Lyadov is a doctor. Academician K.V.

As Vademecum found out, academician Konstantin Lyadov is leaving the Medsi Group of Companies to take up his own medical project. He intends to organize a hospital with a rehabilitation center called “Lyadov Clinics.” The investor of the project will be the main owner of Pharmstandard, Viktor Kharitonin.

As Konstantin Lyadov told Vademecum, we are talking about creating a multidisciplinary clinic with a hospital and a rehabilitation center in Moscow. “The business model of the project takes into account the specifics of working in the compulsory medical insurance system. I sincerely believe that it is possible and necessary to provide medical care effectively within the framework of the state guarantee program, without excluding paid services,” he explained.

The site for the Lyadov Clinic has already been selected. The area of ​​the future medical center will be 14 thousand square meters. m. Lyadov refused to name the volume of investments in the project.

He is currently obtaining patents for new technologies for inpatient rehabilitation: “I hope we will be able to organize full-fledged rehabilitation within the compulsory medical insurance tariffs that exist.” It is planned to scale this part of the project through the sale of rights to use technologies to regional partners.

Earlier, Konstantin Lyadov presented a system for remote rehabilitation of patients at home under the supervision of a doctor - via telemedicine connection. This project, according to Vademecum, is already being tested in pilot regions.

Since February 2017, Konstantin Lyadov has headed the Otradnoe business unit at Medsi Group, which includes a multidisciplinary hospital and a number of clinics in Moscow and the Moscow region. He will continue to take part in the group’s work for some time until the launch of a new project.

“The management of Medsi Group thanks Konstantin Viktorovich for the work done. In record time, including thanks to his participation, the clinical hospital on Pyatnitskoye Highway became one of the leading assets of the network. Konstantin Viktorovich has assembled a unique team of specialists who will continue to work in the group. We consider it a logical and consistent step for him to create his own clinic,” Medsi commented on the departure of one of the group’s key managers.

“I believe that the project has prospects - Konstantin Lyadov has extensive experience in combining the sale of government and commercial services. By positioning the clinic as an inexpensive hospital, it is possible to obtain quotas for both operations and a basic set of rehabilitation care, and make money on sales of additional medical services,” says Vladimir Geraskin, managing partner of DMG.

Information about two new companies controlled by Konstantin Lyadov appeared in the Unified State Register of Legal Entities on June 15. These are LLC “Multidisciplinary Medical Center “Lyadov Clinics” and LLC “Moscow Center for Restorative Treatment”. Lyadov owns 10% of them, and MIG LLC owns 90% each. This company is 70% owned by Viktor Kharitonin.

At the same time, MIG LLC registered several more companies - “Innovation Clinic”, “Nuclear Medical Technologies”, “High Technologies”, “Clinic Group”. The IPT Group, which manages Viktor Kharitonin’s medical projects, did not disclose the appointment of new legal entities.

E. Kryukova:

Hello, this is Media Doctor, “Online Reception”, I’m on air, Ekaterina Kryukova. Today is our Rehabilitologist’s Day, in connection with which we have gathered with Konstantin Lyadov, surgeon, oncologist, Doctor of Medical Sciences, professor, academician of the Russian Academy of Sciences. Hello.

K. Lyadov:

Hello.

E. Kryukova:

Konstantin Viktorovich, let's figure out who a rehabilitation doctor is and why we need medical rehabilitation?

K. Lyadov:

You start with the most difficult question. The name of the specialty changed quite often. And a rehabilitation doctor is probably the person who is responsible for ensuring that our patient, after surgery, after treatment, after some problems with which he ended up in the hospital or with which he came to the outpatient doctor, eventually returns restored to normal life as much as possible.

The ideal rehabilitation doctor is a generalist who understands how to restore the functions of the body as a whole. Since a person often comes with a specific problem, this problem is solved. But while solving this problem, others arise, since the operation leads to certain complications. The treatment is complex, difficult, chemotherapy also leads to side effects on the body. And the rehabilitator must minimize the harmful effects of treatment and optimize the body’s recovery process.

The ideal rehabilitation doctor is a generalist who understands how to restore the entire body’s functions

E. Kryukova:

Do I understand correctly that a rehabilitation doctor cannot attend to every patient after every operation and ask how he is doing? That is, the issue of rehabilitation is resolved at the level of management of the clinic, the institution we are talking about?

K. Lyadov:

Rather, at the level of changing the idea of ​​a doctor, specialist (neurologist, oncologist, gynecologist) about what rehabilitation is. When we meet with colleagues, give lectures, we ask who prescribes these treatment methods, these are non-drug, and sometimes medicinal methods. We will refer you to a physical therapy doctor or a rehabilitation specialist. And we try to explain that the attending physician is responsible for treatment. Therefore, a gynecologist, urologist, oncologist, neurologist must know as much as possible the list of methods and the possibilities that now exist in order to restore the patient.

Why is physical therapy needed in the intensive care unit? You come with some strange instruments and move them over the patient’s stomach, but we operated on his lungs or his legs. We say that when the patient lies down, his intestines do not work very well. And when the intestines are swollen, the lungs are compressed and the diaphragm rises. So he will have congestive pneumonia. If we make sure that the intestines work well, the lungs will not become compressed.

And often even competent specialists have to explain that the human body is a very complex interconnected mechanism. And we can influence completely, seemingly unexpected moments in order to solve those problems that we are unsuccessfully trying to solve head-on. A rehabilitation doctor is an integrative specialist who can approach a problem from different angles and offer a solution using a variety of methods.

The traditional idea of ​​rehabilitation is exercise therapy and physiotherapy. The main part is different types of training, simulators, mechanisms, this is everything that is not related to medicine. However, we also actively use medications to restore the patient in order to prepare him for further treatment. And this is a completely different approach to a person. That is, rehabilitation can begin at any time, and it is very difficult to complete. Because when we go to the fitness center, we can say that we are doing rehabilitation. When we bring a child who cannot concentrate on his studies, and our psychologists work with him in order to teach him to concentrate and not be scattered with attention (attention is now a very common problem), using rehabilitation techniques, electrical stimulation, biofeedback, using all kinds of methods a certain correction, this is also rehabilitation, although this is a healthy child, he, in general, is not sick with anything. And when we go to the gym, we don’t get sick either. But we can improve ourselves endlessly. And so does rehabilitation. It can begin at any time: before surgery, during treatment, after injury. And finishing it is very difficult, because a person always wants to achieve some ideal and become even better than he was before the operation. Therefore, the question here is not simple, and the answer may be quite vague, but, nevertheless, a rehabilitation specialist is a person who looks at the patient as a whole, without isolating his individual diseases.

Rehabilitation can begin at any time: before surgery, during treatment, after injury. And it’s very difficult to finish it, because a person always wants to achieve some kind of ideal and become even better than he was before the operation

E. Kryukova:

It seems to me that when a person finds himself in a situation where he needs an operation, the task of the entire medical team and personnel is to make his life as easy as possible after the operation, to shorten the post-rehabilitation period and any troubles associated with this, and to take into account all the risks in advance.

