Conflict between doctor and patient chi. Conflict situations in medical practice

26.11.2019 -

The conflict situation in the doctor-patient relationship is something that every doctor faces in his career. How to defend yourself in such a situation and how to organize the work of a doctor - we understand in our article.

Causes of conflict situations between doctor and patient

Now we can talk about several reasons for the occurrence of frequent conflict situations:

Internet, where patients learn not only about various diseases, but also about new methods of diagnosis and treatment, sometimes even very dubious, but advertised. Now we have a whole cohort of patients who independently diagnose themselves and prescribe drugs and dietary supplements from a well-known site. And it’s good if they manage to stabilize the condition, but often the symptoms are “smeared”, worsening the course of the disease. And with all this bouquet, coupled with dissatisfaction, anger at the ineffectiveness of therapy and resentment from the money spent, a person ends up at a doctor's appointment.
emergence of diverse diagnostic centers. On the one hand, it is great that medical care has become more accessible, and on the other hand, patients undergo examinations and tests and interpret them in their own way, and this, in turn, can provoke a conflict due to a discrepancy between the opinions of the doctor and the patient.
only about 15% of patients correctly follow the doctor's prescriptions, and this is not a current trend, but in fact a regularity. All this leads to a decrease in the effect of therapy and provocation in the “doctor-patient” sphere.
the image of a doctor in the media, who is now shown as an illiterate bribe taker and a lazy person who is negligent in his work, who is trying to avoid responsibility. If we take 10 publications in the media on medical topics, then two of them will be neutral, and eight will be negative, and not a single positive one, neither about the successes of science, nor about saving seriously ill patients. Thus, the patient is already initially set up for the fact that he will not be helped and will be deceived.
position and slogan "The patient is always right". On the one hand, the patient has the right to receive adequate information about the state of his health and complete treatment which is guaranteed by law. But, unfortunately, complaints are sometimes pointless, or the subject of the conflict goes beyond the powers and resources of the doctor.

IMPORTANT!
Low economic level, often inability to pay for treatment, desire to have access to a doctor “24 hours a day”, attempts to achieve one hundred percent health in cases of chronic diseases, as well as the desire to make the doctor a decisive force in relationships with relatives and friends, is also a background that provokes conflicts.

As a result, at the reception, we are faced with relationships in which both parties are often not protected: both patients and doctors, while communication between them is forced, which means that initially it carries a more conflict-generating underlying reason.

Phrases to Avoid to Minimize Conflict

To reduce stress, it is worth avoiding a number of phrases in a dialogue with the patient.

“This is not my responsibility”, “I will not be paid for this.” In most cases, this will cause the patient either irritation and a desire to write a complaint, or thoughts that the doctor is demanding a bribe. Which is better is unclear. What's the best way to say? “It’s better to approach this question…” or “By protocol and standards, you better do it like this…”
“I don’t have time to talk to you”, “I’m busy”, “Don’t you see, we have a planning meeting!”. You will definitely get either bewilderment and resentment on the part of the patient, or aggression. It is better to use the following options: “I apologize, but now we have an urgent meeting ... I will be free, and we can solve your problem ...”, or “Now, unfortunately, I have to finish this, after which I am ready to talk to you ... ", or "Now I will take time for another patient to finish. And then with a fresh head I will deal only with you ... "
“Perhaps it sounds silly, but…” Most likely, what the doctor said in this case will really be taken lightly. Forget about this phrase.
"Do not be offended, but ...". Likewise. The person is already preparing to experience resentment, because the doctor warned him about it. Better not to use such words.

I would especially like to note the specifics of the relationship between a doctor and a patient in Russia and in the post-Soviet space - this is a paternalistic approach, in which, on the one hand, the doctor is the King and God, he should be trusted, but on the other hand, the responsibility for success or failure in treatment also transferred to the doctor. This is also facilitated by the legislation of the Russian Federation, in which the doctor is not a subject of law, and there is no possibility of full-fledged insurance of his professional liability. Moreover, the very concept and scope of this responsibility is not spelled out at all. Naturally, at the appointment we are not able to resolve legal issues, but talking with each new patient about the limits of our capabilities and the boundaries of mutual responsibility is something that should enter into practice.

