"Super competent and able to do a lot". Surgeon Sergei Rybakov explains what makes European family doctors so good

The author is a former deputy head of the Doctors' Alliance (an organisation recognised as a foreign agent, of course), MD, MBA, QMS.

As Russian-speaking immigrants in Europe, we often remember the therapy fondly as the polyclinic who used to come on house calls.

He would rustle up shoe covers in the hallway, wash his hands in the bathroom for a long time, then examine (I would say "service") you/child/mother/grandmother and write out a sick note along with a small sheet of prescription medication. This unnecessary run-around therapist is a complete archaism of the Semashko's Soviet system, weighing it down and hurting it.

Let's break this issue down in detail.

Undervalued service

I am sure you have never wondered how much it costs to call a GP in our own medical health system. If you open the fee schedule and look for this information, you will be surprised, to say the least.

The state pays a man who worked seven years on his doctor's diploma... three hundred rubles (4 euro) per call.

The call begins not at your doorstep but from wherever said doctor is, and ends when they bid farewell to the patient at their flat. Further, there is also the quota of visits that needs to be fulfilled, regardless of whether a visit to the doctor is necessary or not (spoiler: most often it is not).

I'll repeat, because you have already forgotten or simply do not believe me. There is a three hundred ruble charge for calling in a qualified professional.

How much does it cost to call a doctor at home in Europe

Russia: 4 euro (300 roubles)

Germany - 60-70 euro

Estonia - 60 Euro

Netherlands - 45-50 EUR

Poor qualification of general practitioners

Have you ever wondered who comes to you in the guise of a doctor? Whose time might be so cheap that they let them "courier" around the area?

I'm sure you've never wondered what, exactly, a ‘therapist’ should be able to do.

The answer is roughly nothing that a European family doctor can do.

Let's start with simple skills: auscultation - listening to the lungs and even the heart. While working in the Ministry of Health I found out that the majority of district therapists do not have this skill ‘at all’. To clarify, they know how to do it, they even remember what they need to hear from the textbook, but .... they don't hear it or know what it’s like in practice.

Palpation with percussion: no general practitioner can recognise an alarming pathology that requires surgery by probing the abdomen.

Skin examination: no district therapist knows how to differentiate between rashes. I once found out by experience that the therapists cannot tell the difference between an ordinary infected wound and a trophic ulcer (a specific wound, which takes a long time to heal due to the disturbance of blood circulation and innervation, which requires a specific treatment).

Neither the general practitioner nor the paediatrician are able to examine the ear and assess the membrane condition using an otoscope, not only because of inability, but also due to the absence of one in the arsenal of the district therapist.

You simply place electrodes and interpret ECG results - and there you go! In the soviet reality only a cardiologist is able to do it. I have seen how district doctors cannot even detect a distinct ST-segment - one of the most important signs of acute cardiac pathology.

In addition, district doctors do not know how to: draw blood from a vein, give injections, put IVs, venous and urinary catheters; they are unable to do primary pre-surgical - let alone surgical - treatment of wounds. Even their dressing skills are questionable, a Russian general practitioner needs a nurse for that.

The worst thing is that the service of district therapists is not capable of providing life-saving resuscitation even at the level of a first-aid course.

I insist that I am not criticising specific doctors. They, for the most part, are not to blame. I am criticising a stagnant, archaic system.

Clinical Hospital No. 7, Tver
Photo: vesti-tver.ru

I am silent about some specific skills, such as initial gynaecological or ophthalmological examinations. And let me remind you that a family doctor's office may have a gynaecological chair and an ophthalmoscope. And almost all of the above skills are part of the 'must-have' set of European home/family doctors. It's the standard.

"They abuse paracetamol here as if no other medication exists. Or ibuprofen in a more serious case... "Oh, is your arm broken? Just take some paracetamol and rest." (livinginholland.blog)

But this Soviet "specialist" do this routinely: they can give you a medical certificate, write you a huge bundle of prescriptions, half of which will be filled with Arbidol, which he must prescribe by "instruction", because such "drugs" are included in the list of essential and national clinical protocols.

Note that I say drugs given these drugs have nothing to do with medicine due to a complete lack of evidence of clinical efficacy.

The other half of the list will consist of medicinal teas and vitamins, which are not drugs at all, but at best, dietary supplements.