K. Lyadov:

We often pay attention to the fact that this work begins before the operation. It begins when we see a patient and try to understand what else he has, besides the problem with which he came, how we should prepare his cardiovascular system, respiratory system, and psychological characteristics for surgery. Because sometimes a person is more afraid than is normal, and this also leads to sad consequences. It is better to operate on the day the patient is hospitalized, there is no fear, no unnecessary hospitalization. It is very difficult to convince our colleagues, but more and more of our clinics are coming to the conclusion that the patient must be prepared, come in the morning and have surgery on the same day. It is very difficult to convince the surgeon that the patient needs to be raised as soon as he recovers from anesthesia and allowed to walk. Because a whole complex of mechanisms is activated here: both the mechanism of proprioception and the mechanisms of activation of respiratory analyzers. We are accustomed to walking upright, we should not lie down. And if a person stays in bed even for an extra day, then it is more difficult to restore him. It is difficult to convince our colleagues that as soon as a person has regained consciousness, physical therapy instructors come to him in the intensive care unit, lift him up and walk with him around the bed.

We are accustomed to walking upright, we should not lie down. And if a person stays in bed even for an extra day, then it is more difficult to restore him

E. Kryukova:

Have you now described real-life, scientifically based recommendations?

K. Lyadov:

Really existing, scientifically based methodology, and they are described in our monographs, and this has already been published in Russia and has been discussed several times. But we still have to convince people that this is correct and safe, since fears are present not only among patients, fears are also present among doctors, and there are certain habits.

E. Kryukova:

Tell us more of these tricks. You said that you need to get up quickly on the first day of hospitalization.

K. Lyadov:

You are probably familiar with the situation when you are told that before the operation you do not need to eat or drink, and preferably in the evening. And all over the world it is considered that this is wrong. And 2 hours before the operation, you must definitely drink a glass, 200 g, at least, sometimes a little more, depending on your weight, of a high-energy drink, either special or just sweet tea. Because then the brain tolerates anesthesia much easier. And the anesthesiologists say: “How to drink, he will vomit.” We always have one and a half liters of liquid in our stomach on an empty stomach, and because we drank 200 g of sweet liquid, energy liquid, there was no more of it. But it’s much easier for our brain, and it’s much easier for our intestines, because the intestines don’t like it when it doesn’t receive nutrition, it starts to deflate, bacteria work there, and we get the very problems that I already talked about. We get a tightened diaphragm and lung problems. If this is an elderly person, and if he is a smoker, if it was already difficult for him to breathe, then now we have made it even worse. Because of which? Because we still say that you should not eat or drink on the day of surgery, under any circumstances. No, drink 200 g in 2 hours, and it will be better.

They say that you do not need to eat or drink before surgery. And all over the world it is considered that this is wrong. And 2 hours before the operation you should definitely drink a glass of high-energy drink or sweet tea, because then the brain tolerates anesthesia much easier

E. Kryukova:

The same thing with enemas, now they are trying to refuse.

K. Lyadov:

We don’t, and you know, no problems happen.

E. Kryukova:

All these are prejudices, or did it have some basis, some kind of sanitation of the intestines and adjacent organs, fasting, etc.

K. Lyadov:

You know, it is very difficult to answer this question, it probably was. We studied when it was mandatory, but new drugs for anesthesia appeared, new opportunities to quickly bring the patient out of anesthesia. Because now we can bring the patient out of anesthesia within seconds, it ends, and we can communicate with the patient and activate it. Probably, about 50 years ago this was really impossible; if a person came out of anesthesia in 3-4 hours, it was hardly possible to think that he could be activated so quickly. Everything is interconnected here: the promotion of medical technologies, and changes in methodological approaches, how to prepare a patient, how to operate on him, what to do with him.

If we move on to oncology, it is a completely different oncology. If we move to neurology, to recovery, there have been absolutely amazing changes, and 10 years ago, when we were restoring patients, we were not using 30% of what we use now. These devices simply did not exist, these technologies did not exist. They appeared, and other results appeared.

E. Kryukova:

We started to describe Fast track a little, as I understand it.

K. Lyadov:

Yes, it's closer to surgery.

E. Kryukova:

What it is? A set of measures for what?

K. Lyadov:

This is a set of measures aimed at minimizing trauma from any operation: gynecological, oncological, traumatological, any. Preparation and special approaches to patient management already in the hospital itself. I have already said: hospitalization on the day of surgery, no fasting, no enemas, quick activation of the patient, a whole range of recommendations for medication management. And our task is to make sure that the patient in the evening after the operation can go to the buffet on his own feet and have a snack. This is the ideal of Fast Track.

Our task is to make sure that the patient can go to the buffet and have a snack on his own feet in the evening after surgery.

E. Kryukova:

Regarding oncological diseases, chemotherapy, and previous operations. You say that there are very special measures and rehabilitation actions here.

K. Lyadov:

Fortunately, oncology has changed. It became much easier for us, as rehabilitation therapists, as other operations began to appear. We tell patients all the time that they shouldn’t be afraid of treatment, they shouldn’t be afraid of surgery, they shouldn’t be afraid of going to the doctor because they have become different. Gone are mutilating operations for breast cancer, large incisions for the thyroid gland are gone, we now do this through the armpits. Therefore, no cuts remain. Women do not go to the doctor, afraid of the incision, and they advance their thyroid diseases to those stages when it is too late to deal with them.

The first to change were the operating technologies and the anesthesia technologies. But the process of treating cancer itself has become longer, more effective, but, unfortunately, more painful for the patient. The successes of modern oncology are recognized by everyone, including surgeons, these are the successes of chemotherapy and radiation therapy. New targeted drugs are emerging that act directly on a specific tumor in a specific patient. But they are quite toxic to the body.

Previously, when we talked about the rehabilitation of cancer patients, it was the fight against edema after breast removal, and care for stomas during major intestinal operations. And now we go to someone else, we say that we need to make sure that the patient can endure chemotherapy. The operation has already become less traumatic. But six courses before, six courses after, and if they are not done, there will be no effect, we will not be able to give this dose of the drug, which will kill the cancer cells in the human body. And this is where we come in when we are engaged in restoring mood, fighting nausea, depression, and neuropathies. This word may not be very understandable to a wide audience, but, unfortunately, it is a frequent consequence, a manifestation of complications of chemotherapy when sensitivity is lost. And nothing seems to happen, but the person does not feel his fingertips, he cannot even pick up a cup or a toothbrush. Lose sensation in legs. Everything is fine, but the person cannot get up because he does not feel anything underneath him.

And when we began to develop a set of measures to combat these neuropathies, probably five or six years ago it became clear that this is a problem that we will face more and more often. We have now arrived at a set of measures because we have begun to figure out the mechanisms. There is a hypoxic mechanism, a toxic mechanism, a nutritional disorder, a metabolic mechanism. Even when we inject drugs to nourish the nerves, we inject them by warming up the muscles, warming up the tissue, or we didn’t do this, and the drug didn’t reach the point, and we didn’t get a good effect.

The sequence of procedures is very important: sometimes physiotherapy, sometimes physical therapy, sometimes inhalations and breathing exercises. Because they ask us: why? We explain: you don’t have enough oxygen, and in order for us to fight these consequences, we must fight hypoxia, hypoxic stress. This is the whole complex that, in fact, is decided by the rehabilitation doctor, who allows us to restore a person in 3-4 days between chemotherapy courses and allow him to continue chemotherapy.