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Ways and possibilities to reduce the likelihood of aggression on the part of the patient

What else can help reduce the degree of conflict? This is an understanding of why a patient comes to us at all, in addition to examination, prescribing drugs or performing manipulations. Our patients expect understanding, support, sympathy and respect from us. It is important for the doctor to show that he is ready to be with the patient while he has to fight the disease, that he will not leave the patient alone with the disease. The doctor should say this at the reception, sometimes even more often, taking into account the stages and characteristics of the reaction of the psyche to the disease in a particular patient. This will increase the level of trust and reduce the tension in the relationship with the patient.

It is important for the patient to know and understand that the information that he told the doctor did not fly past the doctor's ears. How to achieve this? The doctor should just periodically say: “I understand you. Please continue. Here, in more detail, please, ”nod your head, accompany these phrases intonation. Feel free to ask again if something is unclear. In the same way, you can find out the reasons for non-compliance medical advice, using an interested tone and phrases: “What can prevent / prevented you from following my recommendations? Let's establish an algorithm that will help us succeed together."

Unfortunately, in a number of cases, especially if the doctor burns out emotionally, thoughts may rush through his head that the patient's complaints are invented or exaggerated. Naturally, this will affect both the tone of the doctor's voice and the expression on his face, which obviously will not improve the situation. Instead, the doctor should voice that he accepts the fact of the patient's suffering, his grief, feeling unwell. No need to say: “Calm down, why are you so upset, your arms and legs are intact!”. This can devalue the patient's experiences and cause misunderstanding on his part.

Turn on active listening, remember the patient's first and last name, look at him during the conversation, treat his examinations with respect, and do not throw the folder with analyzes on the table with the words: “Well, what did you bring me there, again an MRI of everything you could have passed! ". It is better to praise the patient for his reverent attitude to health and the fulfillment of appointments. Sometimes it is important for a doctor to give his subjective assessment of what is happening in the patient's life: “Yes, it was very difficult for you, it is clear why you are angry / upset. You feel abandoned and alone, it's really not easy." Sometimes you can touch the patient's shoulder or back if the situation allows.

Typology of conflict patients

But sometimes, no matter how hard the doctor tries, conflicts arise one way or another. Conflicts in the field of "doctor-patient" are divided into:

subject, or realistic. Arise due to the fact that the requirements or expectations of any of the participants are not satisfied. The ultimate goal for the conflicting is to obtain a certain result.
pointless or unrealistic. Usually they are the result of accumulated negative and often suppressed emotions. The goal of the conflicting person is not the result, but emotional reactions in the course of clarifying the relationship.

Of the two options, the second is more complicated, after all, if there are any realistic expectations on the part of the patient, then the doctor should recognize them and strive to fulfill them.

Let's figure out which patients are prone to provoking conflicts and whether something can be done in such cases.

Skeptics. Such people can immediately declare that they do not trust doctors or demand to refer them to “real professionals”, investing in this concept the degree or position of a doctor. It is important for the doctor to understand that such a patient is not a test of his professionalism, and changing the skeptical approach is not the goal of the appointment. In this case, it is useful to use such phrases in a conversation: “I am listening to you carefully. I can only advise and recommend to you, but you make the final decision yourself.”

Demanding Patients. Such patients tend to require a wide variety of tests, consultations and examinations. The doctor needs to explain to the patient his right to full medical service, which, of course, may not meet all the wishes of the patient and his requirements. In this case, the doctor needs to calmly talk about the standards of care medical care, it can be regretted that these legitimized recommendations do not cover all the requests of the patient. The principle of a “broken record” is also good here, when the doctor repeats the same thing in various variations with a polite intonation.

Viscous patients. Most often, this category of patients includes either lonely people or people with high level anxiety. They tend to visit the doctor as often as possible and sometimes make an appointment unnecessarily. It is important for the doctor to structure such patients with homework assignments regarding the regimen and healthy lifestyle life, as well as to build a plan of examinations in advance and inform the patient about it.

Chronically dissatisfied patients. They constantly complain that the treatment does not help them, and at each appointment, new complaints can be added. Sometimes such patients need the help of a psychiatrist or psychotherapist, however, doctors of another specialty must first of all verbally show their sympathy and acceptance that the prescribed treatment is not suitable. In such cases, it is important to pay attention to establishing a trusting relationship with the patient, more often use the union “we” in speech: “Let's do this to you ...”

