Otitis

Maternity clinic or paid doctor: choose your option. “Punitive gynecology? I haven’t heard”: interview with the head of the antenatal clinic. What are the good doctors in the antenatal clinic?

Gynecologist is a doctor who monitors the condition of the female genital organs, as well as identifies and treats diseases characteristic only of the female body. Very often, his area of competence includes obstetrics - monitoring the dynamics of processes that occur in a woman’s body during pregnancy, and the condition of her genital organs at this time, as well as in the postpartum period. To determine the objective condition of the genital organs of the youngest patients, a visit to a pediatric gynecologist may be necessary.

The examination, as a rule, begins with a conversation, during which the doctor finds out whether the patient has any complaints and measures her blood pressure. First, the gynecologist will examine the external genitalia and the development of the woman’s mammary glands in order to timely identify possible pathologies. If necessary, the gynecologist can refer the patient for additional examination to a consultation with a mammologist (a doctor who specializes in diagnosing diseases of the mammary glands) or for a mammogram. Then the examination will continue on a special gynecological chair.

A mandatory procedure during a visit to a gynecologist is taking a smear for analysis. Moreover, such a smear will be taken from a child or a young girl only from the outer labia. The doctor examines virgins through the anus, inserting a finger there and feeling the internal genital organs. Women who are sexually active are examined using special mirrors. Such mirrors can be either metal or plastic (disposable). This way the doctor can see the condition of the cervix and assess the vaginal environment. Next, the gynecologist, using rubber gloves, enters the vagina and palpates the pelvic area, determining the condition of the genital organs located there: the appendages (they are also sometimes called the ovaries), fallopian tubes and uterus. At the same time, the doctor takes a smear from the cervix for analysis, the result of which can be found out in a few days. If necessary, the gynecologist can send the patient for an ultrasound examination of the pelvis.

How to find a good gynecologist?

A good gynecologist is a doctor who will help diagnose and solve the problem in the shortest possible time at minimal cost. The experience of patients who have already been treated by this doctor will help you in choosing the best doctor. Carefully read reviews about the doctor, his experience and specialization.

We ask all patients who make an appointment with a gynecologist on our portal: “Would you recommend this doctor to your friends?” This indicator is one of the most important when forming a doctor’s rating. Therefore, we can safely recommend doctors with maximum ratings and a large number of positive reviews.

Obstetrician-gynecologist, ultrasound diagnostics doctor at the Mother and Child clinic South-West. Published in the magazine Rody.ru No. 2-2017.

Where is the average expectant mother seen? At the antenatal clinic at your place of residence. And here she often immediately becomes somewhat dependent on this medical institution: she is assigned to a doctor according to her place of residence, she has to go to appointments frequently, and all the time she has to take a bunch of tests and undergo various examinations. Moreover, all this must be done within a certain time frame specified by the doctor, and God forbid you miss any of the appointments or consultations! Yes, examinations during pregnancy are necessary, but you also need to remember about your comfort and your rights. Let's talk about what the expectant mother has the right to in the antenatal clinic.

WATCH ANYWHERE

According to the legislation of the Russian Federation, a pregnant woman can choose any antenatal clinic (GC), and not just the one to which she is attached at the place of registration. This means that you can live in one area of the city, and be observed in a completely different one: for example, near your place of work or simply in a antenatal clinic that you like better. Moreover, you can register for pregnancy even at a antenatal clinic in another city. The main thing is that you need a compulsory medical insurance policy, valid throughout Russia. To register at a antenatal clinic other than the place of registration, you need to write an application addressed to the chief physician of the consultation, bring the original and a copy of your passport, compulsory medical insurance policy, and SNILS insurance certificate.

And even if for some reason you stop attending the antenatal clinic and go, for example, to a private clinic or simply don’t go and that’s it, no one has the right to deregister you from the housing complex. And at any time you can return to your consultation and continue to be observed there.

CHOOSE A DOCTOR

Also, according to the legislation of the Russian Federation, you can choose a doctor who will monitor your pregnancy, or change a doctor who, for some reason, was not suitable for you. To do this, you also need to write an application addressed to the head physician of the residential complex.

And of course, every expectant mother in a antenatal clinic or maternity hospital has the right to read her medical record or birth history, and look at records of examinations performed. And you don’t need to explain why you need it, it’s enough that this is your map and your research. If you do not understand why you need some kind of prescription or analysis, then the doctor should explain everything in an accessible form.

