A medical specialist who has received a Moscow Doctor certificate; a winner of the Best Nurse competition, part of the Moscow Masters professional skills competition; a doctor from the district nursing service; and an orthopedic traumatologist discuss how clinics and hospitals in Moscow are changing, how difficult it is to take part in competitions for doctors and nurses that are organised by the City Department of Healthcare, and also talk about important things for doctors and their patients.
The capital focuses on re-equipping local hospitals which continue to receive new equipment, including up-to-date computerised and magnetic-resonance tomography scanners, angiographs, standard and portable ultrasonic scanners, X-ray machines and plenty more things. Clinics throughout the city are currently being renovated and overhauled, with some of them even receiving new buildings too. The Morozov Children’s City Clinical Hospital is just one example of where a new building of has opened.
Mikhail Petrov: Morozov Hospital’s doctors can treat any injuries and tumours
Head of the Traumatology and Orthopedics Department at the Morozov Children’s City Clinical Hospital
First, I would like to say a few words about myself. I graduated from a medical institute in 2001. In 2003, I completed an internship in pediatric surgery, worked at the Pediatric Surgery Faculty at the 2nd Moscow State Medical Institute, now called Pirogov Russian National Medical Research University. In 2006, I defended my PhD (Medicine) thesis. In 2012, I joined the traumatology department of Morozov Hospital, and in 2013 I became the department head.
It should be noted that by then the Morozov Hospital has been developing actively under the supervision of its head physician, Professor and DSc (Medicine) Igor Koltunov.
The hospital was modernised before my very eyes. We received lots of new equipment, and we learned how to use it. During my first days at the hospital, it lacked any good endoscopic and arthroscopic systems; they were purchased some time later. The equipment we use now is of very good quality. All departments, including our own, started developing after the hospital received substantial support.
A new hospital building opened in 2017, and we reached an entirely new level. We received a lot of the most advanced equipment, as well as revamped operating theatres and diagnostic services. We can now use the latest techniques in the field of children’s traumatology and orthopedics, including the most advanced surgery methods.
Five, seven and ten years ago, children with hip fractures spent three to four weeks lying prone and had their legs extended. Today, such patients undergo low-invasion surgery immediately after arrival. After primary diagnostics, doctors perform operations on incoming children that are not performed in many other countries.
This has become a system. Indeed, this is a major step forward. We have started performing numerous operations on patients with backbone problems in the past three-four years. Today, we operate on patients with any injuries, tumours and deformations. Earlier, we had no technology for doing this. In the last seven years, the system of endoscopic operations has been reviewed. In the past, we performed a small number of practical restorative operations. Today, large-scale restorative endoscopic operations account for nearly 90 percent of all operations. Equipment has made this possible, in the first place.
We receive many patients with combined injuries, including people who have fallen from heights or suffered as a result of road accidents. In the past, they had to spend a lot of time in hospital and often became permanently disabled. Today, such children, including those with head and limb injuries, only spend about 10−15 days here. Most of our patients, including those who were admitted with fractured backbones, long tubular bones and other injuries, are discharged without any complications.
In addition to all this, we can operate on patients with any orthopedic pathology, including banal flat-feet and serious backbone deformations. It takes us about 10−15 minutes to treat patients with flat-feet, but backbone surgery lasts longer. But children who had such deformations become healthy and beautiful. We correct everything, including congenital dislocated hips, various arm-and-leg deformities, and plenty more problems.
As I see it, Moscow’s healthcare system is now approaching European standards, and it has even outstripped them in some areas. Quite recently, I completed a training course at a German clinic, and I realised that the Germans were already lagging behind us by 70−80 percent in many respects. This does not concern equipment alone. To my mind, our healthcare system is developing very well, and we are moving in the right direction.
In 2017, the city launched an ambitious project making it possible to select the best medics. Specialists receive Moscow Doctor certificates and special badges after successfully passing tests and improving their professional skills. Their monthly salaries are also raised by 15,000 roubles.
Olga Khrebtova: Moscow Doctor, a complicated but interesting exam
General practitioner of City Outpatient Clinic No. 46, holder of the Moscow Doctor title
It so happened that I chose a medical institute by accident. Chemistry was my favourite subject at school, but I applied at a medical institute with a girlfriend. I became really interested in medicine in the last years of my studies, and probably even during the internship when I became independent. After graduation I was sent to a rural outpatient clinic. Having worked there for several years, I developed a genuine interest in medicine. Then I moved to Moscow and have now been working in City Outpatient Clinic No. 46 for 18 years. At first I was a GP and now I am a doctor working in the field of my second specialty, which is functional diagnostics, and I also do heart and vessel scans at my clinic.
My colleagues suggested I take part in the Moscow Doctor programme.
“Go ahead, you’ll make it,” they told me. I wasn’t convinced but decided to have a go. It took me three months to prepare for the exam. I used the time I usually spend on public transit going to and from work. I decided not to waste time looking around at people, and I started getting ready for the exam there, because I couldn’t do it in the clinic or at home – I have a small child.