"Imaginary patients". For a number of patients, the disease promises a perceived benefit: the attention of others, financial privileges. In this case, from the very beginning, you should not follow their lead, despite the fact that such patients are ready from the first seconds to surround the doctor with attention and gratitude. The assessment of their condition should be interpreted according to the data obtained during the survey.

Patients "In Search of a Judge". Such patients try to win over the doctor to their side, so that later they can use it as a tool in their relationships at home or at work. Usually, in a conversation with such patients, the doctor can hear the phrases: “Explain this to my mother, she is pushing me”, “Tell this to my husband / wife, it’s because of them that I feel bad.” Such patients tend to build a very trusting relationship with the doctor, they initially very conscientiously carry out all appointments. It is important for the doctor from the very first appointment to set the boundaries of his authority and indicate that he can only deal with treatment, but another specialist decides on relationships.

"Subtractive". These are patients with an initial mindset for filing a lawsuit. Main principle prevention of conflicts in this case - the competent execution of all medical documentation and strict adherence to the standards of medical care.

Means of preventing conflict relationships in the field of "doctor-patient"

Most patients do not want to escalate the conflict. And if we analyze the conflict situation itself, we will see that 2 parties are involved in it - this is a doctor and a patient, and sometimes there are other participants in these events. Let's figure out what the main alarming points can be identified on each side, and how to prevent the build-up of tension at these points.

Our patients have their personality traits as a whole and every person. In addition, they are afraid of many things, ranging from the fear of some kind of manipulation or loss of work and ending with the fear of death. Patients often do not trust the doctor, in addition to everything they are uncomfortable both from the physical manifestations of their illness and from the conditions in which they have to wait for an appointment. Painful process negatively affects the psyche. What can a doctor do to prevent all this:

be internally confident that he or colleagues will be able to help the patient
the doctor should provide information about his education and the projects in which he is involved, or even describe previous experience. At the same time, you should not deceive and add your age, experience, appropriate other people's successes, etc. Deception will be revealed, but trust will be lost.

To facilitate the waiting situation, it is desirable to involve the management of the clinic: installation of air conditioners and water coolers, not to mention access to the toilet rooms and equipment special places for mothers with children. The doctor himself can prepare handouts: various questionnaires for which there is not enough time at the appointment, and booklets on medical topics for those patients who are sitting in line.

If the doctor fails to establish contact with some patient, then it is possible to suggest that the patient change the specialist, telling him about this possibility in the correct form and recognizing that it is not possible to come to agreement and healthy cooperation. Is that possible. There are no ideal doctors and no ideal patients who would suit absolutely everyone.

But there is another side of the conflict - a doctor. How can a doctor provoke an increase in tension, and what to do about it? The doctor may be late, look untidy, use rude intonations in a conversation, talk on the phone during a consultation. All this is unacceptable if the doctor wants to establish a trusting relationship with the patient.

The medical profession is associated with a lot of communication, with the exception of a number of specialties, so the patient expects the doctor to question him. And if the doctor is dry in communication, laconic, then this can cause a large number of tension, anxiety and fear. What can help here? This is the issuance of handouts about the patient's disease and methods of its treatment, verbal contact and active listening technique, the use of facial expressions and gestures by the doctor. Again, do not be too zealous, it is better to rehearse it in front of a mirror or relatives. It is also useful to recommend additional literature or create your own page on the Internet, where the doctor can cover the most common issues.

There are also factors that do not depend on the specialist: this is an inconvenient or short reception time, the need to allocate more time to one of the patients, therefore, the displacement of other consultations and dissatisfaction with other patients, this is the need to prescribe unpleasant examinations and tasteless and sometimes expensive treatment, which can also cause side effects. Here it is necessary to use the “principle of vaccination”: do not wait for people to begin to resent, but independently report possible difficulties. For example, to warn about the postponement of the consultation due to long-term use or talk about possible side effects and recommend where to go and what to do in these cases. If unpleasant examinations await the patient, then he can express sympathy and tell him about the need for the procedure, as well as use the “magic” turn: “You and I understand that ...”, which helps the patient feel that the doctor is on the same side with him.

IMPORTANT!
Separately, it is worth noting that the doctor, in addition to personal characteristics, has professional hazards in the form emotional burnout which negatively affects both professional relationships and health status. Burnout should be prevented, and at the first sign of it, you should not leave the situation to chance. In some cases, it is necessary and timely for specialized help from psychologists or psychotherapists.

