Pseudo-optimization disease: coronavirus paralyzed Russian clinics

Irina Mishina

Social networks filled with photos of clinics, at the entrance to which there are long queues on the street. To open or close a sick leave, patients with signs of SARS or the Omicron strain are forced to wait for a doctor's appointment for several hours, and sometimes even days. If in previous waves of coronavirus, at the slightest symptom of covid, we were urged to stay at home and immediately consult a doctor, now everything is different. People are advised not to call a doctor or come to an appointment, but to self-isolate and follow general recommendations for the treatment of Covid-19. Sick leave - remotely. What came of it?

Yekaterinburg. According to local media reports, hundreds of citizens wait several hours every day for an appointment in the emergency rooms of polyclinics. Most of them have fever, cough and other symptoms of SARS. It is -12 °C outside, and several dozen more feverish and coughing patients are waiting for a doctor's appointment in the building. Those who could not get through to the clinic or open an electronic sick leave come here so as not to get absenteeism from work.

Petersburg. According to Fontanka.ru, the queues in the clinics of St. Petersburg go beyond the boundaries of the clinics themselves. On the way to them, the lines of patients with fever and symptoms of coronavirus stretch for tens of meters. Inside - crush instead of social distance. Thousands of St. Petersburg residents with symptoms of COVID-19 are switching to bed rest, but new rules prevent them from lying down properly. Now a doctor visits adult patients at home only if their temperature does not fall below 38 degrees within a week. In other cases, you need to go to the clinic yourself.

Nizhny Novgorod. According to local media, residents of Nizhny Novgorod complain en masse about the inaccessibility of calling a local doctor or an ambulance. At the same time, polyclinics in the Nizhny Novgorod region have been transferred to an enhanced mode of operation : from 6:30 to 23:00. Residents of Nizhny Novgorod suffering from the disease without symptoms or with minor signs began to receive remote medical care.

Sochi. Yelena Avsetsyna writes on Facebook: “Two hours at the reception in line and four at the doctor’s office (Sochi, clinic, Abrikosova district). One medical registrar and then the patient! To the therapist 60 - 65 people in half a day.

Karelia. Residents of the republic say that patients with fever, waiting for the test, are forced to spend in queues for several hours. Their appeals were filled by the Republican Ministry of Health. They decided to increase the "red zones" in clinics, regional media report.

In Yaroslavl, more than 150 people were forced to spend several hours on the street to take a PCR test. There were people who were sick with the coronavirus and those who were healthy. At the same time, residents of Yaroslavl have repeatedly complained that in polyclinics, patients with suspected coronavirus are in the same queues as patients with non-communicable diseases.

There are conflicting responses from Moscow.

Dmitry Kozlov: “I grabbed an omicron on Sunday. On Monday and Tuesday, the temperature is 38.5, I call 112. The robot answers ... all to no purpose ... today I had to go to the clinic myself for sick leave. Discharged. True, the number was never sent. They also took a PCR test. Positive. Medicines were given out. What was not issued, bought. Until February 15 on sick leave. They will call, and if everything is fine, they will close the sick leave remotely.”

Gennady Mikhailov: “So now you can get a sick leave electronically, I wrote to the State Services, and they opened it for me, I didn’t go to the clinic. Tomorrow they should close and also by phone”.

Natalya Salyakhova: “Has anyone already closed / extended the “covid” sick leave by phone? Today (on the control day) I did NOT get a call, as promised in an SMS from EMIAS. In the message, it was ordered to sit and wait for the doctor's call, not to go to the clinic with my own foot. Bottom line: five minutes to eight in the evening - the promised call is still missing"

Users in social networks provide a link to the EMIAC system service, with which you can remotely go through an initial consultation and even write out a sick leave. There, in particular, it says: “The service is intended for obtaining an initial consultation with a doctor and the initial opening of a sick leave for patients with symptoms of SARS. The extension or closure of the sick leave is carried out remotely without visiting the clinic. The doctor contacts the patient in the audio consultation mode and remotely closes or extends the sick leave. If you have confirmed coronavirus, you do not need to fill out an application for the service. If the result of the PCR test is positive, if it was passed in Moscow, the doctor will contact the patient proactively and, depending on the patient's condition, remotely open a sick leave, or issue a house call and open a sick leave during the visit. If you want to take a PCR test or get a face-to-face consultation, contact the doctor on duty at the polyclinic. In the event of a positive PCR result, you will be given a sick leave for coronavirus for 14 days”.

Everything is simple and clear. But why then queues in Moscow polyclinics?

