years of work, the office of the RT DP No. 11 of the North-East Administrative District was liquidated. With these examples I would like to draw the attention of the management of the Moscow Department of Health to the organization of the children's RT service. The unfavorable situation of this service is due to a number of circumstances.
First of all, attention is drawn to the lack of awareness of both patients and, apparently, health care managers about the possibilities of RT and, although insufficiently developed, there is still an existing network of operating offices in clinics and hospitals. The patient has the right to receive information regarding all directions and methods that can be used for his treatment; the administration of the health care facility is obliged to provide this information, but usually does not do this. Against the backdrop of intrusive advertising of pharmacological drugs, there is a lack of information not only about RT methods in general, but also about the RT rooms available in the structure of children's health care facilities. Thus, the already poorly developed children's RT network is clearly underutilized.
The organization of any medical service begins with a nomenclature of medical specialties. According to the order of the Ministry of Health of the Russian Federation No. 337 dated August 27, 1999, the Republic of Tatarstan was classified as one of the specialties that require additional training of neurologists, and this despite the fact that the neurological morbidity of children under 14 years old, according to data for 1999, is only about 10% of the total morbidity. Our own 22-year practice in pediatric RT shows that approximately half of patients are referred to a reflexologist by neurologists. However, among these children, about 70% are patients with multisystem somatic pathology of a vegetative-visceral or psychosomatic nature. Thus, no more than 35% of patients need specialized neurological treatment, the rest need the help of a general pediatrician. The unified training program for doctors in RT contains all the information necessary for general practitioners to treat patients suffering from diseases of the nervous system. Various aspects of RT in pediatrics are well represented.
Order No. 337 impedes the availability of RT for numerous children in need and artificially limits the ability of pediatricians to master our specialty. A similar mistake has already been made when RT was classified as physiotherapy by order of the Ministry of Health No. 6931981. Modern RT is an interdisciplinary and dynamically developing field that meets the criteria of an independent medical specialty. Theoretical premises are maturing, and the practice of integrated use of RT, manual therapy, bioresonance therapy, homeopathy, homotoxicology and a number of other methods is being developed in the form of a methodologically unified system of providing medical care using apparently different biomedical technologies. However, one can hardly consider the attempt to unite them with the ambiguous term “traditional medicine” (Order of the Ministry of Health of the Russian Federation No. 186 of 06/05/02) successful. Rather, the term “complementary” or “integrative” medicine, which are used in the international professional lexicon, would be appropriate here.
One way or another, it is necessary not to limit, but to expand the opportunities for specialization in RT and ideologically related areas not only for representatives of various fields of clinical medicine, but also for healthcare in general.
reflexologist of the highest category.
Central children's clinic of the Ministry of Internal Affairs of the Russian Federation.
T.G. Tikhonov.
Pediatrician of the highest category,
reflexologist of the highest category,
DGP No. 140 North-Western Administrative District of Moscow
Ph.D. D.L. Kazbekova.
* * *
It is unlikely that the above materials did not come to the attention of medical officials; moreover, they were directly presented to one of the deputy ministers... But the then leadership of the Ministry of Health again did not honor us with any response, thereby demonstrating their indifference to the fate of the Republic of Tatarstan. The leadership of our professional Association will make sure that this issue of the journal falls into the hands of the current leadership of the Russian Ministry of Health. We hope that it will take the necessary steps to resolve pressing issues in organizing the RT service.
You can download the job description of a reflexologist for free.
Job responsibilities of a reflexologist.
I approve
________________________________ (Last name, initials)
(name of institution, its ___________________________
organizational and legal form) (director; other person
authorized to approve
job description)
JOB DESCRIPTION
REFLEXOTHERAPIST
______________________________________________
(name of institution)
00.00.201_g. №00
I. General provisions
1.1. This job description defines the job duties, rights and responsibilities of a reflexologist _____________________ (hereinafter referred to as the “enterprise”).
1.2. A person with a higher medical education and training in the specialty “Reflexology” is appointed to the position of a reflexotherapist.
1.3. Appointment to the position of a reflexologist and dismissal from it are made in the manner established by the current labor legislation by order of the head of the healthcare institution.