E. Kryukova:

Where is the best place for us to establish such communication with a rehabilitation doctor? Can a person come on his own or is it better to stay in a hospital or sanatorium? Which do you think is more effective?

K. Lyadov:

If these are severe complications, then these are specialized centers. And rehabilitation is the same technological branch of medicine as cardiac surgery. If the problems are serious, then it is better to look for a specialized center that deals with these specific problems. It’s just that people who are engaged in recovery from some kind of back problems do not deal with their heads very well and do not deal with oncology at all. That is, this is either a large multidisciplinary rehabilitation center that has specialists in these areas, or they are trying to somehow convince their doctors that they also need to read books, listen to lectures and somehow try to help. It is not simple.

Rehabilitation is the same technological branch of medicine as cardiac surgery

E. Kryukova:

But at the same time, the highest goal of rehabilitation is to achieve independence for the patient.

K. Lyadov:

Achieve maximum quality of life. So that he feels as comfortable as possible and as comfortable as possible in society. So that it can exist and function independently. And even if problems remain, it should not be a psychological problem for him. Because there are situations: a new joint is installed, but it still doesn’t belong. You can’t get hung up on the fact that I want to be like I was 20 years ago when I had my own. This means that we must convince you that we have achieved the maximum effect, you can do whatever you want, nothing hurts, and this is wonderful.

E. Kryukova:

Let's talk a little about heart attack and stroke.

K. Lyadov:

Stroke and neurorehabilitation are, of course, a huge problem. Stroke, traumatic brain injury - very similar changes, a little more, a little less. Brain tissue is lost, functions that have been familiar to a person since childhood are lost. And our task is to restore functions, but using the plasticity of the brain, using those areas of the brain that were never responsible for this before. This is a very interesting task, this is neurorehabilitation. These are clearly rehabilitation specialists, since intensive care doctors save lives, and this is great, completely without irony. But then their next patients come, and the patient goes where? Goes into rehabilitation. Something is done to him during intensive treatment in the intensive care unit.

E. Kryukova:

That is, the state assistance system.

K. Lyadov:

Of course, the first stage of rehabilitation has been worked out quite well, fortunately, this is really necessary.

E. Kryukova:

Without this, the patient will not be released, without the first stage?

K. Lyadov:

At the first stage, the maximum that could be done will be done. But no one can say what the result was. For some people it will be wonderful, and the patient will go home; the first stage was enough for him. Some people need a second one, some people need a third one. And here is the problem that still exists, where he will go at the second stage, and how they can help him at this second stage after a stroke, after a traumatic brain injury.

E. Kryukova:

Could they do something wrong?

K. Lyadov:

The state system does not have enough funds, we understand this, for long-term, serious rehabilitation of the second stage. A significant part manages to help. But if we are talking about serious consequences, unfortunately, this remains paid assistance and is provided in a very small number of centers in the country. I may be criticized, but I think that there are not even a dozen serious neurorehabilitation centers that actually deal with patients in extremely serious condition, but when the acute period has already passed. The dysfunctions are so serious that we must deal with everything comprehensively: movement, the urinary system, the respiratory system, the nervous system, and everything, everything, everything. This is a separate topic, a very difficult category of patients, and these types of rehabilitation are still paid.

If we are talking about serious consequences, unfortunately, this remains a paid service and is provided in a very small number of centers in the country

E. Kryukova:

Is it true that we cannot delay this completely, let’s say in a year we will no longer be able to work with the patient?

K. Lyadov:

It’s better to start working right away, I’ll repeat. But I do not agree that there is no effect after a year, after two, or even after three. We very often see patients who decide to come to us and leave completely different, because we do not know much about our brain, that we have absolutely no idea how it can react to new rehabilitation techniques. I repeat, new methods of stimulation are emerging, new methods of brain development, electrical stimulation of the brain, something that was not discussed at all before.

E. Kryukova:

Tell us a little.

K. Lyadov:

Nowadays the phrase Brain Fitness is very fashionable, when we train the brain with the help of special exercises and with the help of stimulation techniques, computer techniques, and biofeedback techniques. In a healthy person, we can increase the amount of RAM very quickly. That is, after a 30-minute workout, you can take two pages and, after reading, immediately repeat them.

E. Kryukova:

Which specialist is this?

K. Lyadov:

Rehabilitation specialist, of course, as usual. But we always say that you must train. When you go to the gym, you understand that you have to repeat the exercises. It's the same with the brain. That is, the brain demonstrates the same things. We remember from school, if we repeat a poem over and over again, we train our brains, and we finally learn it by heart. Then time passes, we stopped training our brains, we forgot this poem. This suggests that the brain is amenable to rehabilitation, it can be restored, and this does not depend on the duration of the injury. We can find those areas that will allow a person to feel much better and recover much better.

When you go to the gym, you understand that you have to repeat the exercises. It's the same with the brain.

E. Kryukova:

But this should not be just one specialist, it should be a neuropsychologist, a physiotherapist, or something else.

K. Lyadov:

There is the concept of a multidisciplinary team. Of course, a physical therapy doctor and, again, a rehabilitation specialist and medical specialist, a neurologist or oncologist, if we are dealing with an oncological patient. The concept of a multidisciplinary team has existed for a long time in rehabilitation, when everyone is included in the treatment process, connected to the treatment process. But still, there is always someone who coordinates this treatment process. Let's call him a rehabilitation specialist.

E. Kryukova:

Now our patients have progressed a little, and when choosing an operation for themselves, they try to order a laparoscopic one. Do we always manage to meet the patient halfway, and is this always appropriate? Again, touching on Fast track, a quick way out of this state.

K. Lyadov:

You know, Fast track was developed by Dr. Kelet as proof that by performing an operation perfectly, following all the rules that we talked about, you can achieve the same results as with laparoscopic surgery, but with an open one. He argued that it is much more important for the patient to comply with all these rules aimed at his rapid recovery than one 10-centimeter or three 1-centimeter incisions.

E. Kryukova:

But you and I understand this, but the patient is capricious, for example, a woman does not want a scar, she wants a laparoscopy.

K. Lyadov:

He's not capricious, he doesn't feel like it. And she is absolutely right, she wants laparoscopic surgery, which means we need to try to meet her halfway. And now, in my opinion, most hospitals and centers in our country are equipped with laparoscopic equipment. Sometimes, if doctors don't know it, they go for open surgery. I can't say it's bad. But I understand the patient, I understand the patient. Of course, at the first stage, recovery after laparoscopic surgery is much faster. And yet, in this regard, laparoscopic surgery is less traumatic, more gentle and more physiological than open surgery. But it happens in different ways. There are cases when it is not possible to do it laparoscopically, and, by the way, there are fewer and fewer of them. Technologies are moving forward quickly, the da Vinci robot appeared, 3D stands and 4K stands are now appearing. That is, when entering the abdominal cavity, you can enlarge the image, you can see in as much detail as you will never see in open surgery. These are all the advantages of laparoscopic surgery, and they are undeniable. Therefore, the choice is still up to the doctor; we try to follow the wishes of the patient.

