Characteristics of the organization of work of the therapeutic area in the clinic. Job responsibilities of a local general practitioner

18.10.2019 -

Local therapist plays a leading role in the public health system (in the future this will be a family doctor). The complex work of a local doctor combines medical and organizational activities (organization of prevention, treatment, medical examination, rehabilitation, sanitary education work). A local doctor is essentially a front-line healthcare organizer.

It is the activities of the local general practitioner and local nurse that most closely come into contact with the work of organs social protection and is largely medical and social. The local doctor and local nurse have an important influence on solving the client’s medical and social problems in their professional activities social worker. It is the local doctor who, if necessary, should be contacted by a social work specialist in case of difficulties of a client’s medical and social nature.

The work of a local general practitioner is usually organized in such a way that every day he sees patients in the clinic (about 4 hours) and makes calls to patients at home (about 3 hours). The doctor not only carries out calls made by the patient himself or his relatives, but also, if necessary (without calling), visits the patient at home. These calls are called active calls. The local doctor should visit chronically ill patients, lonely elderly people, and the disabled at least once a month, regardless of whether the patient called the doctor or not. When performing a call, the doctor not only treats the patient, but also performs elements social work: finds out the social and living conditions of the patient, contacts, if necessary, with social protection authorities, the RCCS department, pharmacies, etc.

Functional responsibilities of a local general practitioner:

· forms a medical (therapeutic) site from the population attached to it;
· provides sanitary and hygienic education, advises on the formation of a healthy lifestyle;
· carries out preventive measures to prevent and reduce morbidity, identify early and hidden forms diseases, socially significant diseases and risk factors, organizes and runs health schools;
· studies the needs of the population it serves for health-improving activities and develops a program for carrying out these activities;
· carries out dispensary observation patients, including those eligible to receive the kit social services, in the prescribed manner;
Organizes and conducts diagnostics and treatment various diseases and conditions, including rehabilitation treatment of patients on an outpatient basis, day hospital and hospital at home;
Provides emergency medical care to patients acute diseases, injuries, poisoning and others emergency conditions in outpatient settings, day hospital and home hospital;
· refers patients for consultations with specialists, including for inpatient and rehabilitation treatment for medical indications;
· organizes and carries out anti-epidemic measures and immunoprophylaxis in the prescribed manner;
· conducts an examination of temporary disability in the prescribed manner and draws up documents for referral to medical and social examination;
· issues a conclusion on the need to refer patients for medical reasons to spa treatment;
interacts with medical organizations state, municipal and private healthcare systems, medical insurance companies, and other organizations;
· organizes, together with the social protection authorities, medical and social assistance to certain categories of citizens: single, elderly, disabled, chronically ill, in need of care;
· manages the activities of the middle medical personnel providing primary health care;
· maintains medical documentation in the prescribed manner, analyzes the health status of the assigned population and the activities of the medical site;
- systematically improves his qualifications and level of medical knowledge of the district nurse.

A local general practitioner has the right:

· make proposals to the administration of the clinic on improving the organization of medical and preventive care to the population, the organization and conditions of their work and the work of the local nurse;
· Participate in meetings regarding organization issues therapeutic assistance to the population;
· prescribe and cancel any treatment and preventive measures based on the patient’s condition;
· receive information necessary to perform job duties;
· represent the district nurse for incentives and make proposals to impose penalties if she violates labor discipline and unsatisfactorily fulfills her job duties.

For every 8 therapeutic areas, a head position is allocated. department. The assessment of the work of a local physician-therapist is carried out by the head of the therapeutic department based on the results of work for the quarter (year) based on taking into account the qualitative and quantitative indicators of his work, his compliance with the requirements of regulatory documents, labor discipline rules, moral and ethical standards, and social activity.

The local therapist is responsible both for poor quality work and erroneous actions, as well as for inaction and failure to make decisions that fall within the scope of his duties and competence, in accordance with current legislation.

Doctors of narrow specialties can also work according to the local principle: surgeons, ophthalmologists, neurologists, otolaryngologists, dentists, etc. This is a team district method. In this case, a doctor of a narrow specialty can be called to the patient’s home, and you can receive a coupon for an appointment with a specialist, bypassing the therapist. The volume of home care is increasing, and a specialist doctor is monitoring patients over time. The team is led by a local therapist.