Method 5 "P" to cope with the consequences of conflict

We all understand that it is better to prevent conflict than to deal with its consequences. But what if it could not be avoided? Apply method 5 "P".

Give the patient the right to speak. The only thing that in this case is better not to do it in the corridor of the clinic, but to invite you to your office.
Recognize. It is important to agree that the patient has the right to negative feelings about something. The doctor should say that the patient is angry, upset, angry, etc.
Clarify and highlight facts or gist. It is necessary to establish exactly what caused tension and disagreement. This is where the crux of the conflict lies, because often at this stage it becomes clear whether the patient just wants to throw out emotions or achieve a result. It is worth using the phrases: “If I understand correctly, you are not satisfied with ..., and you want ...”. Claims cannot be answered.
Check if your understanding is correct. It is worth using the phrases: “If I understand correctly, you are not satisfied with ..., and you want ... In other words, you think that ...”
Come up with and share a plan to resolve the conflict. It is worth adding the pronoun “we” in this case, so the doctor shows that he does not leave the patient alone in trouble, that he empathizes with him.

In any case, the doctor and the patient are not opposing sides, they have one task - to achieve health. As in any relationship, conflicts can arise in the interaction between the doctor and the patient, they should not be feared, because they are natural, and communication is impossible without them.

Medicine, as an area that affects the most important interests of every person - life and health, cannot exist without conflicts. In protecting these interests, even from an imaginary threat, a person can easily overstep reasonable limits.

But if earlier the conflict situation developed only in personal communication between the doctor and the patient with the involvement of the administration medical institution as an arbitrator, now more and more cases of mutual misunderstanding end up in court. People usually have a negative attitude towards litigation, so even if the litigation is resolved in favor of the doctor, it still damages his professional reputation, and also invariably takes a lot of time and nerves. Like many painful situations, conflict is much easier to prevent than to stop, so every practitioner can be advised to analyze typical conflict situations and consider in advance measures for their primary prevention.

Side one: the patient as a participant in the conflict

1. Afraid

Any doctor, communicating with a patient, must make allowances for the fact that each disease, one way or another, changes the state of mind of a person, taking him further and further from the norm. Even a minor illness awakens the fears that exist in everyone to one degree or another:
fear of serious illness or death;
fear of losing a job;
fear of disability or physical disability;
fear of restrictions on the treatment regimen or diet;
fear of possible painful or emotionally uncomfortable medical or diagnostic manipulations;
concerns about the unforeseen and possibly high costs associated with treatment.

That is, any patient meets with a doctor, already in a state of increased anxiety because its core values are at stake.

Prevention: Perhaps, the only way reduce the patient's anxiety (in addition to curing his illness) - radiate calmness himself, speak in a soft voice, not fuss and show maximum attention.

2. Doesn't trust the doctor

Unfortunately, today the prestige of the medical profession and medical institutions is low. Public opinion established itself in the position of “doctors do not work well”, “polyclinics are no good”. Out of this mistrust come attempts to direct and control the doctor's work, and the growing popularity of self-medication. Both - the richest sources conflict situations. The lack of knowledge about the state of one's health, combined with a large amount of inadequate information from outside sources, gives rise to an erroneous perception of the disease and treatment, as well as dissatisfaction with the doctor's actions, that is, makes the patient "conflict risk". In addition, between the doctor and the patient without medical education there is some information inequality and a situation of dependence, and often patients experience it hard, which creates additional suspicion or anxiety.

Prevention: Show the patient the doctor he wants to see - attentive, competent, understanding his difficulties and ready to help. The desire to quarrel, in most cases, subsides as trust appears.

3. Experience physical discomfort

It is also necessary to take into account the banal physical discomfort that the patient usually experiences before meeting with the doctor. Pain, shortness of breath, long waiting for an appointment in uncomfortable conditions, for example, standing in a stuffy corridor. All this, one way or another, distorts the perception of the situation, worsens the processes of inhibition and increases aggressiveness. For chronic patients, all of the above is even more relevant: despite the fact that the persistence of pathological syndromes gives them time and the opportunity to adapt, it also depletes the reserves of the body, including the central nervous system.