My point of view is that laparoscopic surgery is less traumatic and it should be promoted and it should be developed. Although, I will repeat once again, if the doctor for some reason believes that the operation should be done openly, the patient needs to listen to the doctor’s opinion. The doctor’s task is to make sure that this injury, this incision, interferes with the patient’s life as little as possible or interferes with his recovery after surgery. Thoracoscopic surgeries, this is a completely new word, when we operate on the lungs with the help of devices and punctures, recovery even with laparoscopic surgeries may not be as striking a difference as with lung surgeries.

E. Kryukova:

Is this cancer surgery?

K. Lyadov:

There are a variety of them, there are also benign ones, pulmonary emphysema, bullous emphysema. But still, traditional thoracic surgery involves large, traumatic incisions in the intercostal spaces. These are difficulties with breathing, these are many, many problems, and a person often remains with them for many years. Thoracoscopic surgery allows you to avoid this altogether. That is, there are things here where, if you can do a thoracoscopic procedure, you need to go where they do it, and not stay where they don’t do it. Because here the effectiveness, safety and benefit for the patient are even higher, perhaps, than in abdominal surgery.

If you can do thoracoscopic surgery, you need to go where they do it and don't stay where they don't do it. Because here the effectiveness, safety and benefit for the patient are even higher than in abdominal surgery

E. Kryukova:

Do we train doctors in laparoscopy in medical institutions or is this a personal initiative, some courses, seminars, master classes?

K. Lyadov:

They teach, now there are a large number of simulation centers at medical universities, at the first medical institute, at the Botkin hospital.

E. Kryukova:

That is, whoever wants to do it without any problems?

K. Lyadov:

And whoever wants, they direct, even if they don’t want, they force. The training of laparoscopic surgeons is quite active. Another thing is that a surgeon must still specialize in something, because then the effectiveness of treatment will be much higher if he does not scatter and focuses on one area. Let it be laparoscopic surgery, but intestinal surgery or esophageal surgery, they still have a difference, and laparoscopic too. This is also a separate topic, not only for a rehabilitation specialist, what is more effective, which specialist to choose, who to go to, when decisions are made, to a general specialist or to a person who deals only with such operations. I would probably choose someone who only deals with such operations.

E. Kryukova:

Logical. Konstantin Viktorovich, you are considered a pioneer in the region, that you brought new rehabilitation systems, you led a well-known rehabilitation center for a long time. I would like to ask you, in addition to some conceptual solutions, there were probably complex economic and organizational tasks, and did you have to make compromises in this sense?

K. Lyadov:

The main compromise that was, or rather the main problem that was the compromise that we still have to make to this day, is still the organization of rehabilitation, its inclusion in the healthcare system and the financing of this rehabilitation. Since we work in a system of state guarantees, we provide free medical care. But, unfortunately, we cannot provide a number of things. According to the law, a person may want to receive paid help, but here, for example, it seems wrong to me when there is a person’s desire, whims, wishes, whatever. Yes, I know that I can get it somewhere, but I want to go there, I want to pay money and do it better, as it seems to me, or really so. Unfortunately, the rehabilitation problem is very lengthy, it is very expensive, and the state cannot pay for it. When it is shown, it is needed, and there is no way to finance it, and you need to tell the person that you know, you still need to pay for it. This was a problem for us 20 years ago, and yet we had to accept the fact that this is a paid direction, unfortunately, it remains so now. Much has changed, the first stage has appeared, and during treatment they began to engage in rehabilitation activities. And here the merit of the Ministry of Health. But there is an objective situation.

E. Kryukova:

What is missing?

K. Lyadov:

There is not enough money to treat a small number of severe patients after a stroke, traumatic brain injury, some neurosurgical operations, some situations. There are relatively few of them, but they exist. And while the compulsory medical insurance system is not working, there is no money yet. At one time there were federal quotas, then they were abolished during the ministry of Tatyana Alekseevna Golikova. That is, before her it was recognized that rehabilitation is high-tech medical care. And it was very correct, and it helped people a lot. The rehabilitation center, and our center, and the Institute of Neurology, and the FMBA Center of the Medical and Biological Agency could provide assistance to a very large number of patients and then send them to their place of residence for further treatment at a different level.

Over the past few years, rehabilitation has been removed from the high-tech care system and transferred to the compulsory medical insurance system. But compulsory medical insurance is not unlimited; compulsory medical insurance cannot close everything yet.

As for economic things, organization, training, we were probably pioneers in that we were among the first to actively introduce multidisciplinary teams and understand that rehabilitation is the same direction as surgery, therapy or obstetrics-gynecology, that this is still a separate area that needs to be dealt with separately professionally. At the very beginning, sponsors helped us a lot, it’s probably more correct to say that, and most of the organizations that helped us did not expect money, they did not ask for money back at all, they invested in new development.

At that time there were no serious centers at all; we created a center in the Western style, multidisciplinary. The only thing that distinguished us from our Western colleagues was that they always specialized somewhat. And since we were federal, and the tasks were big, that is, we had the musculoskeletal system, and neurorehabilitation, and urological, and gynecological. When colleagues came and said: why do you have so many things? Because we have a federal center, we have to deal with everything. But on the other hand, it was a huge experience, and then people came to us to learn from our experience, and we communicate a lot with colleagues. Even now, when we are creating a new center, using the already accumulated experience, I don’t see any global problems. Consciousness has already changed; 20 years ago there was no understanding that there was such a branch of rehabilitation; now no one even denies it.

Over the past few years, rehabilitation has been removed from the high-tech care system and transferred to the compulsory medical insurance system. But compulsory medical insurance is not unlimited; compulsory medical insurance cannot close everything yet

E. Kryukova:

It seems to me that only in extreme cases do our people remember this, and if a complex operation is ahead, they will most likely fly to Germany, Israel, if it concerns oncology.

K. Lyadov:

Still, the majority of our citizens will still remain treated in the country. And our task is to make sure that they do not regret it, so that people who came from Germany find out that the person who remained in Russia received the same help and was given the same rehabilitation. But it costs money, and in our country too.

E. Kryukova:

But after an operation not related to a stroke, government agencies will not help us in any way?

K. Lyadov:

After a stroke, they will help at the first stage quite well, and then too. The tariffs are very low, let's be completely honest. 18 days - 48,000 rubles, 50,000 rubles. 18 days of rehabilitation of the second stage, as a rule, are paid by the regional fund. 2000 rub. in a day. But discard 1000 of them for food, for a bed, for other things. 1000 rub. per day, of which 300 rubles. need to pay wages. There is an instructor, a physiotherapist, a psychologist, and a neurorehabilitation specialist, and they will all receive 300 rubles for this patient. in a day. Well, it’s simply impossible to fulfill the volume that he needs. Something is being done, but not to the extent that is needed.

Another thing is that many of the patients do not need serious rehabilitation; they are gradually recovering at home. We are talking specifically about those who are in need. We can provide services at the highest level, cheaper than abroad, but still for money. Rehabilitation, complex rehabilitation, is still an expensive thing. And in Russia it is an expensive thing. It is effective, it allows you to get back on your feet, it allows you to return to life, and really return to life.