1.4. The reflexologist reports directly to _____________________
(head of department,
Deputy Chief Physician)
1.5. A reflexologist should know:
Laws of the Russian Federation and other legal acts regulating the activities of healthcare institutions;
Current normative and methodological documents regulating the activities of medical institutions;
Methods and rules for providing medicinal and emergency medical care;
Contents of reflexology as a separate clinical discipline;
Organization, structure, tasks, staffing and equipment of the reflexology service;
All legal and regulatory documents in your specialty;
Methods for prevention, diagnosis, treatment and rehabilitation of the patient;
Planning the activities and all reporting of the reflexology service;
Methodology and procedure for monitoring your service;
Rules and regulations of labor protection, industrial sanitation, safety and fire protection;
Fundamentals of labor legislation of the Russian Federation
Internal labor regulations;
1.6. During the absence of a reflexologist (business trip, vacation, illness, etc.), his duties are performed in the prescribed manner by an appointed person who bears full responsibility for their proper performance.
II. Job responsibilities
Reflexologist:
2.1. In his specialty, he provides qualified medical care, using modern methods of diagnosis, prevention, treatment and subsequent rehabilitation of the patient.
2.2. In accordance with established rules and standards, he selects patient management tactics and develops a plan for his examination.
2.3. Specifies the scope and methods of examining the patient to obtain a reliable and complete diagnosis of the disease in the shortest possible time.
2.4. Based on the collected data, he performs an analysis, as well as prescribes and carries out the necessary treatment and procedures.
2.5. Conducts daily examination of the patient in the hospital.
2.6. Changes treatment plan as needed
2.7. Consults doctors of health care facilities in his specialty
2.8. Supervises lower-level medical personnel
2.9. Monitors the correctness of diagnostic and therapeutic procedures, as well as the operation of equipment and equipment, instruments, medications, reagents
2.10. Monitors compliance with safety and labor protection rules by lower-ranking medical personnel.
2.11. Timely and competently executes orders, instructions and instructions from the management of the institution
2.12. Complies with internal regulations.
2.13. Complies with labor protection, industrial sanitation and safety regulations
2.14. Timely and competently executes orders, instructions and instructions from the management of the institution
2.15. Complies with internal regulations.
2.16. Complies with labor protection, industrial sanitation and safety regulations
III. Rights
A reflexologist has the right to:
3.1. Make proposals to the management of the enterprise on the optimization and improvement of medical and social care, including on issues of their work activities.
3.2. Demand that the management of the institution provide assistance in the performance of their official duties and rights.
3.3. Receive information from company specialists necessary to effectively fulfill your job responsibilities.
3.4. Pass certification in the prescribed manner with the right to receive the appropriate qualification category.
3.5. Take part in meetings, scientific and practical conferences and sections on issues related to your professional activities.
3.6. Enjoy labor rights in accordance with the Labor Code of the Russian Federation
I V . Responsibility
The reflexologist is responsible for:
4.1. For the proper and timely performance of the duties assigned to him, provided for by this job description
4.2. For organizing your work and qualified execution of orders, instructions and instructions from the management of the enterprise.
4.3. For ensuring that employees subordinate to him comply with their duties.
4.4. For failure to comply with internal rules and safety regulations.
For offenses or inaction committed during the treatment process; for errors in the process of carrying out their activities that entailed serious consequences for the health and life of the patient; as well as for violation of labor discipline, legislative and regulatory acts, a reflexologist may be subject to disciplinary, material, administrative and criminal liability in accordance with current legislation, depending on the severity of the offense.
A reflexologist is a specialist who treats diseases through the use of acupuncture. Special points of the human body are directly related to various systems and internal organs. A professional in this field must have practical skills and extensive theoretical knowledge in the field of neurology. With a clear understanding of anatomy, the doctor can perform procedures without the risk of harming the patient.
The specialty “reflexologist” was approved in 1998. Doctors independently prescribe and perform procedures. The techniques have almost no contraindications, so patients can be adults and children.
Increased lymph flow and blood flow are observed in all biologically active points of the body. In these areas, oxygen is absorbed much more actively, thereby increasing sensitivity to pressure in certain places. In response to the impact, a weak electrical impulse is generated at the acupuncture points, which is transmitted to the organ affected by the disease through a number of nerve centers. The process not only stimulates the functioning of the organ, but also activates the recovery system.