REGISTER FOR ANY TERM

You can register with the antenatal clinic at any stage of pregnancy. True, in a very short period of time, neither a doctor nor an ultrasound will be able to accurately confirm pregnancy, so it is still better to register after the 6-8th week. It is at this time that the doctor will be able to reliably establish the fact of pregnancy during examination.

There is another recommendation - to come to the antenatal clinic before 12 weeks of pregnancy. This is due to the fact that the first is done at 10–12 weeks and at this time the gestational age can be most accurately determined. By the way, those women who register with an antenatal clinic before 12 weeks receive a cash payment called “a one-time benefit for women who register with a medical institution in the early stages of pregnancy (up to 12 weeks).” It’s true that they don’t give you much money at all, but it will be useful to someone.

But all this does not mean that you have to register strictly before 12 weeks. No, you can come at any time (even in the last trimester), the main thing is to have time to take the necessary tests before giving birth.

VISIT AT THE TIME YOU NEED

If you feel well, your tests are normal and you don’t want to go to the antenatal clinic often, you have the right to refuse regular visits to the gynecologist. Just tell your doctor about this, he should respect your decision. Yes, the doctor will warn you that you are responsible for your choice, but he should not intimidate you or threaten to refuse to issue an exchange card. If something like this happens, immediately go to the head physician at the antenatal clinic or contact the health department.

But you need to know that there are studies (ultrasound,) that must be done within a strictly defined time frame, otherwise their result may be unreliable. Therefore, ask your doctor in advance about the timing of some examinations.

SELECT SURVEYS

If you want to do all the examinations you need, you have the right to receive them in full. Each antenatal clinic has a list of tests and consultations required during pregnancy. You can ask your doctor to tell you about them in detail and do everything you need to do.

If, on the contrary, you think that a particular appointment is not necessary for you or is unacceptable to you, you can refuse it. No one has the right to force you to do an ultrasound, screening, or take any medications. And nothing will happen to you for this. Even if you refuse something, you cannot be removed from the pregnancy register or given a birth certificate or exchange card. The doctor will simply record your refusal in the card and write that it was explained to you why this or that study was recommended.

In general, to get an exchange card, you need to take a number of tests at least once (clinical blood test, urine test, smear, tests for HIV, RW, hepatitis B and C) and visit an obstetrician-gynecologist at least twice. The first time you will come for an initial examination and in order to receive a referral for tests, the second time - to enter the examination results into the exchange card. The main thing here is to observe the “expiration date” of the tests.

DO IT AS YOU ARE COMFORTABLE

All examinations in the antenatal clinic are carried out completely free of charge. And even if there is no specialist or there is temporarily no research, you should be given a referral to another medical institution where all this is available. The doctor does not have the right to refer you for any additional paid tests or consultations if they can be done free of charge under compulsory medical insurance.

If you want to do some research yourself for a fee and in another clinic (for example, do an expert ultrasound), then its results must be accepted at the antenatal clinic (and not say that we only trust our tests or specialists).

If you want to be observed in the antenatal clinic the way you need, do not be afraid to talk about your preferences. Calmly and confidently remind you of your rights,your job is to choose what you need from medicine and what you don’t.

The best obstetrician-gynecologist is always nearby

As for the management of pregnancy and childbirth, you need to be especially careful when choosing a doctor. The management of pregnancy, successful childbirth, the health of the mother and the unborn baby depend on his professionalism.

It is advisable to find the best gynecologist before giving birth, whom you can contact at any time. He will become a personal doctor, one who will observe, advise, and carry out research procedures in a timely manner.

From visits to such a doctor, only good memories will remain, and not fears and fear of failure. Pregnancy is one of the best moments in a woman's life. More than half of her future depends on how confident she is in herself and in the doctor.

Among other things, below you can sort the best gynecologists in Moscow by:

rating;
length of service;
cost;
Possibility of home visits.

Many women are familiar with such a medical institution as an antenatal clinic. This is where millions of girls and women of any age go with their problems, concerns and experiences. The Moscow antenatal clinic is a place where hope, faith in the best, and, of course, a health center originate. The huge number of consultations in the capital can cause anxiety in the patient - who can she trust with her problems? You can, of course, ask your friends. But there is a more modern way - contact "ProDoctors", where thousands of women leave their flattering and not very positive reviews about this or that medical institution.