We recently had a situation where we are talking about how much it costs. On the recommendation of our colleagues, the son of a man who suffered a stroke came to us. A fairly young man, with hypertension, over 50 years old, actively working, engaged in mental work. They were in one center, they were in another center, they went through everything that was required, and quite well. But then the opportunities provided by the state ran out, and restoration did not fully occur. And the family had a dilemma: they give up everything, hire a nurse, he remains deeply disabled, or there is a chance to try to bring him back to life by finding money. And when my son arrived, “Let’s see the first stage, two weeks.” Two weeks, then another two weeks, he stayed with us for three and a half months, it cost very good money, but he came back to life. And three months ago they were told that he would remain deeply disabled, bedridden and bedridden. Therefore, the question here is whether it is worth it or not, you need to find the money.

E. Kryukova:

Of course, it is worth and necessary to explain this to people. Let's raise the issue of children's rehabilitation. It seems to me that we have a better situation with this in our country, they treat it more responsibly and there are more existing options on the market.

K. Lyadov:

More charities that help. That is, we return again to the fact that after all, this is an event that is financed by someone, somewhere by the state, somewhere by philanthropists, somewhere by parents.

Pediatric rehabilitation is also very diverse. There are children with cerebral palsy, this is one topic, complex, understandable, developed. There are certain schemes, there are regional programs, and in Moscow there is an excellent center for the rehabilitation of children with cerebral palsy. We work a lot with children and adults remotely, because people still stay at home, and we help them using the Internet, using video cameras, our instructors watch how they work at home.

Right now, exactly the same program is underway, equipment is brought to children’s homes by the Department of Social Protection, for disabled children, usually with cerebral palsy. And, of course, it is very important that they study correctly, so that parents understand what can be done and what cannot be done. That is, these programs have been worked out. We are trying with oncological rehabilitation, there are hematological patients, and a hospital, and the Dima Rogachev Center, and sanatoriums, where these children then move and where they try to care for them and recover, on the one hand.

On the other hand, we pay very little attention to the prevention of childhood injuries and the recovery of children after injuries. We often encountered this in sports rehabilitation. Because a child can fall, he can break something, but the group, the section moves ahead very quickly, that is, when he came there three months later, he had already fallen so far behind that they were no longer involved in him. It’s not even that he’s not promising anymore, it’s just that they’re already throwing the ball into the hoop, and he’s still at the stage when he was just rolling it around the floor. And we try to help such children, we work with them, bringing them to the same level of readiness as children who have not had trauma. This is a separate topic of sports rehabilitation, because we must bring an athlete or a child, no matter who wants to play sports, to the level of sports readiness for sports events. This is also a separate topic, it is very important for children, children are so vulnerable, they are so worried when they later come to the section and find themselves out of work, that we also study, and this is an interesting, rewarding topic.

Scoliosis, heart defects, recovery from heart defects, recovery from cardiac surgery, many problems. But here, fortunately, charitable foundations help, we do a lot, we work a lot with foundations, mostly with neurological patients, but also with cardiological patients.

We pay very little attention to the prevention of childhood injuries and the recovery of children after injuries

E. Kryukova:

On the consumer side, is it better to contact highly specialized centers? With regards to adult rehabilitation, sports, children's rehabilitation, cerebral palsy and so on. Or are there centers that perfectly combine all of the above?

K. Lyadov:

You know, those who combine, there are not even 10 of them, there are five of them in the country, and everyone knows them, we all know each other. Patients move from us to colleagues, from colleagues to us. 4-5-6 centers, and this is not only Moscow, this is also Yekaterinburg, the center of Professor Belkin. But again, Yekaterinburg is the center of Professor Belkin, and we are no longer talking about specialized centers, because despite the presence of departments in regional and regional hospitals, these are not specialized centers. You still need to choose a center that deals with, say, recovery after spinal surgery; if that’s all they do, and they do it successfully, then you can safely go there.

E. Kryukova:

Your problem, in other words.

K. Lyadov:

Yes, this is your problem. But you don’t need to go there with a urological problem or with the problem of recovery after gynecological surgery, this is the business of our multidisciplinary centers.

E. Kryukova:

And there should be a multidisciplinary team, preferably.

K. Lyadov:

Multidisciplinary, and there are not very many such centers.

E. Kryukova:

Thank you very much for a wonderful broadcast. The guest was Konstantin Lyadov, surgeon, oncologist, doctor of medical sciences, professor, academician of the Russian Academy of Sciences.

K. Lyadov:

E. Kryukova:

We discussed rehabilitation, thank you, be healthy, goodbye.

K. Lyadov:

K.V. Lyadov is one of the leading Russian rehabilitation specialists. He considers this specialty, which appeared on the horizon of domestic and world healthcare relatively recently, to be the profession of the future. And if 15–20 years ago it was not very clear why such doctors were needed, now rehabilitation has taken its special place among other medical specialties - such as surgery, therapy and resuscitation, and has become their indispensable assistant. Indeed, without modern rehabilitation, the efforts of all other doctors sometimes turn out to be useless. We are talking about what this specialty is, how it has changed in recent years and what awaits us in the future.

Konstantin Viktorovich, you didn’t start out as a rehabilitation specialist. And your doctoral dissertation was devoted to stomach ulcers.

In those years when I started, rehabilitation in our current understanding did not exist. In all the multidisciplinary hospitals and clinics of the First Medical Institute, where I started working, there were departments of physical therapy and physiotherapy, but this was not an important, main specialty that you pay attention to.

- And why?

When we used to come to the hospital, there were such patients whom we now discharge home. Because they usually didn't survive. There was no scope for serious rehabilitation. For example, when we now talk about rehabilitation with problems of the musculoskeletal system after endoprosthetics, we must understand that 30 years ago this area was just beginning to develop, and patients with lesions of the hip or knee joints could count mainly on drug treatment and a little on physiotherapy. When I started, surgery, oncology, and gynecology were developing at a rapid pace, but as they developed, they left a large number of problems, which they began to think about solving as patients with these problems appeared.

From my point of view, in our country, rehabilitation in the modern sense began with cardiology, with post-infarction patients, when thrombolysis, stenting, successful cardiac surgery appeared, and then they began to understand that in some cases it is not enough to just perform an operation. We also need to think about how to restore these patients after surgery. And the fact that rehabilitation as a system began to develop in our country is a great merit of Evgeny Ivanovich Chazov, who always drew attention to the need for an integrated approach to the treatment of patients. Undoubtedly, work was constantly going on both in neurorehabilitation and in other areas.

- When did you become interested in rehabilitation as a field of medicine?

When I was already the chief physician of the Moscow Basin Hospital, I first paid attention to this area, since it was at the intersection of sciences. There was a contingent of patients who needed constant rehabilitation to maintain their professional qualities. It was very interesting. We worked with rescue teams, and my doctoral dissertation was devoted to the diagnosis of certain borderline states, when a person becomes not very functionally capable. That is, he feels fine, but we understand that he will not be able to withstand the entire shift or the entire shift, he will not be able to fully fulfill his duties. This was the first part we started doing. And the second part is what to do so that he can do all this.

- Did you understand this?