The exam itself proved to be very complicated – the most difficult one in my life. But it was also interesting. I think all doctors should try to take it because if they fail they’ll want to read more medical literature or at least review the materials they failed on.
The exam was complicated but it was fair. I think it was helpful for reviewing my knowledge but also my endurance and ability to concentrate. This is why I would like to thank those who wrote it. They did a good job.
I liked the exam because while preparing for it I had to read a lot of medical journals, recall my past years and our teachers who explained how we should work and what we should do in emergencies. So I focused my skills and knowledge during these preparations and learned new things. Moreover, it helped me clarify what I didn’t know well enough and what I needed to learn and where I had already become proficient. This is all very interesting and essential in my work because it is important to learn new things to help people.
I appreciate that Moscow clinics have upgraded so much equipment. In the past we worked with simpler devices, but now we have ultrasound equipment with new functions. This is great. We diagnose patients faster and then can send them to the right specialists to receive positive results sooner. My colleagues and I, and our patients, are very happy about this.
Computer availability, new programmes and electronic medical records are also very convenient. You can look online without looking for paper files and find out what doctors patients have visited, what they have been diagnosed with and what is happening in general. Queues have disappeared and patients have become more organised. They take a slip for a medical appointment and visit the doctor, knowing they’ll be received at the appointed time. Doctors also feel less stressed – everyone is becoming better organised.
In addition, patients have noticed that it’s easier to receive high-tech aid. A patient visits a doctor; he is diagnosed with a serious problem, sent to a hospital and operated on quickly. In a week or two after the surgery he comes to me and the problem is resolved. The clinic-hospital link has been improved and both doctors and patients appreciate this.
Professional skills competitions are held every year. Winning a competition not only increases the reputation of the winner among their colleagues but also provides material incentive. In May the results of the Moscow Masters competition for medical nurses were announced.
Lyudmila Shabalina: After winning the Best Nurse competition, I understand how children feel during Unified State Exam
She is a nurse at the Bakhrushin Brothers City Clinical Hospital and winner of the Moscow Masters professional competition
I decided to become a nurse, rather than a doctor, when I was only a little girl. I enrolled at a medical school, graduated from it and started working first at a therapeutic department and then at an intensive care unit. My total work record as a nurse is 23 years.
Our intensive care unit employed dedicated professionals, and it was very interesting to work there. Although we faced various problems, we were happy to see patients recover from major health disorders. It is impossible to describe the joy you feel after your team has brought a patient back to life.
My hospital’s management decided that I could represent my department at the Moscow Masters competition. First, I took part in a qualifier for the Eastern Administrative Area and was placed first among intensive care and anesthesiology department nurses. After that, I took part in the city level event.
My colleagues and the chief nurse backed me during the tests. It was interesting and extremely exciting. You know that you are capable of doing what is required, but you feel nervous because it is, nonetheless, an exam. We had to film a special video during the finals. Of course, this task was interesting, but we are not professional actors; therefore it was pretty hard to film it.
In reality, it is really great to test your skills, to hear other participants reply to questions and to become acquainted with your colleagues.
The second round was similar to the Unified State Exam. Now I know how our school children feel when they take important exams. This, too, is quite valuable. Now I know how this happens. The process is rather difficult and you cannot help feeling nervous.
It should be noted that Moscow boasts many skilled nurses in this field. Some of them don’t take part in the event, some have failed at some point, but this does not mean that they are not professionals. I made it to the top and I am proud of my new title.
Senior citizens or seriously ill patients unable to visit outpatient clinics need to be helped at home. The city has established a district city service for providing such patients with adequate care. Local authorities provide incentives to doctors and nurses involved in the project by paying each of them 25,000 and 15,000 roubles per month, respectively.
Tatiana Andreyeva: Our patients are happy when we call on them
GP with the district nursing service of City Outpatient Clinic No. 107
I have been working as a doctor for the past five years. After graduating from a medical school, I received patients and I teamed up with the newly-established district nursing service. Basically, this is the same as when patients would come to us. We never have a dull moment.
We examine and treat patients at home, we keep medical records, write out prescriptions, adjust any treatment whenever necessary and deal with on-duty doctors who are required by patients with aggravated conditions.
Earlier, we received people at outpatient clinics for eight hours each day, and we did not visit anyone at home. Or we called on them very rarely. It turned out that these people’s health condition was not checked on thoroughly.
District nursing allows us to monitor these patients’ condition and to prescribe medication. This considerably improves their treatment. We are doing our best to help with medical-social expertise and disability retirement eligibility documents.
Patients in need are pleased when our district nurses or doctors and paramedics pay them a home visit. About ten patients every day (45−50 people per week) receive medical help thanks to this system.
We are just starting out with our district nursing service and I am confident that our service will expand and improve in the future. Each patient’s case is absolutely unique, and we often need to find out how to keep an eye on any specific patient at his or her home.