Choosing a antenatal clinic in Moscow is a difficult task. Many girls and women want to find one closer to home, so that the doctors are qualified and the quality of services is at a high level. After all, there can be a lot of reasons for contacting a gynecologist:

diseases;
congenital pathologies;
menstrual irregularities;
hormonal disruptions in the body;
pregnancy;
birth of a baby;
abortions, surgeries, etc.

Not every antenatal clinic in Moscow has an excellent reputation. Using our “popular” rating, you can form your own opinion about the clinic you are interested in and the doctors working in it. Now there is no need to conduct an oral survey of neighbors, girlfriends or acquaintances about where they provide high-quality advice and effectively treat any women’s ailments.

Choosing a antenatal clinic in Moscow

At the beginning of this century, 14 independent consultations for women operated in the Russian capital, 10 in gynecological hospitals and maternity hospitals, 95 as part of medical units, clinics and hospitals.

History of antenatal clinics in Moscow

Medical institutions whose purpose is to provide obstetric and gynecological outpatient care to women when they are pregnant, or have just given birth, or have any gynecological diseases. The very first consultation for women was created by obstetrician A. N. Rakhmanov in Moscow at the maternity hospital named after A. A. Abrikosova. This maternity hospital was built in 1906 at the expense of the philanthropist Abrikosova. Nowadays it bears number 6 and is located on the second Miusskaya street. By 1923, 21 antenatal clinics were already functioning in Moscow. Since 1925, social and legal (formerly legal) offices in antenatal clinics began to be created.

At the beginning of August, Afisha Daily published the text “,” in which the patient, who is also the editor of this site, shares her bewilderment about the trials pregnant women go through in such institutions. We decided to continue the topic and give the floor to the doctors: the head of one of the Moscow consultations agreed to answer our questions.

Irina Bolosheva

Head of the antenatal clinic at the City Clinical Hospital named after. E.O. Mukhina

- How did the reorganization of Moscow healthcare affect antenatal clinics?

- Tricky question. There are several aspects to the introduction of a unified medical analytical system (UMIAS). On the one hand, this is a very convenient thing: a person can make an appointment with a doctor via the Internet, change the appointment time at any time, and there are SMS notifications. But, on the other hand, the time is now strictly regulated so that there are no queues. For us it's 15 minutes. And given our specialization, this causes certain difficulties. This is contrary to the federal order of the Ministry of Health, which sets out the approved standards of time that must be spent on each patient.

The number of examinations and tests that need to be commented on has increased, because women are worried, especially pregnant women - for some reason their level of anxiety has increased today. He reads something on the Internet, but we need to dissuade him and explain. But now there is no time for this, and people want communication and judge the doctor based on its results. What opinion will be formed about the doctor and his attitude towards the patient if he writes all the time without ever looking at the patient? But the doctor, in fact, is also obliged to fill out documentation, examine, conduct examinations, perform various manipulations - for example, install a spiral.

- Of these 15 minutes, how much time does the doctor spend on paperwork?

- There are a lot of papers: maps, documentation, various magazines. But if there is a well-trained midwife or nurse, then in principle the doctor fills out only the patient's medical record.

- How much does a doctor in a antenatal clinic earn on average?

- It all depends on the workload, on the length of service, on the category. There are doctors who are on duty a lot and take overtime - this is paid in a completely different way. Basically, our doctors of the highest category earn from 30 to 40 thousand. Considering that the cost of living is about 16 thousand per person in Moscow, and doctors are family people, there are also nurses - divorced women who drag the whole family down. At the same time, the doctor has a shift schedule - on the evening shift you work until 8, and the next day you have an appointment at 8 am. In everyday terms, this does not suit many people: there is no one to pick up the child from kindergarten or school. Well, in terms of psychological stress, the work is difficult.

- What motivation then does a doctor have to work in a public institution rather than in a private one?

- Our motivation is not financial at all, that’s clear. As the employees themselves say, they are satisfied with the manager and the team is very good. And this is a very important thing. This is probably why people work for 20–30 years. For example, I have been working here for 29 years.

- How many young specialists have come to you over the past 10 years?

Three specialists.

- What is the average age of doctors?