We realized that there is a need to organize restoration activities. We started traveling around to see what was being done on this topic in the world - Germany, Switzerland. This was 1998–99. The understanding came that we did not have the rehabilitation that had already begun to develop abroad during these years at all. Then everywhere there were the same departments of physical therapy and physiotherapy, there were sanatoriums, for example, the Herzen sanatorium of the Presidential Administration or the famous Goluboye sanatorium of the Third Directorate, and now the FMBA, where, if a person was lucky, he could go after a stroke, a craniocerebral or spinal injury, and there they began to deal with it. But there was practically no systematic approach specifically in hospitals.

We began to develop primarily neurorehabilitation in our hospital, however, it soon became clear that almost all areas need rehabilitation.

Subsequently, when colleagues came to us, they were surprised why the center was so diverse. After all, it is traditionally believed that one center deals with neurorehabilitation, another with cardiac patients, and a third with cardiac surgery. Moreover, the approaches are different after open cardiac surgery and endovascular interventions. Rehabilitation is necessary in both cases, but there are specificities.

- What about endoprosthetics?

Not all colleagues agree with me, but I think that we are still right when we talk about the rehabilitation of patients after endoprosthetics. Destruction of the hip or knee joint is painful for the patient. He cannot walk and is in constant pain. And suddenly he is given some kind of pain relief, be it intravenous, endotracheal anesthesia or conduction anesthesia, the joint is changed - and the pain disappears. And the man himself became different. He doesn't have to be afraid to step on that joint. The main problem here is psychological. The work of a psychologist who knows how to convince the patient of this is extremely important. That's why we play a huge role in patient schools. There are a lot of fears. Unlike strokes, which occur suddenly, this has a different specificity. It was my knee, but it's no longer mine. The patient lies, does not sleep, he feels that his leg now seems to “live” separately from him. Here our research runs parallel to the research of our foreign colleagues. Meeting at congresses and discussing these topics, we see that the situations are similar and we try to solve them together. The same English scientists to whom we like to refer, studied the problem thoroughly and came to the same conclusions as us. It turned out that we were absolutely right in insisting that the patient be put on his feet on the day of joint replacement surgery. Why? Because if this is not done, then he will get up much later.

- Will he be afraid?

Yes. And then he doesn’t have time to remember all his fears. As soon as the anesthesia wears off, the instructor comes to him and says: “Get up! Go!" And the next day he still has this feeling that he can walk. If we gave him the opportunity to lie down, sleep, and wake up with the feeling of his problem, that he has a “foreign” hip or knee, then the duration of his hospitalization will be longer. This is already a proven fact. It takes two days to convince him that it’s not scary.

- Does this apply to all rehabilitation patients?

Very many. There is such a concept - multidisciplinary teams. This is an understanding of how exercise therapy, physiotherapy, a psychologist, a nutritionist, and so on can relate to surgery. But the work of all these specialists must be organized, their place and time in the rehabilitation process must be determined and paid. By the way, I had to give interviews more than once, explaining that telemedicine is the same work of a doctor as a regular appointment. This takes up his time, the consultation must be included in the work schedule and must be paid. The misconception is that I called and everyone answered me right away. It doesn't happen that way.

It's the same here. It was necessary to find all these specialists and money to pay for their work. Understand at what point they need to connect. Introduce group classes. Then we moved to schools, realizing that in principle it is much easier to gather 20-30 patients before surgery, while they can still come themselves, explaining to them in advance what problems they may encounter and how to solve them. And then after the operation there will only be 2-3 patients who do not know all this. This makes the job much easier. But we had to start from scratch, because, again, the concept of rehabilitation did not exist. And gradually an understanding came of how to work and which patients to cover.

Why did you have to cover all patients - neurological, orthopedic, and cardiac? Is this right?

Now that would be wrong. Of course, patients should be cared for by specialized medical centers. But we were pioneers, so the coverage was very wide. We had departments of neurorehabilitation, cardiac rehabilitation, orthopedic rehabilitation...

- What about oncology?

Necessarily. Oncological rehabilitation has been and remains. However, oncologists have only recently begun to recognize rehabilitation. For a long time they did not understand why it was needed. Wonderful oncologist surgeons told me: “Why? The main thing is the operation, it was performed competently, radically and everything is in order.” This is what used to happen in all other areas of surgery: you perform an operation and everything should somehow form by itself.

- This is wrong?

This is not entirely true. Oncological rehabilitation now, from our point of view, is no longer the rehabilitation of women after a mastectomy or patients with colostomies after rectal surgery. This was 20 years ago. If we now see such patients, then we believe that these are errors and incorrect treatment before the person came to us, because modern combined treatment does not involve traumatic major operations that would lead to such consequences.

- However, they exist.

Yes, they are. Patients with the consequences of severe traumatic interventions come to us, and we help them to the best of our ability. But still, after a radical mastectomy with lymph node dissection, it is difficult to achieve an ideal effect. Swelling and lymphostasis remain. This is bad because these patients are an example of what should not be done. It is for this reason that women are afraid to go for a mammogram: they will find something on me - and then it will be like this. All the same, there is no life, no chest, my arm doesn’t bend, my husband left, I can’t go to work. And indeed, her hand is like a deck. The woman is deeply disabled. Therefore, they think: I’d better not go, I’ll be patient, maybe it’ll go away on its own.

- And for the same reason, everyone is afraid to go for a colonoscopy and all other studies. How should it be?

And there must be a competent combination treatment, correctly selected chemotherapy in accordance with the individual assessment of the tumor. We now know several dozen types of tumors of the breast alone. They are grouped into large complexes, and in each case specific complex treatment is required, in some cases genetic therapy. And here a completely different rehabilitation comes to the fore - rehabilitation between courses of chemotherapy, which is usually poorly tolerated, causes a number of side effects, and these effects often force a woman to abandon chemotherapy altogether, and the work of psychologists is important. This usually occurs after the third or fourth course of chemotherapy. The first and second passes easily - then problems begin. Moreover, men refuse chemotherapy less often than women. Apparently they are less emotional. They tolerate loss of sensitivity or nausea more easily. They don't care that much. The woman perceives all this dramatically, she doesn’t want to hear that one or two more courses, an operation - and that’s it, you’re healthy. Be patient for another six months - and life lies ahead. She doesn't want to listen and gives up everything. And it is very important that during these intervals we carry out a number of correct measures aimed at reducing depression, returning sensitivity, changing a number of parameters that interfere with life.

- Or baldness, for example.

This is just the least that worries patients during the treatment process. Yes, many people worry before starting treatment, but then these fears subside. Because the hair will grow back, but real health problems are present during courses of chemotherapy or radiation therapy: anemia, neuropathy, post-radiation cystitis, colitis. Our main task is to select complexes of drug therapy, physiotherapy, and psychological correction to stabilize the patients’ condition. Our task today is to help the patient undergo a long course of treatment as comfortably as possible. Well, rehabilitation after surgical treatment also remained. But she, too, is changing.

- What exactly has become different?

Let's return to breast cancer. If a gentle operation was performed, it is not at all so traumatic. This is either a subcutaneous mastectomy or even radical resection. If the surgeon carefully approaches the extent of lymph node dissection, the consequences will also be much less pronounced. They also have their problems, but they are different, less pronounced.