The nurse also takes a direct part in the reception of patients (prepares the documentation necessary for the reception, writes out prescriptions for medicines, fills out referral forms for examination, measures blood pressure, body temperature, etc.) and carries out doctor’s orders at the site (does injections, puts mustard plasters, enemas, checks patients’ compliance with the prescribed regimen, etc.). If necessary, the activities of the doctor and nurse at the site can be organized as a hospital at home, when the doctor visits the patient at home every day, and the nurse carries out medical prescriptions at home.

The implementation of this principle is facilitated by the fact that professional activity medical workers in our country takes place under the conditions of a unified state healthcare system. This ensures planning, deep scientific and social validity of therapeutic and health measures, and comprehensive assistance and support.

Since internal diseases occupy first place in the structure of population morbidity, the leading role in practical healthcare belongs to the local general practitioner. More than 50% of all initial visits to the clinic are made by a general practitioner. However, only 20% of those who sought medical help require subsequent hospitalization. The remaining 80% are examined and treated in a clinic.

The principle of locality

The organization of outpatient therapeutic care is based on the local-territorial principle. The territory served by each clinic is divided into sections, each of which is assigned to a specific general practitioner. By established standards, no more than 3,000 adults should live in one medical area. In 1962, the national average for a therapeutic medical area was 3078.5 residents. The local principle has a number of very important advantages over others. possible options organizations outpatient care. With average numbers of visits within 2 years, the clinic is visited by almost 90% of the entire population of the district, and after 3 years of work, the doctor becomes closely acquainted with almost every resident of his district. This gives the local therapist the opportunity to know well the health status of each family member, everyday life, professional conditions, the level of sanitary culture of those living on the site, which makes it possible to achieve high efficiency therapeutic and preventive work on the site. Therefore, compliance with the principle of locality is one of important criteria assessment of the clinic's activities. In this case, it is customary to use the following indicators:

locality in service in a clinic, i.e. the ratio of the number of patients in one’s own area to the number of patients seen by a doctor;
locality in home care, i.e. the ratio of the number of visits to patients in their area to total number visits made by a doctor.

High numbers of these indicators (within 80-90% and above) characterize the good organization of local-territorial therapeutic services.

The work of a local general practitioner includes the following sections.

Treatment of patients in the clinic and at home.
Preventive measures, among which the first place is occupied by medical examination of sick and healthy people.
Participation in hospitalization of patients.
Participation in the work of VKK and VTEK-
Referral of patients to special treatment and diagnostic institutions, dispensaries, sanatorium-resort institutions.
Health education.

The working time of a local physician-therapist is divided between work at the reception in the clinic and servicing calls at home. The following estimated workload standards for the local physician are provided: seeing 5 patients for 1 hour in the clinic and serving 2 patients for 1 hour at home.

Organization of work in the clinic. Modern city clinic represents a multidisciplinary medical institution providing specialized medical care. It consists of one or more therapeutic departments and departments of other specialties (surgical, ENT, etc.). Each therapeutic department includes several local doctors. It is headed by a director - a well-trained, experienced therapist. Within the framework of the therapeutic department, special rooms are combined: adolescent, cardio-rheumatology, infectious diseases etc. In addition, direct relation to therapeutic service have dispensary rooms operating in some clinics (oncology, tuberculosis, etc.).

Each local doctor must have a weekly work schedule, designed so that morning appointment days alternate with evening appointment days. This is necessary so that the patient can contact his local doctor at a time convenient for him. Such a schedule should be posted near the registration desk. To receive patients during the absence of their local doctor, a doctor on duty is assigned to the clinic. However, the admission of patients by the doctor on duty should be limited only to cases of urgent need. In other circumstances, the patient should be advised to see his doctor during office hours.

When visiting a clinic, the patient goes to the reception desk, where he receives a voucher for an appointment with his local doctor or other specialist. The doctor issues a coupon for a second appointment.
Basic form medical documentation in the clinic there is a medical card for an outpatient (registration form No. 25). It is as important as the medical history of a patient being treated in a hospital. A card is created for each patient upon their first visit to the clinic. In addition to the passport part, which is filled out by the registrar, the doctor enters the following data into the outpatient card.

