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Access to a urologist is possible only after “blind” treatment
Rima, who lives in one of the Lithuanian cities, did not doubt that she would receive help even during the quarantine, but she had to face a completely different reality.
“I lost a lot of weight, I felt worse, my eyes started to swell, so I went to the family doctor. The consultation was carried out remotely: I told you what it is, how I feel.
The doctor prescribed blood, urine tests, and an ultrasound. I said that I would also like to see a urologist, but they explained to me that now the system is such that you must prescribe treatment first, and only if health does not improve after completing the course of treatment, it will be possible to register with a urologist.
Therefore, I have to receive treatment for a couple of weeks as directed by the family doctor, and only if they do not improve, I will be referred to a urologist. And, as he explained, he will prescribe the treatment through a remote consultation. And only if after the prescribed treatment does not improve, can you accept me physically. Maybe some kind of illness is happening, and the situation is such that for at least a month I will just try to get treatment. Maybe it will help you.
Photo by Tomás Preikša / Klaipėda Seamen’s Hospital working during quarantine
A dark lump appeared on the toe. I went again to the family doctor, who registered me for a remote consultation with the surgeon. That’s what I’m wondering, how do I explain it clearly enough on the phone, without examination, what’s going on here?
In such cases, questions naturally arise about how part of the medical staff can physically work and receive patients: performing blood tests, ultrasound and others, second-level doctors, in this case a urologist or surgeon, cannot accept. It would be even more strange when a doctor who works in a private polyclinic clinic cannot receive free in one polyclinic, but can pay a fee in another clinic ”, the interviewee was angry.
According to her, most of the patients complain that now in medical institutions it is a real disaster. I had heard from a family nurse that GPs were going crazy for workloads, and second-line doctors, only accessible after one or a few weeks of remote consultation, had only one other patient per day. “It is absurd what is happening in medical institutions at the moment,” the woman is convinced.
It’s even weirder when a doctor can’t admit you to a polyclinic for free and can pay you at another clinic for a fee.
By the way, a few weeks of waiting is the best case. Some specialists, who had to wait a few months for consultations and quarantine, are now available only in the fall or even December.
Suspected cancer has to go the way of the cross
Vytautas Paulikas of Vilnius, suspected of having prostate cancer during quarantine, says that most of the necessary tests were done only because of humanity, dedication, and non-compliance with the rules.
“By age, I was directed to a prevention program to control my prostate. The urologist found minor changes that made him suspicious. I was assigned an MRI study showing cavities similar to bone metastases.
Then it all started. The family doctor sent me where he could. As soon as I found the doctors, I bow to everyone, they are all amazing, sensitive, immersive. Even if they didn’t have something to do, they still made the move. There were those who offered to help themselves.
I couldn’t say the same about the system. Our medical management is not geared towards making things happen quickly. All tests have been done for me and will still be done only on the initiative of individual doctors. Apparently, when cancer is suspected, doctors simply make a human effort to speed up the diagnosis as much as possible. If they had followed the established order, we would hardly have made so little progress in a month. It would be impossible to register for the consultation yourself, because there are simply no places. I think it would not have fit in two months either, “said the interlocutor.
The man is convinced that poor health management is not just about quarantine, but that quarantine has highlighted it even more. Although when faced with a serious problem, doctors respond sensitively and try to help, people with simpler problems, from what he has heard, have to wait and suffer for much longer.
Why is there a shortage of doctors right now?
President of the Union of Medical Leaders of Lithuania (LGVS), director of the polyclinic document of the Vilnius Center. Dr. Kęstutis Štaras stated that currently the biggest problem in reducing the availability of services, especially in the periphery of the country, where there are not many specialists, is related to the order of the Minister of Health that prohibits doctors from working in several institutions at the same time. weather.
Photo by Irmantas Gelūnas / 15min / Kęstutis Štaras, Director of the Polyclinic Center
“When COVID-19 outbreaks were registered in various hospitals, the Minister issued an order that doctors in different institutions must work in cycles, one month working in one institution, another month, in another. For example, almost all dentists at Žalgiris Hospital they have a private practice and, of course, they are self-employed, which means that the availability of emergency care in the hospital has decreased significantly. It is true later, when it became clear to everyone that more people they could die from other illnesses than COVID-19, this order was adjusted, and responsibility for medical procedures passed to managers.