From 40 to 45 years, but this is on average. Because two doctors are about 30 years old, 30% of doctors are already about 50 years old, and the rest are about 40 years old.

By and large, the doctor’s rights are not protected in any way, even though this is the 21st century

Patients sign an informed consent that everything was explained to them, but they are not given any information - neither about the purpose of the document, nor about their state of health or treatment.

This document is signed upon your first visit. What is it? You agree to be observed in this institution, by this doctor, who will provide you with primary medical care, including examining, examining and prescribing treatment. You give permission for medical intervention (even ordinary procedures like ultrasound and cardiotocography are considered as such). I understand that it may be a formal approach to require consent in advance. On the other hand, this does not oblige the patient to anything. And if he does not want to take certain medications or undergo an examination, if he goes to consult with some other doctor - now this is fashionable, this is not forbidden. The patient has the right to change the doctor, and I always cooperate in this matter. Although often a woman simply has an initially biased attitude. Either I read some reviews, or my neighbor said something.

- Does it happen that a doctor refuses a patient?

- Of course, sometimes patients come to me directly with the doctor, and he says: “We agreed to separate by mutual consent.” But this is a rare case.

By the way, we asked lawyers: “The patient has many rights, but what rights do we have? Is it possible to refuse a patient, knowing that we will not be able to reach an agreement if she does not trust me?” They didn’t answer anything concrete. By and large, the doctor’s rights are not protected in any way, even though this is the 21st century. True, Federal Law No. 323 contains a very interesting phrase: “The patient can choose a doctor with the consent of the doctor himself.”

Many women complain that antenatal clinics do not explain anything to them, and doctors perceive questions as a personal insult. What to do about it? Where can patients get information?

For example, I always explain if I have time. Sometimes I have to dissuade people of things that the doctor could not dissuade. I can explain for half an hour, but you must understand that during an appointment with a doctor you don’t have as much time as I do. When they complain to me that the doctor doesn’t say anything, I ask: “Bring me your card. I'll explain." 9 times out of 10 I say: “You should be happy that everything is fine with you and there is nothing to explain to you.” But people are not satisfied with this; they need to explain every point. And this is normal, you need to communicate with the patient. The doctor must also be a good psychologist. Calm down, understand, explain. All this subsequently goes into the stage of trust or distrust, and therefore effective treatment - whether the woman tells you anything about any symptoms or not.

Do you know that 93% of patient complaints are unfounded? This year there was not a single substantiated

- Are there any complaints about disrespectful treatment of patients - sometimes they get personal, for example?

- We have all been working together for a long time, and I have been leading the consultation for almost 10 years, so I know what and from whom to expect. I can say for sure: the general level of culture, humanity, and simply self-respect will not allow us to treat a patient this way. We employ intelligent young or middle-aged women. Even the reception and wardrobe workers are praised in our consultation.

- Do you keep statistics of patient complaints? What are the main complaints about?

- Each complaint is monitored by the deputy head physician for clinical expert work and always finds out whether it is justified or not. I collect explanatory notes for all requests, call absolutely all patients, invite them to a conversation: I have a reception for the population on Thursdays, an open day. For some reason no one comes. I try to meet patients halfway. Sometimes I even take it to my place to observe if they ask.

Of course, sometimes there are complaints - mainly due to misunderstandings. And then, forgive me, now patients are also not sugar. Did you know that 93% of complaints are unfounded? There have not been any substantiated ones this year.

- What are they complaining about unfoundedly?

- I went to do an ultrasound, they looked at me wrong, they pressed me painfully, they didn’t give me a napkin. Sometimes such treatment happens that I feel ashamed for the person.

- What if they really pressed hard?

- Yes, some studies allow pain, especially prenatal screening, when a lot of things need to be measured, the fetus needs to be turned out so that it can be painful. Some doctors will warn you about this, some won’t. The woman does not understand this and may complain about it.

- In this case, do you carry out any work so that this specialist can warn you in the future?

- I think doctors themselves draw their own conclusions after they write me detailed explanatory notes.

- What should you do if you are treated rudely at a reception in a residential complex - they treat you with disdain and get personal?

- I think that the girl needs to change the specialist, because it is difficult to prove this except with a voice recorder. In such a situation, you need to go to the head of the consultation and change the doctor and explain the situation.

- It depends on the manager whether such a boorish specialist will work in the organization or not?