And somewhere in between you can find the NSAIDs (non steroidal anti inflammatory drugs) you need for your condition: aspirin, paracetamol, ibuprofen and others; maybe something symptomatic for a runny nose or sore throat - in other words, all the things any overseas doctor would prescribe you over the phone.

And yes, I know of a huge number of cases where the GP has missed the very obvious symptoms of a serious illness or life-threatening condition.

Telephone consultations

Let me raise the question: 'Why do you need such a specialist with home delivery? ".

Can't you take your own or your child's temperature? Can you not describe the colour and consistency of their poo? Can't you take a picture of the rash on your phone and send it to the doctor? Can't you read the instructions for using a glucose meter to measure your blood sugar?

Most typical illnesses can be treated simply and cheaply. Initial symptoms are relieved by drugs you can buy in your local supermarket.

And if you do need a consultation, you can get it over the phone, as strange as it may sound to our immigrants.

Anything else is a pointless waste of resources.

Primary health care plays an enormous role in the whole structure of Swiss healthcare. In Switzerland about 90 % of all diseases are treated at home and this saves an enormous amount of money by dispensing with the need to call in expensive specialist doctors for any minor detail.

Even saturation, using a pulse oximeter, you can also measure yourself (as many did in covid). By the way, a tip for girls: get rid of your manicure and wash your finger beforehand, otherwise the device will give you a horrifying reading, you will think you are dying, and you will waste another doctor's time.

If a mother calls the doctor because her child has a temperature of 39, she will first be questioned about other alarming symptoms (disorientation, lethargy, fainting, wheezing). Because a high temperature in a child by itself is not uncommon. So you should call and describe the situation in detail. Not  say "help, he's not well", but list the symptoms and answer the doctor's or nurse's clarifying questions in detail.

Martini Hospital, The Netherlands (Groningen)
Photo: martiniziekenhuis.nl

"If a worried mother tells us that her child has a fever, we advise to give a fever reducer and come and see us when he feels a little better," says Monika Naujoks of the Children's Medical Centre Düsseldorf (KiZ). (quotation from DW)

Professional burnout

Imagine a general practitioner who's been running door-to-door with a stethoscope for fifteen years. On-call in the morning, on-call in the afternoon, filling out paperwork in the evening. It's a horribly defective system.

Believe me, professionally there will be nothing left of them in three years. Because they have studied seven years to be a doctor, but works as a courier.

Filatov Hospital no. 15, Moscow
Photo: Igor Ivanko / AGN Moskva

This permanent fatigue and exhaustion will sooner or later affect the patient, and the only question will be what will be the cost of the mistake?

In other words - for your love of house calls because "I think I have a fever", sooner or later either you or another, less fortunate patient will pay the price.

The home doctor in Dutch medicine is like the infantry in the army, the front line, they are the hardest hit. Their qualifications are demanding, and they must also keep up-to-date with medical news, Ministry of Health regulations, commissions, etc. (source: How to communicate effectively with your family doctor in the Netherlands)

Nothing personal

In the post-soviet system, a lot depends on the personality of the doctor or even the personality of the nurse. If we are talking about the health care system, you cannot rely on a specific person - it is very important that you get the same care everywhere.

"I urgently need a good oncologist", "tell me where the best place to treat retinal detachment" - this is hard to imagine in Western Europe.

Treatment protocols, quality of care, availability of medicines, level of specialists - it's unified across the country. This is the "average hospital temperature". The same applies to home/family doctors.

Of course, there are celebrities everywhere - in medicine too. But these are either leaders of entire scientific fields or specialists of the highest level, say Franz Weidinger, president of the European cardiology community. But even in a European country you have every chance of being seen by such a star doctor if you have a proper diagnosis.

Bremerhaven-Reinkenheide gGmbH, Germany (Bremerhaven)
Photo: klinikum-bremerhaven.de

Summary

For me, as a professional with experience in several European countries in addition to Russia, the question of the necessity of such a profession as "district therapist" is very pressing.

Read this text again, when you're next in want to complain on the subject of "I was interrogated for half an hour on the phone, refused to look and again prescribed paracetamol.”

And if you're so sick that you can't make it to the emergency room, you don't need a district therapist, you need an ambulance. That's why the institution of courier therapists is completely useless.

Don't confuse service with treatment and stay healthy.

By: Sergey Rybakov

The author's opinion does not necessarily reflect the opinion of the editors