What methods does he use for treatment?
During the treatment of diseases, a professional reflexologist can use various methods of influencing biologically active points.
- Acupressure is a technique that involves influencing acupuncture using acupressure with fingers.
- Pharmacopuncture, which is the subcutaneous administration of medications (in most cases, homeopathic remedies) to acupuncture points.
- Acupuncture, which is the most common reflexology technique, involves inserting thin needles into different parts of the body. The length of the needles used directly depends on how deep a certain point is located. Depending on the method used by the specialist, the injection technique is chosen - fast, slow, deep, superficial, with scrolling and combining several needles.
- Apitherapy, which involves the use of bees, as well as their waste products - honey, wax, propolis, royal jelly. Treatment can be carried out through direct stinging to biologically active points, as well as in combination with medications, hormones, exercise therapy and physiotherapy.
- Application reflexology, in which stimulation is carried out using special plates and balls that are attached to the skin in certain areas, after which they remain for several days or a day (in the case of the elderly and seriously ill, as well as children). Some reflexologists use sprouted seeds and grains, ginger, garlic, onions and other irritants as applications.
- Magnetic puncture is stimulation of points provided by alternating or constant low-frequency magnetic fields.
- Thermopuncture, in which the points are stimulated by cauterization with wormwood cigars and special cones. The procedure differs in that it has a slight irritating effect: the patient does not experience pain or other unpleasant sensations, but only feels warmth in the stimulated area.
Each method has its own characteristics, advantages and disadvantages. The choice of a technique that will ensure the achievement of the goal in the shortest possible time is directly carried out by the treating reflexologist.
In addition to these techniques, many doctors use personal techniques that have proven to be effective. To date, more than 900 acupuncture points have been discovered, which are associated with various systems and organs of the human body. Individual procedures and complex courses of treatment help improve overall well-being and also open channels for the flow of vital energy.
In situations where a patient suffers from a number of unpleasant symptoms, but doctors at the clinic cannot identify the cause, the best solution is to contact a specialist in the field of alternative medicine. The reflexologist uses his own diagnostic methods, during which he studies the state of the internal organs based on the “signs” displayed on the body. By influencing certain points and monitoring reactions, the doctor can draw conclusions about the presence of problems. In addition, thanks to modern technology and the use of advanced equipment, the accuracy of diagnostic procedures has increased significantly.
What diseases does it treat?
Among the ailments that a reflexologist helps to cope with are many pathologies of the musculoskeletal system (myositis, arthritis, bursitis, periarthritis, heel spurs, arthrosis). In addition, people suffering from hypertension, chronic bronchitis, gastritis, pancreatitis and headaches often turn to specialists. Reflexology helps to cope with nephritis, diseases of the genitourinary system, metabolic disorders, and anemia.
In addition to physical diseases, influencing various points of the body is an effective way to combat insomnia, depression, emotional instability and increased anxiety.
When should you see a reflexologist?
The help of a specialist can be useful not only during treatment, but also during preventive measures. Practice shows that people turn to a reflexologist when traditional treatment methods do not give the expected result. Professional help will help with:
- chronic pain and allergies;
- disorders of the reproductive system;
- chronic and acute inflammation;
- developmental delays in children and cerebral palsy;
- skin and infectious diseases;
- recovery after strokes, polio, epilepsy attacks.
Often, people suffering from alcohol, drug and other types of addiction who have become disillusioned with traditional methods of treatment seek the help of a reflexologist.
What organs does a reflexologist work with?
It is impossible to determine the main “working body” of a specialist in the field of reflexology - the doctor acts on all active points of the human body. The procedures allow you to cope with diseases of various organs, as well as prevent the development of chronic ailments.
It is an integrated approach to developing a course of treatment that helps achieve maximum results.
Reflexologist: how is the appointment?
The reflexologist conducts consultations in a fully equipped office, where there is a special couch, advanced devices for electroacupuncture and other manipulations using modern techniques, as well as a sterile cabinet in which kits for acupuncture procedures are stored.