- Unfortunately, the code of ethics is not spelled out in the employment contract. It is not easy to fire a doctor for systematic rudeness. If a doctor accumulates a certain number of justified complaints, a reprimand is first made, then they may be reprimanded and recorded, and so on. The Labor Code is the same for everyone. Another question is what you can try to educate first. Fortunately, I have succeeded so far. Agree, if people regularly complain about the same doctor and it’s a system, it’s immediately obvious. And if I know that the doctor is wonderful, a good person, well, I snapped - maybe I didn’t feel well or something happened at home. We are all human. The doctor himself will understand that he is to blame. You can’t destroy a person for one offense. Our work is no less stressful than that of surgeons.

- Why do you think it happened that Moscow women are afraid of gynecologists and complain about rudeness in antenatal clinics, for example, about being called an old woman? How do you feel about the fact that in Russia free gynecology is called punitive?

- Punitive gynecology? I didn't hear it. Regarding rudeness: if a patient comes to you for help, it is absolutely not the doctor’s place to evaluate her or her actions. For example, this is her desire to give birth at least at the age of 50, and your task is to help her with this, and not to discuss that “you should have had it earlier”, “you shouldn’t have had ten abortions”. We put attitude first. I always say: “Girls, the patient will always note first your attitude, and then your professionalism. Your professionalism is not needed if you don’t have an attitude.”

- In many antenatal clinics, patients are poked. How do you address a patient - “you” or “you” - and how do you feel about addressing a patient using “you”?

- If we ignore the “doctor-patient” gradation, then communication on a first-name basis, this is my personal opinion, as with relatives or friends, brings us a little closer. Of course, you need to communicate in “you,” but, for example, very young women come to me, even younger than my daughter, and then I ask: “Is it okay if I speak in “you”?” Most often they don’t mind. Naturally, in most cases, both I and our doctors try to say “you”; firstly, it is respectful, and secondly, it is correct.

- Why do they still ask pregnant women at their initial appointment: will you continue the pregnancy?

- We don’t ask at all, this is already some kind of atavism. I even forgot about this phrase. In general, I’m used to the fact that everyone basically continues their pregnancy, which somehow faded into the background for me, that it could be different. Nowadays there are many commercial institutions, and pharmacological abortions are widely used. Very few people come to us with such requests. And, again, there is no need to judge anyone, it is the woman who makes the decision.

- Does the child’s father have the right to attend consultations in the housing complex? Or other relatives?

- Pregnant women sign a document on non-disclosure of medical confidentiality, and if in it they indicate all their relatives to whom they trust information about themselves, please let them be present.

- How often do residential complex employees improve their qualifications?

- This is officially prescribed by federal laws. Each doctor undergoes advanced training once every five years, and this is monitored by the HR department. This confirms or increases the doctor’s category. Each head necessarily has a schedule for the year, which doctors go to study when, and the same goes for nursing staff - midwives. Additionally, many doctors can take some short-term courses.

- By choice?

- Yes, if they are interested in something and have the opportunity to learn. This does not affect the category, but is necessary for professional development. We often go to lectures, conferences, symposiums, conventions, and clinical discussions. We offer internal advanced training courses, including quite rare ones - for example, in hemostasiology or immune treatment.

- Do you select employees based on their qualifications? Or do you motivate them in some other way?

- Fortunately, I don’t need to pursue a personnel policy, because we have an established team. Many doctors and nursing staff have been working here for 20–25 years. Almost all doctors have the highest category, there is one candidate of sciences. 70% of our doctors have two specialties, and they use this in their work. Let's say, an obstetrician-gynecologist and an ultrasound doctor, a hematologist or an endocrinologist. This is a very rare combination.

Employees are motivated to learn only by personal desire. In terms of money, you can suffer just because of the category, but not much. There is such a thing as the image and reputation of an institution, and we work for them. Nowadays life happens on social networks, so a person, before coming, carefully studies who works, what reviews, what ratings.

- It turns out that according to the law, a woman can choose any institution to which she will be assigned, regardless of her registration?

- Absolutely right. Most antenatal clinics in the city are located at clinics. We work at the perinatal center - and this is a very rare, exclusive case. Since February 2016, the Moscow City Health Insurance Fund, which issues policies, has provided two letters of recommendation, according to which you can now attend any consultation by simply writing an application, without leaving your clinic.