Unfortunately, we have very few sources of conveying information to the masses. We know this ourselves, but it is difficult to convey to citizens that everything has changed. Everything has changed. Come for mammography, fluorography, colonoscopy, gastroscopy, ultrasound and screening studies, donate blood for tumor markers, because cancer today can be cured radically, completely, and you can forget about the disease forever. Rehabilitation also became different. Our efforts are combined with the efforts of other doctors and psychologists, and we see the results of our joint work.

Konstantin Viktorovich, for many years you worked in large state medical institutions, holding leadership positions there. And suddenly, a year and a half ago, you went to MEDSI - the very first and largest network of private medical clinics in Russia today, where you manage the inpatient part. Why did you need to go to MEDSI?

Yes, this is one of the largest medical associations in our country. Only a small part of it was under my leadership - the clinical hospital and the adjacent Otradnoye clinics. And all this happened for a completely understandable reason. Many of my colleagues know the feeling that you can do more, but you are caught up in the routine of leadership work. There is simply no time left for anything else. I then came to Veronica Igorevna Skvortsova, who literally six months earlier had signed me an indefinite contract as head of the treatment and rehabilitation center of the Ministry of Health, and said that I would still like to try to implement my ideas and developments. It was impossible to do all this in this busy environment.

- Did she understand you?

Yes, she understood me, and we continue to contact her, she supports our developments at the level of the Ministry of Health, and this helps us a lot.

However, here too you have a leadership position, and quite a responsible one. Isn't there a lot of turnover here?

In this sense, everything here is organized very well. I was given the opportunity not to engage in routine activities. I do strategic work. I am learning how to work in outpatient departments. This is a new direction for me. But my main task is strategy, and therefore there is time to implement ideas, bring them to the desired condition, patent them and get results.

- What developments seem most relevant to you?

We have long wanted to bring to life a new type of rehabilitation complex, and in November 2017 we opened it. This complex is our attempt to bridge the gap between the patient’s condition when we discharge him and when he ends up at home. Since we have been engaged in home rehabilitation for a long time, we have seen over and over again: what the patient could do in the hospital, suddenly stops doing all this at home. He refuses to get up, walk, and do some things that he clearly did with us. And the following happens. When a person gets sick and ends up in a hospital, especially in such a difficult situation as a stroke or traumatic brain injury, everyone there helps him. And it is right. But you get used to it very quickly. And you get used to it, not even in terms of the fact that you want to be a dependent, but in terms of the fact that you can’t do something, say, put on a shirt - nothing, they will help you. And this moment was missed. So they lifted him up, stood him up, and he walked away. But we are close all the time. Doctors, nurses, relatives, staff. And a person gets used to the fact that he will always be helped. But then he finds himself at home - and there he is faced with a whole series of things that he does not understand how to do on his own. We needed a complex that would bring us as close to reality as possible. Yes, it's a simulator. But this is reality, recreating situations close to life. We tried to take into account all the situations that a person may encounter when he finds himself at home, on the street, on public transport, in a store, etc.

- Where did you start?

We started with clothes. Indeed, when we help a patient get dressed, we cannot understand what is wrong with him. Therefore, clothing is one of the main tasks.

In this case, the instructor and operator are behind the glass. They see him. They can come to the rescue at any time. This is a 100% safety guarantee. But they are not nearby. The patient does everything himself. And this is extremely important. We have a special fixation system, but, nevertheless, he must do everything alone.

- How much time do you give to complete the task?

We look at the time and if we see that within, say, three minutes a person cannot put on a jacket, then he will not bother for an hour. We understand that he is not succeeding, and we begin to work through the task together with the instructors. We change the task parameters.

Often we cannot understand what is happening in the brain of a sick person. Even a healthy brain can’t figure it out. It seems to us that everything is fine, but before going home, he must first select the things he needs on the TV screen. By completing this task, we understand how he copes with the tasks of recognition, recognition, what a neuropsychologist should pay attention to, because we are releasing him into life, and he must be able to navigate it independently. After all, if he cannot understand something, he begins to withdraw. First there is aggression - then he hides in his “shell”. “I’m not going anywhere.” - "Why?" - "Will not go". And we promote them with the help of psychologists and psychotherapists. It turns out that we must teach them to understand what is needed for taking a shower, for going to the store, for cooking.

- In your complex, considerable attention is paid to virtual reality. But it will not replace life.

Yes, everyone is really into virtual reality now. But if he presses on the wallet on the screen, then in real life he will not recognize it. Because he was taught to put pressure on his wallet. Therefore, our second task is to choose the right items. He did it. But in real life he is helpless. Therefore, the door opens on the screen - and he goes out into real life. This is an imitation of a store where there are real, real items: a carton of milk, a can of peas, bread, butter, cheese. Or a pharmacy where he needs to buy medicine. Or just a walk. What's the weather like there? Should I take an umbrella or not? He must provide for all this. This is all a complex of various tasks, which is a “smart” rehabilitation room. Yes, this is not an apartment or a store, but it is a construction set that simulates a number of tasks that it encounters in real life.

- What else is important?

Sounds. We don't pay attention to the fact that the hospital is quiet. A person in a hospital is focused on walking, on completing tasks. And then he finds himself at home - and suddenly withdraws. We begin to communicate with relatives, find out when the short circuit occurred, and it turns out that he went outside. And there is the noise of cars, barking dogs, voices. He turned and left. Because we haven't trained him to respond to sounds and concentrate despite this. That is, he performs his movement, although there is noise around him.

We began to understand the reasons for our patients' falls. The thing is that at the first stage of rehabilitation we teach you to look at your feet. And when he goes out and is distracted by something, he forgets about his legs. And he was used to feeling support under his feet. And the task of this “smart” hall is this: a certain image appears in front, and here he slowly walks along the path and at the same time completes the task. We need to count how many red cars passed in front of him. He must forget about looking at his feet. And when we layer all the layers of reality on top of each other, we understand what we were missing.

- Which task was the most difficult?

One of the most difficult tasks, as it turned out, was the escalator. And specifically getting off the escalator. Do you understand why?

- Lack of support?

Yes. The path is over, there is nothing to hold on to. And he falls. Getting off the escalator turned out to be the biggest problem for patients. And in Moscow, for example, escalators are everywhere - in the metro, in shopping centers. And they were simply afraid to go to them. This problem also had to be solved. We specifically removed the support of the simulator so that patients could remain without it. And they didn't fall. We teach them to maintain balance. Gradually they stop being afraid of this, although at first there is panic.

- What about the entrance to the bus or tram?

They don't think about it at all. And when we started asking the patients’ relatives, it turned out that this was a whole problem. Where do they put the stick when they have to get on a tram or bus? He has paresis, his arm doesn’t work well, his leg doesn’t move well, but he walks and is active. He needs to go to the pharmacy or to the store. And then he approaches the tram. The wand is in his left hand. With it he grabs the turnstile. The stick falls. He is lost. Trying to lift her... That's it. The tram has left. Or they pick him up and lift him onto the tram. But this is not very pleasant for him either. Next time he won't get on the tram.

- How to solve this problem?