Data from the patient’s survey: his complaints, history of the present illness, brief life history, past illnesses, heredity, occupational hazards, etc.
The results of an objective examination, which should be focused and detailed.
Additional studies (laboratory, instrumental, consultations with other specialists) and their results.
Therapeutic and preventive measures, including work recommendations, diet and diet, medicinal purposes, physiotherapy, physical therapy, referral to a hospital, to a dispensary, for sanatorium-resort treatment, etc.

Due to the lack of time on the part of the clinician, all these notes must be reasonably concise.
The records of the head of the department, doctors of other specialties, as well as the results of additional and special studies are entered into the medical record of an outpatient patient. This allows any specialist, when visiting a patient, to familiarize himself in detail with his previous diseases. During treatment, the outpatient’s medical record is kept in the attending physician’s office, and the rest of the time it is stored at the clinic’s reception desk in a special file cabinet.

Severe, weakened and febrile patients should be cared for by a doctor at home. A doctor is called through the clinic's reception desk by the sick person himself (by phone) or by his relatives, neighbors, etc. Calls are recorded by the registrar in the home care log, which is available to each local physician. After reviewing these records and those selected by the registrar outpatient cards sick, the doctor attends calls at appropriate times. The patient must be visited on the day of the call.
When visiting a patient, the doctor determines the diagnosis, prescribes treatment, and ensures that all necessary additional research And medical procedures. If necessary, the doctor should help organize care for the patient at the clinic or hospitalize the patient. Diagnostically unclear patients can be consulted at home by the head of the therapeutic department and doctors of other specialties.

If a patient with an infectious disease is detected at the site, the doctor is obliged to fill out and immediately send to the sanitary-epidemiological station an emergency notification card (registration form No. 58). In addition, each such case must be recorded in a special infectious diseases register (Form No. 60).
Modern equipment of clinics with laboratory and instrumental research methods makes it possible in most cases to make a diagnosis and carry out treatment on an outpatient basis. Indications for hospitalization of therapeutic patients are: the impossibility of establishing a reliable diagnosis using research methods available to the local doctor, and the characteristics of the disease (its nature, severity, etc.) requiring hospital treatment.

The closest assistant to the general practitioner is the local nurse. Her responsibilities include: assisting the doctor when receiving patients in the clinic; Carrying out medical prescriptions at the patient’s home; assistance in conducting medical examinations; maintaining medical records; conducting epidemiological surveys, vaccinations, ongoing disinfection and assisting the doctor in sanitary educational work and working with the sanitary assets of the site.

Submitting your good work to the knowledge base is easy. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

2.3. Registration, types, organization of work.

The registry of the city clinic is a structural unit of this institution, designed to ensure timely registration of patients for appointments with a doctor in the clinic and at home.

Direct management of the work of the registry of the city clinic is carried out by the head of the registry.

The main tasks of the clinic registry are:

Organization of preliminary and urgent registration of patients for an appointment with a doctor, both when contacting the clinic directly and by telephone;

ensuring clear regulation of the intensity of population flow in order to create an even load of doctors and distribution by type of care provided;

Ensuring timely selection and delivery of medical documentation to doctors’ offices, proper maintenance and storage of the clinic’s file cabinet.

In order to perform the above functions, the registry must include:

A) inquiry department

B) department for making appointments with a doctor

B) house call recording department

D) a room for storing and selecting outpatient medical records

D) room for processing medical documents

E) medical archive

G) office for issuing and processing documentation

3) self-recording table

In order to provide continuous service to patients during the entire opening period, the registries of city clinics on weekdays begin work from 7.00-7.30 hours.

Patients can be registered for appointments either directly at the reception desk or by telephone; pre-registration of patients is also organized. The receptionist ensures that patients spend as little time as possible making an appointment with a doctor. It is especially important to regulate repeat visits to patients, which make up the bulk - about 2/3 of visits. These visits are regulated by the attending physician, who issues the patient an appointment card. It is advisable that primary and repeat patients are received separately and that primary patients are received during the first hours of the doctor’s work, because primary patients often go to the clinic in in serious condition. For the primary patient, an outpatient medical card is filled out at the registry (form 025-u). Coupons for all medical appointments are prepared by the receptionist at least a week in advance. The registrar must write down the office number, full name. doctor.