At the initial stage, the doctor collects the patient’s medical history, identifies complaints and assesses his condition. It is very important to determine the localization of the pathology in a timely manner in order to competently draw up a manipulation plan. That is why it is necessary to provide the specialist with detailed and honest information about your lifestyle, diet, past illnesses and injuries. It is better to take with you a medical card, recent results of examinations and tests.
You should avoid going to a reflexologist during periods of exacerbation of chronic illnesses or warn your doctor in advance about your condition. Only with up-to-date information can a specialist create an effective treatment program that will not provoke negative consequences.
It is very important to consider that in order to achieve maximum results, it is important to complete the course of treatment, even if after several sessions the patient begins to feel relief. A decrease in pain does not mean that the problem is completely eliminated.
What tests need to be taken?
Before an appointment with a reflexologist, you usually do not need to undergo additional instrumental and laboratory tests. However, there are situations when a specialist can prescribe an examination in order to get an objective idea of the state of the human body. If you have ready-made research results and opinions of other doctors, you should take them with you.
Like all professional doctors, reflexologists recommend that their patients seek help in a timely manner, including regularly undergoing preventive procedures to protect themselves from a variety of ailments. Any disease is much easier to prevent than to cure.
- eat in a timely and balanced manner;
- regularly exercise and rest;
- stay in the fresh air for at least one hour a day;
- timely and fully treat all current diseases, including common colds, and also abandon untested folk methods.
Thanks to the effectiveness of reflexologists, confirmed by hundreds of thousands of positive reviews, the services of specialists in this field are very popular.
If earlier doctors of alternative medicine used only their hands, knowledge and intuition, today modern computers help them in the treatment process. The system ensures diagnostic accuracy and helps perform the procedure without harming the patient's body.
It is the responsibility of any medical practitioner to improve their knowledge and skills. Certification is considered one of the methods of training, which has its own requirements and characteristics, based on the results of which specialists are assigned the appropriate category. Each category of doctors occupies a certain level in the hierarchy of the medical field.
Goal and tasks
Participation in the certification process is voluntary. In the process, the specialist’s personal worth, level of knowledge, practical skills, suitability for the position held, and professionalism are assessed.
Certification of doctors for a category carries with it a certain interest:
- It's prestigious. Allows you to occupy a higher position and allows you to draw the attention of management to yourself. Quite often, the categories of doctors are indicated on signs at the entrance to their office.
- In some cases, the highest category allows you to reduce moral or physical responsibility to the patient’s relatives. Like, if such a person could not solve the problem, then it is difficult to think what would have happened if a less experienced doctor had been in his place.
- Material side. Medical categories of doctors and promotion through the levels of the medical hierarchy allow for an increase in the basic salary.
Types of certifications
The legislation distinguishes several types of certification activities:
- assignment of the title “specialist” after determining theoretical and practical skills;
- qualification category of doctors (obtaining);
- category confirmation.
Determining the level of knowledge for the designation of a “specialist” is a mandatory step before appointment to the position of a doctor. Conducted by special commissions in postgraduate education institutions. The following candidates will be considered:
- after internship, master's degree, residency, postgraduate study, if there is no diploma "doctor-specialist";
- those who have not worked for more than 3 years in a narrow specialty;
- those who did not undergo certification in a timely manner to obtain qualifications;
- persons who are denied the opportunity to receive the second category for objective reasons.
Each doctor has the right to receive a category in several specialties at the same time, if they are related. The main requirement is work experience in the required specialization. The category of general practitioner is an exception.
Basic rules and requirements
There are second, first and highest categories of doctors. There is a rule of consistency in receiving, but there are exceptions. The requirements are discussed in the table.
| Qualification category of doctors | Outdated requirements | Requirements for current orders |
| Second | 5 years of practicing experience or more | At least 3 years of practical experience in the specialty |
| Submitting a work report | Personal appearance, including participation in an interview, testing | |
| First | Department Head or Leadership level required | At least 7 years of practical experience in the specialty |
| Upon receipt - appearance, confirmation occurs in absentia | ||
| Higher | Manager position required | More than 10 years of practicing experience in the specialty |
| Personal appearance in any case | Personal appearance, including participation in report evaluation, interview, testing |
Validity periods
According to the old orders, there were certain circumstances that were classified as social benefits and made it possible to extend the period of the current qualification. These included:
- pregnancy and child care under 3 years of age;
- a month after dismissal due to reduction;
- business trip;
- state of temporary disability.