We teach him: the cane can be hung on the other, poorly functioning hand. You can hang it on a coat button. There are different options, and they also need to be worked out. There is no need to be ashamed or afraid of anything - everything can be learned. You hang the stick on your sore hand, pull yourself up with your healthy hand, get up, take the stick with your healthy hand - and go about your business.

- Have you foreseen everything or are you constantly discovering new unsolved problems?

In the course of work, new and new problems constantly emerge that we must learn to solve. Let's say different types of surfaces. Slippery, rough. A person may fall because the street is slippery. Or is there paving stones there - how to walk on them? We teach him to navigate and decide how to behave in a given situation. Don't be shy, don't be afraid of it.

We were at the opening of the “smart” hall four months ago. We talked with the first patient, who seemed to be a very positive person. Time has passed. Is it possible to draw any conclusions?

You know, after classes in this room they all become much more positive. We are very pleased with this effect: it means that the patient realized that working in this room means another step towards a normal life. Many of them could no longer imagine this. But it happens. They overcome phobias and fears and learn to live fully. Then such a patient breaks out of the corridor space into the space of real life and realizes that it continues to work. There is a feeling that life is getting better. And before it often seemed to them that life was over, they were simply living out their lives.

- The patient I spoke with suffered a stroke four years ago. This also seemed very unusual.

What’s even more interesting is that all these four years he did not take public transport. He went out into the yard, walked, but did not approach the stops, because he did not understand how he could go somewhere.

- And now?

Now he travels almost every day. We continue to contact him, as we do with other patients. A person lives an active life, takes care of himself.

What also seems incredibly important: he underwent rehabilitation completely free of charge. In a private clinic. And not only him. It turns out that there is a certain government program under which people who have suffered a stroke and have disabilities can undergo rehabilitation for free, even within the walls of a private clinic, which is MEDSI.

The program we are talking about is currently only valid in Moscow. This is a program of the capital's Department of Social Protection, and this is an extremely important thing. At MEDSI, about 300 people underwent rehabilitation within the framework of this program this year alone, and several thousand in Moscow. This is a large-scale program that is developing, expanding and producing amazing results. We work with adults, but there are huge programs for children. These include exercise equipment, rehabilitation centers, and sanatoriums. A very large-scale work that is actually being carried out in Moscow. In other regions there is no such systematic work yet. But this is a huge support both for the person himself and for the family.

- What are your future plans?

Our next topic that we are currently working on is that, within the framework of free rehabilitation under compulsory medical insurance, we want to make it as full of procedures as possible. Limited tariffs cannot give a person everything he needs. We are trying to solve this problem with the help of simulators, computer programs, and modern digital technologies.

An incredibly important topic now is public-private partnership. MEDSI shows us an example of a successful example of this kind. After all, people for the most part do not know that it is possible to undergo free treatment in a commercial clinic.

Many are surprised that this is so.

But most don't even know. However, it turns out that there are a number of programs within which this is possible. In what other areas does MEDSI cooperate with the state?

Patients with acute coronary syndrome, endovascular surgery, stenting, oncology and chemotherapy, joint replacement, some surgical and gynecological operations, which are quite complex and high-tech - we do all this within the framework of the state program and at the expense of the state. We can and should do this, talk about it so that people know and are not afraid to come to us.

- Are there any obstacles and problems in this direction?

Undoubtedly. Rehabilitation of seriously ill patients in intensive care units is a “black hole” of our medicine. Nobody wants to take on such patients, because it’s a cheap rate, but very hard work. Constant care and very specific procedures. It is easier and more profitable to take a person for an operation. Much in organizing such work depends on the combined efforts of enthusiasts and regional leadership. An example of effective interaction is the Clinical Brain Institute of Yekaterinburg, headed by Professor A.A. Belkin, the highest enthusiast and professional.

- We wrote about the Clinical Institute of the Brain.

Yes, but there are only a few such examples. In most cases, no one wants to do this for the reasons I mentioned.

At the same time, it is important to understand that rehabilitation is not just about helping people who find themselves in difficult life situations. You return them to normal life, give them the opportunity to work, do housework, and not be a burden to themselves and others.

Yes, that's definitely true. Rehabilitation is now in great demand all over the world because we see the results. No one would pay so much attention to this if it were otherwise. I remember well the time when it was not very clear to us why complex neurosurgical interventions were performed. Doctors saved a man’s life - and left him in a condition requiring constant care. The concept of “rehabilitation” did not exist then. Now a real revolution has taken place here. We have learned to rehabilitate the most severe patients after strokes and heart attacks, after oncological interventions, chemotherapy and radiation therapy, total joint replacement, and this is not just caring for people who cannot be left to their fate. We have learned to give them back to society.

Conducted the conversation Natalia Leskova

Academician, professor, doctor of medical sciences Konstantin Viktorovich Lyadov will head the MEDSI Inpatient Cluster. Previously, since 2006, Konstantin Lyadov served as director of the Federal State Budgetary Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation.

Konstantin Viktorovich Lyadov was born in Moscow in 1959, graduated from the First Moscow Medical Institute named after I.M. Sechenov. Since 1997, he worked as the chief physician of the Moscow Central Clinical Basin Hospital, later as director, executive director of the National Medical and Surgical Center named after. N.I. Pirogov. Konstantin Viktorovich is a member of the working group on cardiac rehabilitation of the European Society of Cardiology and the editorial board of the journal “Bulletin of Restorative Medicine”, the author of more than 300 scientific articles and 12 monographs. Academician K.V. Lyadov is a leading expert in the rehabilitation of patients after stroke and myocardial infarction with damage to the musculoskeletal system and the rehabilitation of patients with injuries. He is rightfully considered one of the pioneers of introducing new modern technologies in rehabilitation.

At MEDSI, Konstantin Lyadov will develop the MEDSI Inpatient Cluster project, which will include the Clinical Hospital in Otradnoye, the Otradnoye Sanatorium, the Clinic in Shchelkovo, the Clinic in Stupino, the Clinic in Krasnogorsk, the Clinic in Otradnoye, the Clinic in Mitino, and the Ambulance Service. help, Polyclinic on Solyanka. The successful implementation of the MEDSI Inpatient Cluster project will allow the company to strengthen its position in the market for the provision of outpatient, inpatient and rehabilitation services.

Together with Konstantin Lyadov, a strong team of specialists from various fields of medicine came to MEDSI, including Professor, Doctor of Medical Sciences Tatyana Vladimirovna Shapovalenko, chief physician of the MEDSI Clinical Hospital in Otradnoye, who previously held the position of Deputy Director for Medical Work of the Federal State Budgetary Institution "Treatment and Rehabilitation Center" » Ministry of Health of the Russian Federation. Tatyana Shapovalenko is the author of numerous publications in domestic and foreign medical publications on the issues of restorative medicine and medical rehabilitation, and is also known as the presenter and chief physician of the series of television programs “Give Yourself Life” on the Rossiya TV channel, dedicated to a healthy lifestyle.

“The arrival of specialists of this level to the MEDSI team will allow us to expand the company’s competencies, combine all stages of medical care and strengthen the direction of medical rehabilitation,” said Pavel Bogomolov, medical director of Medsi Group of Companies JSC, Candidate of Medical Sciences.