Prevention: Take care, as far as possible, of the comfort of patients at your appointment and in anticipation of it. If stuffy, ask the nurse to open the window in the hallway, arrange an emergency appointment for patients who feel worse than others, for example, with fever or acute pain. Place brochures on the table interesting information on the medical topics(only without intimidation).

4. Under the influence of endogenous factors

Many pathological processes directly affect the central nervous system. Patients with diseases respiratory system, chronic anemia, vascular pathologies experience chronic hypoxia of the brain, which inevitably leads to a deterioration in intelligence and does not exclude the inadequacy of reactions to what is happening, especially during exacerbations. Also cause increased irritability may be ordinary hypoglycemia, not uncommon in cases where the patient came on an empty stomach to take tests or be examined. Again, do not forget about the endocrine status and its impact on mood and well-being. Both normal and pathological fluctuations in the level of sex hormones can increase the conflict potential of behavior. In addition, there are typical age-related changes psyches, often including delusions of damage and persecution, the hero of which may be the attending physician. It is impossible not to mention alcoholic encephalopathy, which also does not exclude aggressive and conflict behavior.

Prevention: Alas, there are not so many chances for the prevention of this aspect. It remains to remain calm and unruffled. In some cases, you can directly warn the patient that the disease affects the mood - this will help to understand the problem and adjust communication not only with the doctor, but also with other people.

The personal characteristics of the patient should be taken into account. There are people who purposefully come to the clinic or hospital to make a scandal. There are pathological querulants who take pleasure in writing all sorts of complaints. There are elderly or lonely people who experience a lack of communication. There are also those who want to get rich by receiving compensation through the courts. All of them, one way or another, try to satisfy these needs at the expense of the doctor.

Prevention: It is almost impossible to prevent such conflict situations, they just need to be experienced. But even here, the correct construction of communication and competent timely actions will help mitigate the conflict. Never raise your voice or show irritation - this creates a feeling of your helplessness and loss of control over the situation. Some people just want it, don't give them that pleasure. So, by the time of the meeting with the doctor, the patient already has a huge number of potentially conflict factors. A small reason is enough to implement any of them. Nevertheless, the doctor-patient conflict is always at least two-sided. I would like to note right away that, in my opinion, the vast majority of neglected conflicts are the result of the doctor's illiterate behavior. The situation of communication "doctor - patient" initially implies some leadership and control on the part of the doctor, and it is not always possible to maintain this disposition and not with everyone.

Faced with conflict situations in real life, a young specialist is forced to learn from his own mistakes, without having the time and opportunity to acquire special knowledge. The solution to this problem can be, for example, conducting conflict-free communication trainings at the initiative of the administration of a medical institution. The option is not so fantastic, given that conflicts with patients that have reached the stage of litigation, examinations and payment of compensation are very, very expensive, while many of them could well have been prevented.

Side two: the doctor as a participant in the conflict

1. Provokes the patient with trifles

Being late for work, an unbuttoned or stale dressing gown, a sharp invitation to the office, talking on the phone during an appointment - every seemingly trifle can serve not as a reason, but as an excuse to pour out all the accumulated negativity. These moments are by no means always amenable to correction, because many patients have “invincible” stereotypes, for example, “a doctor is good only if he is elderly and experienced” or “a good surgeon must be a man.” And in this case, even a highly qualified specialist, if it is, for example, a young woman, will be rejected regardless of the actions.

Compliance with business etiquette and tidiness in appearance significantly reduce the risk of interpersonal conflicts and help to establish a relationship of constructive cooperation with the patient. The timely start of the appointment, the fixed time of the doctor's rounds create a sense of order and soothe.

2. Not communicating enough with the patient

Lack of patient information is serious problem, especially if we remember that obtaining in an accessible form complete objective information about the state of one’s health and informed consent treatment is a statutory right of the patient. Competent presentation of information, in my opinion, in more belongs to the field of medical art than to medical science. If it is not enough to speak, the patient gets the feeling that the doctor does not pay due attention to him and his disease, or deliberately keeps something back in connection with an unfavorable prognosis. In addition, misunderstanding may arise: sooner or later, every doctor faces the difficulties of translating from medical language into “human”.

