"Patients to hang yourself right away?"

According to the Deputy Prime Minister of the Government Olga Golodets, an independent rating of oncologists will appear in Russia. It is assumed that it can be used both to identify the best practices and to exchange the experience of leading oncologists of the country. Refined experts believe that in oncology, in addition to the rating, there are much more serious issues that require solutions - from poor -quality diagnosis to inaccessibility for patients with the necessary drugs.

We have no choice of a doctor, since the Law prescribes the precinct principle

In mid-October, the first independent rating of Russia's therapists appeared, which included 500 best district and general practitioners, that is, the primary link in the sanitary service. Deputy Prime Minister Olga Golodets called this study breakthrough and important for the entire population, since it affected areas where more than 80 million people are served. According to her, the best therapeutic practices will become the basis for high -quality service of the population.

The question of the need for the rating of oncologists was discussed at the recently past Council under the Government of the Russian Federation on the issues of guardianship in the social sphere. An informed interlocutor in the government apparatus says that while the idea is at the stage of study, as well as the criteria for evaluating the work of oncologists. However, it is possible that the basis of the new rating will take the developments from the rating of therapists.

We have very few good oncologists, I won’t call a dozen

According to the press service of the Ministry of Health, in 2015, 10 thousand Russians accounted for 0.57 oncologists. The prevalence of malignant neoplasms last year amounted to 2329.8 per 100 thousand people - this is 39.8% more than in 2005 (1681.3). Experts explain such an increase in an increase in the number of diseases and detection, as well as more survival of cancer patients. Every year, according to Rosstat, more than 470 thousand Russians make an oncological diagnosis, each fourth of the sick (24.8%) dies within a year.

The President of the Russian anti-cancer society, the corresponding member of the RAMS David Zaridze says that from the fact that any of the oncologists will be called the best, and someone, on the contrary, the situation with the provision of oncological assistance in the country will not change.

Patients of doctors who did not get into the rating immediately hang themselves?

“We have very few good oncologists, if you ask me to name my names, then I won’t name a dozen,” explains David Zaridze. - This idea with the rating, in my opinion, does not make sense at all. Everyone will vote for their brother-see-director, and it will be some kind of absolute nonsense.

Another famous metropolitan oncologist, who asked not to indicate his last name, also considers the venture with the creation of the rating useless.

- Oncology is a very multifaceted profession. Doctors are engaged in different types of tumors, various methods of treatment (surgery, radiation therapy, drug therapy, palliative therapy). There are oncogynecologists, oncomorologists, onco-headings, and so on, ”he lists. - You can not compare soft and white.

According to the President of the League of the defenders of the patients of Alexander Saversky , in the event of such a rating, the main question arises: and the patients of doctors who did not get into the rating immediately hang themselves, or what to do?

- And what about the doctors themselves? Those who are in the ranking - can they immediately leave in paid medicine? And what's the point? We have no choice of a doctor, since the Law prescribes a local principle, ”says Alexander Saversky.

In his opinion, the rating itself has nothing to do with the quality of treatment.

“Each doctor must treat as part of the standard, and if not, there should be a certificate of non -compliance,” Saversky is convinced.

Human rights activists claim that the regional authorities are pressure on doctors so that they not only do not prescribe medicines, but also do not make some diagnoses. The fact is that the establishment of a correct diagnosis in some diseases, especially cancer, automatically entails the appointment of expensive drugs. At the same time, officials usually refer to the lack of money. But if the patient begins to complain, then the prosecutor’s office and the court, as a rule, take his side.

- It is very difficult to get competent help, for example, in Saratov or Orel. But Moscow is not far from them, so they go there immediately. At the same time, not in any hospital, but in a good hospital - not to every doctor. A good department (equipped and staffed) is a rarity, it is created by a good doctor. The one who knows English and reads modern articles himself writes and delves into everything new, ”says Ekaterina Bermant , the founder of the Alive charity fund, which regularly collects money for the treatment of cancer patients. - At the same time, we do not have an algorithm of action and it is not clear how to act correctly within the framework of free medicine.

Alina herself is a doctor and works in the best regional hospital. Her 72-year-old mother has lung cancer, 4th stage. Alina says that sometimes even her "reinforced concrete medical psyche" does not withstand the entire procedure for knocking out drugs. She considers the rating of oncologists nonsense, because in practice there is nothing to work for the oncologists.

