Boris Mendelevich: ‘Let’s be honest with our people!’

How the doctor and patient can agree with each other

In his column in Realnoe Vremya, Deputy of the State Duma of the Russian Federation from Tatarstan Boris Mendelevich wonders how to ensure that people are satisfied with health care and doctors don’t complain about patients’ rudeness and inadequate behaviour.

Russians’ satisfaction with the quality of medical services is just 38,7%

The quality of medical care is crucial in health care. Of course, we can build new hospitals and polyclinics, purchase the up-to-date equipment and the latest medication… But, unfortunately, we won’t be able to achieve the most important thing — high-quality medical care — that means the population’s satisfaction with our health care only by pumping in money. And it is the key criterion of evaluation, moreover, of not only doctors but also deputies’ performance.

For instance, I can provide such numbers. According to the country’s Ministry of Economic Development, Russians’ satisfaction with the quality of medical care in 2018 totalled just 38,7%, moreover, this indicator fell by 1,2% compared to 2017. What are the reasons? Do authorities pay so little attention to the sector? Is medicine still miserable and financed as a residual?

In fact, it's not all bad. Now a lot is being said about health care, this sector under the scrutiny of the country’s leadership. I’ve been in medicine for over 35 years and I can responsibly claim that the state has never paid so much attention to Russian medicine. For instance, look at the well-known national project Health Care: 1,725,9 billion rubles are allocated for it. Also, Vladimir Putin tasked with creating the programme Improvement of Primary Health Care with about 500 billion rubles and the president’s order On Health Care Strategy Development through 2025 and so on.

No understanding

But a very uneasy dilemma arises here: how to save quality in quest for paces and at the same time increase the population’s satisfaction. Because if we study surveys more carefully or ask patients ourselves, it will turn out that people, as a rule, are dissatisfied not with diagnostics and treatment but service — waiting time, sultriness in the corridor, insufficient politeness of the medical staff, etc. What is more, not all patients have exemplary behaviour. According to a survey of doctors online conducted by RNC Pharma analytic company and Doctor at Work social network, 63% of doctors have faced patients’ inadequate behaviour, another 32% have seen rudeness.

What is the problem?

The case is that, in my opinion, we (I mean the state in general and the medical community in particular) don’t speak with people the same language. At times, there is no dialogue as such at all.

If we develop this thought further, today we need a social agreement, a social pact very much today: the state and the medical community are on one side, the population, that’s to say we, potential clients, are on the other. We should come to an agreement so that everyone will have clearly formulated rights and duties that are formulated in a no less clear way.

Who owes whom?

As a deputy, I think that the state must fully guarantee the population a certain package of free medical care. Most importantly, the borders of these guarantees must be clearly formulated. In other words, how much medical care the state is ready to provide free. Let’s be honest with our people!

The medical community (doctors, nurses, attendants) in turn must fully provide a person with due medical care and in accordance with fixed standards and clinical recommendations. But medical workers themselves must be fully provided with all necessary social guarantees, security and a decent salary.

I actively work in this area together with my colleagues: I create a bill on compulsory insurance of professional responsibility of all medical workers and agree on it with all related ministries. In a word, any conflicts that arose when medical care was provided in Russia fall on doctors’ shoulders. And it turns out that people who must save your health and save lives become participants of trials whose number grows year after year. In addition, the interest of law enforcement agencies in doctors’ activity grows year after year. And here doctors as well as the medical staff turn out in quite a not simple situation. Now we are doing our best to make sure with time when making life-changing decisions a doctor will think, first of all, the patient’s life and health, not about how to protect himself from prosecution. But I want to especially note that apart from the right to timely and high-quality medical care, people must have an important commitment — to care about their own health. I am deeply convinced that we won’t be able to achieve considerable changes and improvements in Russian health care without people who care about their health. A person can’t lead an unhealthy lifestyle, ruin his health and go to see doctors and require them to treat him when natural consequences appeared. Everybody must be responsible for one’s own health. And this must be a postulate.

In conclusion, I will note that no matter how we criticise it, health care is at the peak of relationships between the state and the population. And not only people’s attitude to medicine but also to the state in general depends on how good these relationships will be.

By Boris Mendelevich