Prevention: Barriers in communication between a doctor and a patient are natural, but understanding their essence and causes, one can mitigate their potential harm. For example, do not be lazy for the tenth time a day to explain the need to take antihypertensive drug and its mechanism of action. If the patient wishes to know more about his disease, let him know it from you. Place information on posters near the office, recommend literature that you consider adequate, make a page on the Internet where you can ask you a question, print out standard recommendations on regimen and diet and give out along with prescriptions.

3. Extends the queue or spends little time

Lack of time is a purely practical problem, arising from the congestion of the healthcare system and regulations that do not take into account the need to communicate with the patient. For 10–12 minutes of an outpatient appointment, it is almost impossible to produce a high-quality initial inspection and a survey, fill out necessary documentation, determine the preliminary diagnosis, prescribe treatment and examination. Thus, the doctor is forced either to delay the appointment, reducing the number of patients admitted and forcing them to wait, or to approach the examination in a simplistic and formal way, creating in patients the completely just feeling that they are "badly treated." Both options contain simply huge conflict potential. In addition, the lack of time for reception significantly increases the risk medical error, which, apart from possible harm patient, in itself is a ready-made conflict situation.

Prevention: Try to correctly form the queue of patients waiting for an appointment. For example, for patients who need to talk, offer to queue at the end of the appointment. If you feel that the patient is difficult, ask the nurse to warn those waiting that the appointment time will shift slightly.

4. Prescribes uncomfortable examinations and difficult treatment

A rare doctor would not want to calmly accept a patient in a well-equipped office, quickly prescribe and receive the results of modern tests and additional studies, save the patient from having to undergo painful and unpleasant procedures, prescribe optimal treatment without any restrictions and see recovery as the result of his work. Unfortunately, this is not always the case. Also, not all patients realize that their health insurance may not include some kind of examination or treatment.

Prevention: By competently and politely explaining to the patient that you do not set the working hours, for example, of the laboratory, many problems can be avoided. If a we are talking about invasive diagnostic methods, try to take the side of the patient - sympathize with him before the frightening procedure, but explain its necessity, and also that, despite discomfort, thousands of people go through it.

5. Has personality traits

Not every doctor during the appointment is able to become the patient's best friend and tell everything he knows. In addition, some difficulties in the treatment process quite naturally include mechanisms psychological protection up to reciprocal aggression directed at the patient. A rare doctor is not under the influence of long overtime, night shifts and other emotional overloads. All this also exhausts the psyche and gradually forms a syndrome. professional burnout to which a separate article could be dedicated.

Prevention: Consult psychologists or specialized literature that tells how to manage anger and relieve stress; do yoga or sports, be outdoors more often.

Strategy and tactics

The primary task on the way to conflict prevention is to correctly build communication. This will help determine the goals of the parties. It is important for the doctor to conduct an appointment without any special difficulties, draw up documentation and move on to the next patient. The goals of patients are much more diverse. The goal of getting an examination and treatment, recovering and going home is not so common and, as a rule, does not lead to conflict situations. Non-medical goals (for example, to communicate, get a sick leave or disability, or comment on a treatment prescribed elsewhere) are most often not achieved. The patient who did not receive the desired result automatically blames the doctor for this and hurries to show his negative emotions. The most important thing in cases of such requests is to refuse the patient quickly, reasonably and categorically, explaining your refusal by your job priorities.

It must be constantly remembered that the doctor and the patient are in the same boat. Doctors are overloaded with work - the patient hardly makes an appointment and sits in a queue. The doctor is limited in the appointment of studies and procedures - the patient risks his own health. Lack of finances leads to the fact that the patient meets with a doctor or nurse, pulled up and overworked by endless part-time jobs. The administration often pays much more attention to the complaints of patients than to the difficulties of workers.

No matter how trite it may sound, but the most important thing to prevent conflict situations is the correct, competent and timely performance of your work. Remember that a well-cured patient will not inflate the conflict, but with a deterioration in well-being, the prerequisites for the development of the conflict will intensify and escalate, and here the importance of adequate symptomatic therapy should be especially noted.

And most importantly - do not be afraid of conflicts, this is a normal part of human interaction. However, if some of them can be prevented, it is better to do this in order to make life easier for yourself and for patients.

Based on media materials

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Only one in ten is completely satisfied with the way our healthcare works. And more than half (52%) have complaints about medicine.