The main problem is with tests for coronavirus. An excellent algorithm was invented for doctors and patients: to help at home only the most difficult. Where exactly was the mistake made? Patients complain that one of the reasons for the pandemonium is the long sorting. First, tests for covid are taken at the clinic, and only after that the patient is given a preliminary diagnosis, and then, regardless of whether it is a coronavirus or not, everyone is sent to one office. As a result, it takes about half an hour to receive one patient and fill out the paperwork. When there are hundreds of sick people, all this multiplies the scale of the disaster.

We have contacted the Moscow Department of Health with a request to comment on the situation. They denied the fact of Moscow queues:

“Information about large queues of patients with SARS in Moscow clinics is not true. There were isolated cases of queues a few days ago, associated with the simultaneous treatment of a large number of patients with signs of SARS. These situations were resolved as soon as possible. Today, the number of doctors on duty in polyclinics has been significantly increased. They work from 8 a.m. to 8 p.m., seven days a week. All polyclinics in Moscow have a separate entrance for people with symptoms of a viral infection to separate patient flows, all floors of the building have a navigation system and signs for maintaining social distance”.

We were also told:

“You can come to an appointment without an appointment with the doctor on duty at any clinic, regardless of the presence or absence of an attachment ... As for the process of obtaining and closing a sick leave, we inform you that from January 28, with symptoms of SARS, Muscovites over 18 years old will be able to remotely open a sick leave without visiting a polyclinic . To do this, you need to send an application using the electronic form on the mos.ru portal, after which the doctor will contact the patient. He will conduct a consultation, issue an electronic prescription for medicines and automatically open a sick leave for SARS for seven days. The closure of the sick leave will also take place remotely after the patient’s well-being is clarified during an audio consultation. If, for health reasons, the patient needs to continue treatment, then the sick leave will also automatically be extended. You do not need to come to the clinic to receive sick leave. It will be available in the electronic medical record and automatically sent to the employer.”

There is a question about the delivery of PCR. In clinics, in order to pass the test, you often have to stand in a long queue. In private laboratories, such an analysis costs about 2,500 rubles, if you need it urgently, the price doubles ... You can take an express test in some shopping centers, but even there the queues stretch for tens of meters and there is no question of social distance. Yes, and confidence in rapid tests is low. Sharing my personal experience, I can say: in my case, all express tests showed a negative result, even when the saturation dropped to 85 and lung damage exceeded 60%. And only a full-fledged PCR in the hospital showed a positive result, but it was too late ...

Why such a trouble with PCR, no one undertakes to explain. But, I think, and here it was possible to foresee everything in advance. The question is also about electronic services, because the speed and quality of the Internet in Russia are not the same everywhere, and the country's Internet coverage is far from complete. So, with electronic records and electronic sick leave, everything is fine, probably in Moscow, St. Petersburg and several other large cities, but in the outback people are forced to stand in line for hours at the clinic. Well, if we talk about the older generation, then not everyone owns computers. Why, a rare pensioner just has a gadget.

Where is the failure in our primary link and how to eliminate it? With this question, we turned to the doctor of medical sciences, rector of the Higher School of Organization and Management of Health Guzel Ulumbekova.

“The primary link is failing again.

Even before the pandemic in Russia, there was a 1.5-fold shortage of doctors in the primary care, and a two-fold shortage of paramedics in the countryside. Plus, the doctors themselves get sick, like everyone else. Now, at least a third of doctors are sick. The issue of consultations by phone or via video communication can be resolved in Moscow, St. Petersburg, in large cities where there are available personnel. But in most regions today this is not possible.

To remedy the situation, there is one of the solutions that is used, for example, in Finland, in England, in China. The patient himself enters the site or downloads the application, where he answers the questions of the checklist. Depending on the answers, the system distributes them into 3 groups. The first - "green" - these are those patients who can stay at home, since there is no threat to their health. The second group is the so-called "yellow". It includes patients whom the system connects with a doctor, and he gives recommendations, consults. The third group - the so-called "red" - includes patients who need to urgently go to the hospital. This advanced patient triage system could help relieve queues at polyclinics, as happened in China, where there is a large shortage of primary care physicians. There, about 300 million patients are connected to this system. You can think about introducing similar algorithms in Russia, but the problem of a shortage of doctors in primary care still needs to be addressed, ”says Guzel Ulumbekova, Doctor of Medical Sciences.

There is only one conclusion: in the conditions of optimized Russian medicine, the patient has to rely either on himself or on a miracle.