The free drug, which is laid for it with such a diagnosis, was given to us for the fifth month after my mother went metastases

-Mom has been living with the 4th stage for 22 months, she is in good shape, does without drugs, cooks jam, prepares, builds her grandson, and all because I took all the treatment in my own hands-I read all the foreign literature on its diagnosis, consult with the best specialists. Despite the fact that I, as a doctor, knock out everything that is supposed to the maximum for her, and all the procedures are done to her as part of the compulsory medical insurance, more than 1 million rubles have already been spent on her treatment. Every month, we spend from 9 thousand to 70 thousand rubles on medicines, thanks, people help us, ”says Alina. “I would never have been able to give my mother these two years of life, if not for the opportunity not to use cheap generies and not wait for the drugs for years.” I was told by doctors who treat my mother that it is "easier to fly to Turkey for" Alimta "than to knock her out of the dispensary." The free drug, which is laid for it with such a diagnosis, was given to us for the fifth month after my mother went metastases.

The fact that she has breast cancer, Muscovite Svetlana Myltseva recognized in March 2014. And before that, she, who had recently gave birth to her daughter and discovered a strange seal in her chest, did the doctors advise better to express themselves and treated from lactostasis. And as a result, the correct diagnosis was made only six months later, they said that she has a 3rd stage, wait for the operation, and then do “chemistry”.

Friends took off for examination in Israel, where Svetlana conducted a study of the whole organism using PET-KT. And the news turned out to be even worse: multiple metastases in the bones were discovered-in the spine and ribs, that is, it was already the 4th stage, which means that the operation that was planned in Moscow is generally contraindicated.

Since then, it has been regularly checked and treated both in Israel and in Russia. Metastases against the background of taking a new generation of biological products have gone. With money for treatment, relatives and friends help her, collect on social networks . Svetlana believes that oncologists' rating themselves will help little, because the main trouble is a poor diagnosis and inaccessibility of modern drugs.

We have the biggest problem with drugs and underfunding

- Ultrasound is poorly done - they miss a lot of oncology in the early stages. And yet, of course, a huge problem is the inaccessibility of drugs: it took me 1.5 years to knock out the preparation "Beidime" with my disease! And if it can still be obtained in Moscow, then in the regions this is very bad, ”says Svetlana. Only 220-230 thousand spent on medicines. Every three weeks for two and a half years of treatment, until she was given a free "Beidime".

Svetlana missed two tricks of the necessary "feathers" because she did not find money for medicine. The last examination showed that the tumor mutated, and now again I needed an operation.

Hematologist Mikhail Laskov , oncologist, believes that the oncologists' rating would make sense with a developed professional community, and the auditors do not know who they are checked, as they do in England, for example.

- There are blind glasses with a difficult diagnosis that are already dismantled, give to other doctors to check their qualifications, and no one knows either the patient or the specialist who did histology. I can’t even imagine who could do this. Working on the "land", you see that now we have the biggest problem with drug provision and underfunding in this area. It is still bad with the anesthesia of palliative patients and radiation therapy, which is made in the regions on outdated devices. After all, we see extracts, not press releases, ”says Laskov. -On the other hand, it has become better with research, CT-MRI in Moscow, for example, can be done in almost every city hospital, and this is very important for making the correct diagnosis.

The creation of such a registry is about the 127th task

According to Laskov, no less problem with the self -education of doctors. In October, an article on ovarian cancer was published in the most influential magazine in general medicine in the world. The magazine has a metric from which you can find out in which countries the text has been opened and read. English -speaking countries are leading in it - the USA, Canada, Australia and Western Europe. From Russia, according to metric, there were only 30 views.

-The creation of such a registry is about the 127th task in a number of measures necessary for progress in the effectiveness of treatment of patients with cancer. It would be important if we had private medicine and for the implementation of "continuity" doctors would need to know other oncologists (surgeons, radio therapists, etc.). And so the register of doctors will not solve any problem, ”says Alexey Maschan , deputy director of the FNGC Dgoi named after D. Rogacheva for scientific work, director of the Institute of Hematology, Immunology and Cellular Technologies (ISIS).

The main thing now, according to Maschan, is an improvement in the formation of doctors, a multiple increase in the number and qualifications of nurses, equipment clinics with normal infusion technology, the creation of modern hospital infrastructure ("hospitals, not shed-baroil complexes"), revolution in the approach to pain relief and accompanying therapy, and providing normal effective drugs. In addition, state stimulation of the involvement of patients in clinical studies and acceleration of integration of innovative methods of treatment into everyday practice is necessary.

The Department of Deputy Prime Minister said that the idea of creating oncologists is now being discussed, but there is no solution to what it will be.

- The rating of therapists was the first study of the results of the work of doctors built on objective data. He allowed not only to identify the best, but also to determine the pain points. The study of the results of the work of oncologists, also based exclusively on objective data, pursues the same goals. And the choice of this sphere is determined by the fact that the mortality from cancer in the country is great, ”Golodets explained in the apparatus.