What to do if there is a conflict between the patient and the doctor? How to ensure that patients are not kept in queues for hours to make an appointment the right specialist could it be without problems, without making a lot of effort? Who will help the offended patient? "RG-Nedelya" asked the All-Russian Union of Insurers (VSS) for clarification.

The right to complain

The federal law "On Compulsory Medical Insurance in the Russian Federation" says that we all have the right to receive quality medical care. And the task of monitoring the quality of work of polyclinics and hospitals is entrusted to insurance companies. medical organizations.

The insurer who issued you the CHI policy is obliged to protect your interests as a patient. Insurance companies conduct scheduled inspections in medical institutions - this is the first direction of control. And the second direction is work with citizens' appeals. Therefore, if the conflict situation cannot be resolved directly in the medical organization (with your doctor, head of the department, deputy chief physician for medical work and, finally, the chief physician himself), dissatisfied patient has every right to file a complaint with insurance company.

Documentation

The direct work of HMOs with citizens' appeals is regulated by Federal Law N 59-FZ "On the Procedure for Considering Citizens' Appeals Russian Federation"dated May 2, 2006 (59-FZ), which lists all the necessary conditions filing an appeal, the procedure for its consideration and many other important points.

1 When should I file a complaint?

The insured has the right to complain orally or in writing in all absolutely cases related to the receipt of medical assistance by him. compulsory medical insurance policy. Moreover, it does not matter in which region of the country he received this assistance - where the citizen lives and where he received the policy, or in another where he went, for example, on vacation or on a business trip.

The regulatory documentation of the MHI system contains a possible list of complaints. “If in this list a person does not see the reason why he personally wants to apply to the CMO, this does not mean that there is no need to complain,” they emphasize in the VSS. “If a citizen believes that his rights in the compulsory medical insurance system have been violated, then . The employees of the insurance company are obliged to give a full answer on the merits of all the questions raised in the appeal. "

2 What are the most common complaints?

Providing compulsory medical insurance policies,

Choice / replacement of MO in the field of CHI,

Selection / replacement of a doctor in the MO to which the citizen is attached,

Choice / replacement of QS,

Organization of the work of the Ministry of Defense,

Sanitary and hygienic condition of MO,

Logistics of the Ministry of Defense,

Ethics and deontology of health workers (that is, how the doctor and medical staff treat the patient),

The quality of medical care provided

drug supply,

Denial of medical care under compulsory medical insurance programs,

Collection of money for medical care, which should be provided free of charge, under the compulsory medical insurance policy, that is, according to compulsory medical insurance programs.

Often the conflict between the patient and the doctors can be resolved out of court

3 What to do if the insurance company does not help

There are cases when the insured citizen believes that there are grounds for a complaint about the work of the insurance company itself. The Territorial Compulsory Medical Insurance Fund supervises the work of insurers. Therefore, you can complain about the work of employees of the insurance company to their management, but you can also contact the controlling organization - the Territorial CHI Fund.

4 Step-by-step instructions: where to go first

First instance: chief physician or his deputy for medical work,

Department (Ministry) of Health of your city, district, region,

The insurance company that issued the CHI policy,

Territorial branch of the MHIF of its region,

Court, prosecutor's office.

Important. Complaints can be filed orally or over the phone, but it is best to submit them in writing. So your opinion will be recorded, it will be more convenient to consider it, track all stages of the workflow.

5 What documents to attach to the application

The complaint itself is written in free form. Many insurance companies, for the convenience of citizens, have templates, standard forms for citizens' appeals.

The application indicates exactly where the citizen is applying (name of the state body or municipal government, name of the insurance company, etc.). You can contact the official (his last name, first name, patronymic or position are indicated).

The requirements for writing an appeal are set out in paragraph 1 of article 7 of the 59th federal law.

When filing a complaint, a citizen has the right to submit any additional documents and materials or apply for their reclamation, including in electronic form. These can be extracts from medical records, prescriptions for medicines, copies of appointments for examinations, receipts and checks for medical services, etc. It all depends on the reason for the complaint.

6 What to do if the necessary documents are missing, lost, the doctor did not provide them

It is enough for a citizen to file a complaint with the insurance company and attach those documents (originals or copies) that he considers necessary. To conduct a full check, the CMO itself will request the missing documents.