The benefits are not valid at this time. The certification commission may decide to extend the validity period at the request of the head physician of the medical institution. If a doctor refuses to appear for the commission, his category is automatically removed after a five-year period from the date of assignment.
Documentation
A report on the work done over the past few years, approved by the chief physician of the healthcare facility and the personnel department where the certified person works, is also filled out. Copies of documents on education, work history and assignment of current qualifications are also sent to the commission.
Attestation report
The introduction includes information about the identity of the doctor and the medical institution where he holds a position. The characteristics of the department, its equipment and staff structure, and the performance indicators of the department in the form of statistical data are described.
The main part consists of the following points:
- characteristics of the population undergoing treatment in the department;
- possibility of carrying out diagnostic measures;
- carried out medical work with the indicated results for specialized diseases;
- deaths over the past 3 years and their analysis;
- implementation of innovations.
The conclusion of the report consists of summarizing the results, indicating possible problems and examples of their solutions, and opportunities for improvement. If published materials are available, a copy is attached. Indicated and studied over the past few years.
Points for promotion
Each specialist receives points that are used in making decisions about qualifications. They are awarded for attending conferences, including international congresses, giving lectures to colleagues or nursing staff, distance learning with a final certificate, and taking courses.
Additional points are awarded for the following achievements:
- publishing of textbooks, manuals, monographs;
- publication of an article;
- obtaining a patent for an invention;
- presentation at symposiums with a report;
- speaking in institutions and the media;
- obtaining a title;
- defense of the thesis;
- awards by public authorities.
Composition of the commission
The commission consists of a committee, whose work takes place during breaks between meetings, and a narrowly focused expert group, which directly conducts certification of a specialist (exam, testing). Both the committee and the expert group consist of persons holding the following positions:
- The chairman, who oversees the work and divides responsibilities between the members of the commission.
- The deputy chairman performs the functions of the chairman in full in his absence.
- The secretary is responsible for registering incoming documents, preparing materials for the work of the commission, and recording decisions.
- The deputy secretary replaces the secretary and performs his duties during absence.
Each expert group includes specialists from related specialties. For example, the category of dentist and its receipt/confirmation requires being in the group of a periodontist, orthodontist, pediatric dentist, or therapist.
Order of the meeting
Certification is scheduled no later than three months from the date of receipt of data about the specialist by the committee. If the data does not match the requirements for the latter, the documentation will be refused (no later than 2 weeks from the date of receipt). The secretary of the committee agrees with the chairman of the expert group of the required specialization on the date of the examination.
Members of the expert group review the certification documents for the category, completing a review for each of them, displaying the following data:
- level of practical skills of a specialist;
- participation in social projects related to the medical field;
- availability of published materials;
- self-education of the certified person;
- compliance of knowledge and skills with the declared category of doctors.
The examination must take place within two weeks from the date of receipt of the report. The result of the review is an indicator of the possible outcome of the certification. The secretary informs the specialist of the date of the meeting, which includes an interview and testing. More than 70% of correct answers allow you to consider the test passed. The interview takes place by questioning the person being certified according to theory and practice, the knowledge of which must correspond to the requested qualification.
The meeting is accompanied by the preparation of a protocol, which is signed by the members of the expert group and the chairman. The final decision is noted on the qualification sheet. A specialist receives the right to retake the exam only after a year. Within 7 days, the certified person receives a document confirming the promotion, reduction or refusal to assign a category.
Extreme measures
The administration of the medical institution can send a request to the commission so that the doctor is deprived of qualifications or promoted ahead of schedule. In this case, documents are sent to justify the decision. The commission considers the issue in the presence of a specialist. Failure to appear without a valid reason allows a decision to be made in his absence.
Protest
From the date of the decision, the doctor or medical institution can appeal the result within a month. To do this, it is necessary to fill out an application specifying the reasons for disagreement and send it to the commission under the Ministry of Health.
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