The department for making appointments with a doctor may have windows for servicing workers and making appointments with specialist doctors. In this department, for each doctor there is a folder in which medical records of outpatients (f. 025-u) who make an appointment with the doctor are inserted.

The doctor is called in person or by telephone. The registrar, having accepted the call, enters it into the house calls log, selects medical records of outpatients and, together with the log, passes it on to the doctor serving a certain area.

Information department- begins with the appointment schedule of doctors and various departments of the clinic.

There are two systems for registering patients for appointments: centralized and decentralized.

At centralized In the system, registration is carried out in a single registry, regardless of what disease the patient comes to the clinic with. For each patient, a single outpatient medical record is created, in which the records of all doctors are entered for all visits by the patient to the clinic.

At decentralized system, individual doctors' offices have their own registry. It should be considered more correct to have a centralized registration system and a single medical record for an outpatient patient, allowing each medical specialist to know about all the diseases for which the patient visited the clinic, which is very important for correct diagnosis. In some cases, decentralized registry is allowed.

The storage of medical records of outpatients in the clinic is carried out by sections, streets, and within the streets - by houses and apartments. It is advisable that all apartments be marked. It is advisable to store medical records of industrial workers and adolescents separately.

· carrying out preventive measures to prevent and reduce morbidity, identify early and latent forms of diseases, social significant diseases and risk factors

· carrying out medical examination of the population

· dispensary observation of the health status of persons suffering from chronic diseases

· Conducting all types of medical examinations

· organization of sanitary and anti-epidemic measures

· organization of vaccination events

Medical examinations – complex medical interventions aimed at identifying pathological conditions, diseases and risk factors for their development.

Types of medical examinations:

· Preventative medical examination carried out for the purpose of early (timely) detection of pathological conditions, diseases and risk factors for their development, non-medical consumption narcotic drugs and psychotropic substances, as well as for the purpose of forming health status groups and developing recommendations for patients

· Preliminary medical examination carried out upon entry to work or study in order to determine the compliance of the employee’s health status with the work assigned to him, and the student’s compliance with training requirements

· Periodic medical examination carried out at established intervals for the purpose of dynamic monitoring of the health status of workers, students, timely detection of initial forms occupational diseases, early signs exposure to harmful and (or) hazardous production factors in the working environment, labor, educational process on the health status of workers, students, in order to form groups at risk of developing occupational diseases, identifying medical contraindications to carry out certain types of work, continue studies;

· In-depth medical examinations periodic medical examinations with an expanded list of medical specialists and examination methods participating in them. Conducted in relation to individual categories citizens in cases provided for by the legislation of the Russian Federation.

· Pre-shift, pre-trip medical examinations

· Post-shift, pre-trip medical examinations

Preventative work estimated:

· complete coverage of honey. inspections (the ratio of the number of those examined to the number of the population subject to inspection, multiplied by 100);

· percentage of the population examined to identify the disease (the ratio of the number of examined to the population);

· frequency of detected diseases (the ratio of the number of detected diseases to the number of examined ones);

· clinical examination indicators (completeness of coverage, timeliness of registration at the clinical examination, specific weight of those newly taken under observation, average number of those undergoing medical examination at one site, outcomes and effectiveness of clinical examination).

Prevention– disease prevention, an integral part of medicine Types:

· primary – a set of measures aimed at preventing the development of acute diseases.

· secondary – a set of measures aimed at preventing the development of chronic diseases.

· tertiary – a set of measures aimed at preventing the development of disability in society and preventing deaths.

The most important component of all preventive measures is the formation of medical and social activity among the population and attitudes towards healthy image life

Healthy lifestyle promotion: methods of oral, printed, visual and combined propaganda.

The method of oral propaganda is the most effective. It includes: lectures, conversations, discussions, conferences, club classes, quizzes.

Characteristics of the organization of work of the therapeutic area in the clinic. Job responsibilities of a local general practitioner

The principle of locality

Submitting your good work to the knowledge base is easy. Use the form below

Similar documents

2.3. Registration, types, organization of work.

Latest Posts