7 What will be the result of the test

It depends on her results. If, for example, a citizen complained about the quality of medical care provided, the insurance organization will conduct a so-called targeted examination of the quality of medical care. If it turns out that the patient is right, and any defects are found, the medical organization where he was treated will be punished. Usually we are talking about penalties. In addition, after the check, the "feedback" rule applies: the essence of the violations found is brought to the attention of the clinic management. So the chief physician has the opportunity to draw conclusions and correct the work of his subordinates.

By the way

The patient is not always right

A few days ago, an emergency occurred in Bashkiria: a patient who was waiting for an appointment injured a doctor because a health worker received a colleague out of turn. The incident occurred in the Salavat polyclinic. The 24-year-old girl was waiting in line in front of the X-ray room, but the polyclinic economist walked in. The girl burst into the office next, grabbed a pen and slashed the doctor's arm with it several times. The attacker was found on the policy, which, while running away, she left in the clinic.

Doctors are increasingly becoming victims of inappropriate patient behavior. It is clear that lynching is unacceptable, all conflicts must be resolved by civilized methods.

"Cases when the doctor-patient is not right in the relationship occur quite often," comments the head working group advice on health insurance All-Russian Union of Insurers Alexei Bereznikov. - And this is often due to the erroneous idea of the patient himself about what he can count on when contacting medical institution. For example, some patients feel that the doctor or receptionist did not talk to them politely enough. After the check, it turns out that the services are provided with high quality, there are no violations on the part of the medical organization. Also, patients do not always understand that the doctor has certain legal obligations. In some cases, relatives are dissatisfied with the fact that a serious illness is reported to the patient directly, but they forget that there is a 323rd the federal law by which the doctor is obliged to inform the patient about the diagnosis. There is a certain percentage of complaints about adverse outcomes. For example, old man he is dying of a myocardial infarction, he is over 80 and this is his third heart attack, but his relatives are sure that the person was killed, they did not provide proper assistance. Or the patient dies from oncology in the 4th stage, but the patient himself has not undergone medical examination for many years, not to mention contacting a specialized specialist. In such cases, one must understand that there is a course of the disease, people are mortal and they can die due to natural causes, including as a result of an advanced disease.

On average, the percentage of unfounded complaints from patients to insurance medical organizations about the quality of medical care medical services depending on the region is about 8-10 percent".

The girl persistently sought treatment at the Syzran trauma center and demanded to tell her the name of the doctor, since the medical staff did not have badges.

During the visit of the patient to the Syzran trauma center, a conflict occurred that ended up on video recording; it was posted on the YouTube channel by a patient. The girl, who was videotaping her appointment (which is not prohibited by law), began to demand from the doctor a signature on the prescription of the medicine, and tried to find out the name of the doctor. A dialogue took place between the interlocutors, during which the doctor tried to get the stubborn patient out of the office, who wanted to know who, in fact, she was receiving and why the medical staff did not have a badge indicating the name and position. In the video, the doctor speaks rudely to the patient and, in response to her demand to give her last name, escorts her out of the office.

The management of the Central City Hospital conducted an audit. The result was an appeal to the police with a request check on the patient. The hospital is convinced that all the claims of the patient to the doctor were unfounded. It is reported by "My city of Syzran".

As the hospital management found out, the girl went to the emergency room with a request to prescribe treatment for her. Such situations periodically arise in the Syzran trauma center, whose task is to provide emergency assistance rather than treating the disease itself. According to the publication with reference to the Central City Hospital, the girl went to the emergency room for the second time, although she was given a recommendation in advance, on August 3, to go to the clinic and undergo treatment.

The patient needed outpatient treatment in a polyclinic at the place of residence, where he would be given recommendations, properly executed, - commented on the situation, the head physician of the Central City Hospital, Elena Kazymova.

Elena Kazymova also explained the situation related to badges, the absence of which angered the patient. Badges were purchased for all employees of the Syzranskaya Central City Hospital, but in Russia there is no law obliging medical workers wear them. AT employment contract and others normative documents there is also no such requirement.

Since the Central City Hospital decided that the information published on the YouTube channel discredits the honor and dignity of the medical institution, the administration of the Central City Hospital appealed with a statement to law enforcement agencies and the prosecutor's office with a demand to verify the validity of the published information and, if an administrative or criminal violation is found, to bring the perpetrators to justice, said Elena Kazymova, head physician of the Central City Clinical Hospital.