In our outpatient clinic, we have established a procedure whereby a doctor cannot work the same day with us and in another institution. Of course, if something happened, the leader would still be the culprit. As a result, some managers have banned their staff from working in other institutions, and, of course, patients suffer. Peripheral medical institutions cannot guarantee the provision of services to patients with chronic and other illnesses because they do not have access to specialists. And no one counts how many people die because they do not receive timely advice. The numbers would be much higher than the deaths from coronavirus, “explained the interviewee.
No one counts how many people die because they do not receive timely advice.
The LGVS president said there was no evidence that any institution would arbitrarily avoid updating services without him. According to him, services are not provided just for lack of specialists.
“Clearly, there may be isolated human factor related cases where the patient really needs live consultation and is only remotely registered with a specialist. On the other hand, sometimes the patients themselves increase their symptoms and the doctor evaluates them and interprets them differently, “said the doctor.
K. Štaras assured that only the invasive procedures were completely stopped at the polyclinic under his leadership. After all, to perform them, the patient had to have a coronavirus test 48 hours ago. Other consultations were made, it is true, first the doctor remotely evaluated whether it was necessary for the patient to come.
“Consultations with live specialists are slowly returning. In April, 35% of them were provided at the Centro polyclinic, and in May, around 60%. In the morning, while the rooms are still completely clean after at night, we accept pregnant women, children and later, all the rest.
Still, traffic has dropped. Previously, the doctor could accept 4 to 6 patients per hour, now one or two, because after each patient it is necessary to carry out disinfection, ventilate the facilities. After all, we need to protect both patients and doctors. If doctors become ill en masse, the availability of services will further deteriorate.
Physically, access to the doctor was reduced by approximately 50 percent. However, this does not mean that patients do not receive specialized advice. They get it remotely. Their condition is evaluated and, if necessary, they are invited to come.
Finally, this situation showed the number of unnecessary consultations that occurred when the patient was hurting something and was already going to the doctor. In this case, the coronavirus did a good service, i. and. patients realized that they could also consult a specialist by phone. In my opinion, this form of consultation should even be encouraged and legitimized. It is convenient for both patients and doctors, and also saves money, “said the doctor.
Sigismund Gedvila / 15min photo / Thank you doctor mark at the Santara clinics
How services are provided in polyclinics
Jolita Jakutienė, Deputy Medical Director for Diagnostic and Outpatient Work of the Santara Clinics, stated that although the outpatient services at the institution had never been interrupted, those that could be postponed were postponed. Services have been gradually updated since mid-May, but doctors’ hours are organized in such a way that patients have as little contact with others as possible.
“We have organized the live consultation network in accordance with current physical contact and hygiene requirements, so we have provided far fewer than before. Before each consultation, our staff contacts the patient, finds out if they have a fever, have not been in contact with the patient or has not been away, and then allowed to come. Chaperones can only come if the patient needs help.
Patients who come to a scheduled consultation receive a message, which office and which doctor should they go to. Please save this message on your phone as it must be displayed before entering the outpatient building. In this way, the objective is to guarantee that only registered patients enter the building, because we must all be vigilant.
The patient is also asked not to arrive earlier than 10 minutes in advance. until the scheduled visit. Once the office worker is sure that the patient is scheduled, he goes directly to the office. There is no need to visit the reception, as all documents are ready.
Once we have completed the waiting patient consultation, we will also begin registering new patients.
So the corridors are empty. And while it appears that the doctors are doing nothing, they are actually working hard: reviewing patient records, setting study times for patients so they don’t meet with each other. It takes us a long time to maintain the new order, “said the doctor.
However, there is much more to remote consultation than live. It is first given to those patients who had registered before quarantine. During quarantine, scheduled services were provided only to those at risk of significant deterioration in health. For other patients, consultations were delayed. Right now, everyone is getting in touch little by little and trying to find out what their health is, what complaints they have, what kind of evidence they have, etc.
“Part of the consultation ends there, because it is enough to give recommendations over the phone. However, there are many areas where it is not possible to assess the condition without a live examination, and laboratory or instrumental testing is required. Such patients are invited to In the near future, when we complete the pending patient consultation, we will also begin registering new patients.
All newly enrolled patients will be required to have an electronic reference listing their health status. They will be registered for remote consultation. By viewing the referral information, the physician will be able to decide more quickly on additional tactics, and such consultation will take less time. Now it takes half an hour to 45 minutes for all the data to be clear. In addition, it is currently possible to register only with doctors from those specialties that do not have waiting lists. If a person needed a consultation in March, we must first help them, “said J. Jakutienė.
