Translated material
Under the cover of Hippocrates
Ask any Dagestani how he feels about people in white coats, and you will hear in response the signature phrase: “I don’t trust our doctors at all.” It turns out that either the distrustful people have gone away now, or there is no smoke without fire: people either had to convince themselves, or from the sad experience of others, of the abilities of local healers.
What is noteworthy: before, under Soviet rule, doctors were sacredly believed. Today, with a fairly high level of equipment in medical institutions, the number of “non-believers” is only growing.
“You pay them, and you follow all the instructions, but it doesn’t get any better,” a client of one of the capital’s paid institutions with a very encouraging name complains to me. In order to get pregnant safely, a patient at the clinic spent a long time being treated for all sorts of female ailments, and seemed to have recovered, but that was not the case. It turned out that the husband had to be treated first. In search of the best doctors, the couple visited all the highly and not so advertised urologists-andrologists, but they could not identify the cause of his infertility. But there were a lot of recommendations: one of the Dagestan luminaries even wrote out, naturally not for free, a miraculous recipe that some rural healer would envy, consisting of nuts, honey... (and I won’t say further, it’s a company secret). But alas, the recipe did not work, angering the already dejected couple. And if it took them 2 years not to find out the reasons, then in the case of my other interlocutor Oksana, it took 4 years to find out the reasons for her “chronic miscarriages”. We dug into endocrinology, and the cause turned out to be gonorrhea, a gift from my husband. If it had been identified earlier, Oksana would not have spent money on all kinds of consultations and expensive courses of treatment, which were essentially ineffective.
In general, Dagestan doctors show unusual interest in various natural remedies. One of the patients of the Gerontological Clinic, Olga, encountered such a lover of folk remedies in the person of an otolaryngologist (currently not working at this institution). The doctor diligently forced various pills and drops on patients containing natural honey components costing from 250 to 500 rubles. Initially, the patient, suffering from chronic sinusitis, took the medications, but, convinced of the ineffectiveness, she stopped. But the “beekeeper” doctor, who did not want to part with the patient, who gradually turned into a client, diligently invited her to a paid clinic (where he also worked part-time), promising to demonstrate miracles of healing, this time with the help of the latest technologies.
Zaira, who lost her sister, as she believes, due to a medical mistake, does not believe the doctor either. She was diagnosed with liver disease. And while she was being diligently treated, the girl literally melted before our eyes. Shortly before the death of the patient, one of the doctors who was observing the course of the disease had an epiphany, and on his recommendation, the relatives performed a spinal puncture on the dying woman. The result was stunning: blood cancer (leukemia) in a hopeless stage...
Who, to whom and how much?
If previously doctors diligently invited patients to their paid clinic, forming a circle of clients, now they understand: the game is not worth the candle. As one of the Dagestan doctors admitted to me: sometimes there is more benefit from a state institution. In a paid center, only a certain percentage goes to the doctor, but in a public center (if you gain a clientele), you can make good money, of course, by sharing it with your superiors. Therefore, in some antenatal clinics you can observe long lines of people suffering to enlist the attention of a valuable specialist whose name is well known.
“Dagestan doctors have settled down well,” says Raiganat. She moved from Makhachkala to Moscow, where she works as a therapist in a Moscow clinic. There, the doctor doesn’t even think about making a side income. The activities of her Dagestan colleagues under the guise of the Hippocratic Oath make her shudder, to put it mildly. “When I come here, everyone is just talking about money and talking about who gave whom how much for the simplest procedures that doctors and nurses are obliged to perform for free. What then is the point of running supposedly free clinics? It is necessary to draw up a price list and hang it outside the door; what is the point of fooling a patient’s head with insurance policies and fairy tales about free medicine?
Another Moscow colleague of hers decided to move to Makhachkala for family reasons and, in search of work, went to a certain private clinic based on an advertisement. The first question they asked her: “Who are you from?” sounded like a bolt from the blue. “They were not interested in my length and experience at all, it turns out that the vacancy announcement was just a formality,” she was indignant...
By the way, about policies. In any clinic, at the entrance to the doctor there is a notice that if you have a policy, the doctor must provide all services free of charge. The announcement is frankly mocking, because everyone knows that this is not so, and they consider it pointless to complain. After all, no one has canceled the territorial principle (as well as the principle of getting a job and the level of service), and even when the Federal Law “On Health Insurance” comes into force, the patient remains firmly attached to his “native clinic”.
In some private clinics, you can use your policy to get a discount on medical services and consultations. For example, if without a policy a doctor’s consultation costs 500 re, then with a policy it will cost 420 re. An attempt to find out why the policy does not fully cover the costs of private medical services was unsuccessful. Apparently, this is a great secret.
Doctors are also... people
“The main thing is that the specialist is good; if not, then money won’t help,” Fatima is sure. About two years ago she had health problems. Sharp pain appeared in the heart area. The therapist sent me for an ECG and at the same time a FLG. As a result, the heart turned out to be normal, but an x-ray of the lungs revealed suspicious changes, meaning the doctor suspected tuberculosis. Fatima was sent to a tuberculosis clinic, where the diagnosis was not confirmed, and she was sent back to the clinic. The clinic prescribed medications against pneumonia for a course of 10 days. During this period, the girl lost 10 kilograms. Barely dragging her feet to the minibus, she somehow got to the clinic and asked the doctor to put her in the hospital, but heard the answer: you’ll slowly get better, you can go to work. Remembering how sympathetically she was greeted at the tuberculosis dispensary, she immediately went there. And she was not disappointed, the doctor not only listened to her with understanding, but immediately prescribed her broad-spectrum drugs to rule out all options from pneumonia to tuberculosis (with repeated tests, of course).
“I am still grateful to the doctors who work there, they are very attentive and do not take money,” she says with gratitude.
“Well, you see, we treated you for pneumonia, but you should have been treated for the “tube,” the doctor said when meeting with Fatima in her own clinic. Imagine her surprise when she did not find any calcites (traces of tuberculosis) on Fatima’s FLG. Well, it’s okay, and the old woman can get screwed, the doctor threw up her hands... Moral damage, of course, doesn’t count. Doesn't happen to anyone.
– Look at the prices in the markets, how can you live on 7-8 thousand? We are people too, her colleague makes excuses. We have no incentive to work and seek an individual approach to everyone. You know that a doctor who operates on patients with AIDS and hepatitis receives meager bonuses - 367 rubles. at the end of the month?
– Why then did you get such a low-paying job?
“Not everyone has a place in the markets; someone has to work in their specialty,” she answers evasively.
It turns out that what prevents doctors from making a correct diagnosis is not a lack of knowledge, but a meager salary. And doctors demand “gratitude” for medical care from patients as compensation for the same meager salary. It's a vicious circle. But in reality it turns out: they stupidly recoup their contribution for admission to a medical school, for getting a job. Not everyone has the opportunity to open their own private clinics, as a 26-year-old graduate of a Moscow university did just recently. Of course, you can oblige doctors not to combine work in a private and public clinic, you can increase salaries, bringing them to the optimal level, when communicating with doctors you understand that this will not correct the situation, because the problem lies not so much in the place of work and the amount of wages, but in policies of the management of medical institutions based on a monetary approach to medicine. Doctors are just middlemen. And since no one has yet canceled the disease, they will not have a shortage of “hostage” patients.