A similar procedure applies to other primary health care institutions. The Vilnius Antakalnis Polyclinic website publishes:
“Representatives from Antakalnis Polyclinic will contact patients whose visits have been canceled due to quarantine and will register them as soon as possible. Be patient and wait for the call (if you canceled the visit yourself, in that case you should contact the reception of Antakalnis Polyclinic) You will be admitted to the polyclinic no more than 10 minutes in advance until the time of your assigned visit. Upon arrival at the outpatient clinic, your body temperature will be measured and the details of your registration. You must have an identity document and a protective mask upon arrival. “
Photo by Julius Kalinskas / 15min / Saulius Čaplinskas
Negative consequences of pandemic measures.
According to the director of the Center for Communicable Diseases and AIDS, prof. Dr. Saulius Čaplinskas, everyone faces the problem of access to treatment during the pandemic.
“The COVID-19 pandemic could be characterized by the fact that most people will die not from coronaviruses, but from indirect damage, measures taken by governments to stop the pandemic.” All non-emergency services are delayed or severely restricted, from certain operations to sexual health services, smoking cessation programs, mental health support, dentistry, vaccinations, cancer screenings, and routine health checkups .
Focusing on an evil already has dire consequences. Patients around the world are denied care for cancer, kidney dialysis, and emergency transplants, and the results are sometimes fatal.
In the Balkans, women are forced to undergo experimental abortions, and in the UK, human dental self-medication efforts are reported.
In the Balkans, women are forced to attempt dangerous experimental abortions, and in the UK, human dental self-care efforts are reported to use gum, wire cutters and supercles. Researchers have warned that losing control of diseases like HIV, tuberculosis and malaria in some places would be the same as causing direct coronavirus.
Experts fear more people will die of cholera than COVID-19. The World Health Organization has estimated that at least 80 million babies can develop diphtheria, polio, and measles because the pandemic has interrupted vaccination programs in at least 68 states. Polio is believed to be able to return. Finally, it is believed that the global quarantine and the resulting economic crisis could lead to the so-called desperate deaths, as some people resort to alcoholism or commit suicide, “said the doctor on his Facebook account.
SAM: institutions must open doors when they are ready
In response to a request from the Ministry of Health (SAM) for its evaluation of patient complaints about access to services, 15 minutes, indicated by:
“However, it is important to note that we live in an age where modern technologies help solve many challenges. As quarantine has shown, some services provided by medical facilities can be successfully delivered remotely: medications Used by patients, medical devices (MDPs), including reimbursable ones, can be extended without a visit to the family doctor.
This means that physicians can prescribe the necessary treatment, adjust it, and explain research results remotely when necessary. In case the doctor, after consulting the patient by phone or other means of communication, decides that the patient needs a physical consultation, it is necessary to agree on the patient’s arrival at the institution at a specific time, “says SAM’s response.
According to the Ministry, the procedure for medical personnel, according to which they cannot work in several institutions at the same time, is necessary because it ensures that contacts between employees are minimal, in case of infection, contacts between people can be traced infected and thus guarantee the safety of employees and patients. Ensure the prevention of cross contamination.
The fact that only part of the institutions prepared and resumed the provision of services within a month is worrying.
“Both the outpatient clinic and the hospital should open their doors when properly prepared to ensure the safety of patients and staff. The fact that only part of the institutions prepared and resumed the provision of services within a month is worrying. This should not be the case, and one of the reasons for this is likely to be the current funding model. For this reason, decisions have already been made to change the financing model used by the institutions since the beginning of the quarantine, where financing is secured under the so-called twelfth rule, that is. and. when the institutions receive monthly the amount foreseen in the contracts with the territorial sickness funds.
From now on, the twelfth payment model will only apply if the medical institutions are before June 8. it will have started providing scheduled services and will continue in effect through June. This payment system is beneficial for medical institutions, since they can decide for themselves how much to provide and they will receive a twelfth of the payment at the end of the month or, if the service is provided for a larger amount, for all services actually rendered to the patients.
It is anticipated that those medical institutions that have until June 8 will not begin to provide scheduled services, one twelfth will not be paid and will only be paid for the services actually provided to patients, “SAM said in a letter.
According to the ministry’s representatives, when the situation with regard to the availability of services improves, it will depend both on the epidemiological situation in the country and on the efforts of the medical institutions themselves to resume the services provided as soon as possible.
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