People of Action: "A family doctor is a one-man army"
What does the everyday life of a family doctor look like, what happens to young personnel, why are people dissatisfied with the medical reform? Rubryka asked a doctor. We explain how to replace a family doctor. Spoiler alert: it's easy.
Family medicine is the only type of medical care that affects everyone: according to world statistics, 80% of all health issues are now addressed at the stage of general medical practice. A family doctor isn't just a therapeutist with advanced functions. It's a universal specialist, well-versed in all medical problems of each patient, regardless of age and gender. This doctor makes diagnoses, prescribes treatment, refers to specialized doctors or inpatient treatment if necessary, advises on disease prevention, and is also the main lifestyle coordinator and counselor for the whole family. More than 22,000 Ukrainian primary care physicians provide primary care for adults and children in contracted institutions. Among them are 15,155 family doctors, 4,452 pediatricians, 3,284 physicians. At present, 30 million 610 thousand Ukrainians have already chosen their doctors, and on average, there are 1,300 patients per one family doctor, physician, and pediatrician.
Today, May 19, Ukraine will celebrate World Family Doctor Day for the fourth time. Now that the next wave of coronavirus has finally subsided, primary care professionals who've been working in the double-load mode for more than a year will be especially pleased to hear: "Congratulations and thank you, doctors!"
Ruslana Omelianchuk is a general practitioner of the family outpatient clinic №1 of the Center for Primary Health Care №1 in Mykolayiv.
She's been working at the institution since 2017, immediately after the internship.
Ruslana is the youngest doctor of the center, a very energetic, sociable, and exceptional person. These traits, as well as openness, friendliness, ability to work effectively, and lack of habit of complaining, help her keep her hand on the pulse of more than 2,000 patients, keep a personal medical blog, and participate in charitable foundations, study, and travel.
Why are people becoming doctors in Ukraine?
Ruslana decided to become a doctor in elementary school when she was a little girl from the village of Honoratka, Orativ district, Vinnytsia region. "My father often said that he saw me as a doctor. He died when I was 8 years old… So when it came time to choose an educational institution after graduating from school, I had no doubts. Only medical, because my dad wanted it so much! I studied at Vinnytsia National Medical University named after Mykola Pirohov, the best university in our country!"
The path to a dream of six years of study was difficult for Ruslana: "Now I understand that, in fact, the student years were the best, but then everything seemed incredibly hard for me." Every year during the summer holidays, from 2th to 5th year, the girl worked as a nurse in the departments of internal medicine, surgery, and gynecology, on night shifts in the maternity hospital, and had experience working in the ambulance.
"Then there was a division," Ruslana Omelianchuk recalls, "and they decided for me that I should become a family doctor." I studied on a scholarship, and in 2015, 80% of graduates became family doctors. To say that I was "satisfied" with that decision at the time is to say nothing. I wanted to become a gynecologist, I really liked it, I understood and knew gynecology. But we had no connections or money, so the choice was made without a choice."
Internship, or everything as if in a fog
The only thing that the former student was allowed to choose is a place of future work: the city of Mykolaiv or the village in the Vinnytsia region. Without thinking too long, she chose Mykolaiv.
She arrived in an unfamiliar city with two bags, and within a week, began an internship. "I cried for two weeks. I was under constant stress: no acquaintances, relatives are very far away. The salary is 1200 hryvnias. I celebrated my first birthday in the new city alone, by myself."
But it lasted only two weeks. Tired of feeling sorry for herself, the young intern wiped away her tears, mobilized, found a second job, and started working.
"I remember the first month of work was like in a fog," says the doctor. "I went to work and understood nothing. So I asked a lot of questions because family medicine was new to me, and besides medical knowledge, you need to figure out medical documents, which must be properly executed. It's better to ask than to pretend to be omniscient and then, as a result, make nonsense mistakes that take away more energy and time from you and others. The first patient? I remember the first woman I examined in a gynecological chair. And the first patients, as a family doctor, no. I remember that everyone always wanted something from me :-)"
Why people are dissatisfied with medical reform
And then the medical reform began. Ruslana thinks it was easy for her to join it because she didn't work in the old system. She was one of the first to score her 2,000 patients on declarations. What helped recruit patients? In response, she smiles modestly: "I don't know. Everyone was getting new patients, and I was doing it too. I'm an energetic, socially oriented, equable girl who wants to work to gain new experience, knowledge, and skills. I have many ideas and suggestions, easily get across with people, and compromise to achieve a common goal, and believe in myself. And people were able to believe me!" Although a pediatrician has arrived in the outpatient clinic, mothers come to Ruslana with a request to take them with the child under their medical care; it also indicates a high level of trust.
According to the young doctor, family medicine is good, but there's a great shortage of doctors in Ukraine. And because of this, not all people are happy with the reform.
Doctor's weekdays, or how to keep up with everything
Every day 35-60 people come to see Dr. Ruslana Omelianchuk. The working day starts at 8:00 and ends in different ways, "I can be free at 15:00, or I can write a form for a disability evaluation board until 00:00."
Besides her primary job, the ambitious woman manages to study at two universities: Zaporizhzhia Medical University on "Phthisiology" and the National University of Shipbuilding named after Admiral Makarov, "Manager of Healthcare Institution." Ruslana is also responsible for HIV patients at the center where she works. She worked as a teacher at a local medical college for almost two years.
Ruslana continues her medical work at home. She keeps her page on Instagram and Facebook (she's the only family doctor in Mykolayiv who has her own professional blog). She's fond of photography and photo shoots. And Ruslana, as a doctor, conducts online consultations not only for her so-called "contractual" clients but also for others.
"I've been consulting everyone interested online for more than a year. And I'll tell you honestly, you don't always have to go to the hospital! From my practice, 40% of appeals can be resolved by phone. Why did I decide to work here as well? Because training, conferences, subscriptions to sources with the most reliable information, literature are not free. And I'm constantly studying, attending about 20 conferences a year, including international ones. A family doctor is a one-man army who must know everything."
"Unfortunately, in our country, being a doctor means not only constantly learning, but also often moving forward against the raging wind, even when that wind knocks you off your feet. Working a few jobs, going to a private clinic after a night shift, having a minimum official salary, and being prepared for the fact that everyone will count your income to a penny, without even knowing what they're talking about. Being a doctor is to constantly invest in training, equipment, knowledge because the world is on the go. This is the daily maximum risk and minimum protection! It means having time and strength for everything, having neither strength nor time for yourself! It's living with a phone in your ear, waging war on Internet experts without medical education, and trying to explain why your treatment plan is better than the one on the Internet. Smiling, even when they openly spit in your face because of a hotline and complaints about the chief doctor and other documents, they don't sleep. It means respecting, loving, and appreciating doctors, my colleagues because every day these people do a feat that is beyond words. Those who are around the clock near the sick, who faint from fatigue, who are sick and saving, those, giving the most valuable thing: health and life! It means looking for a way out of hopeless situations and believing in miracles, and believe me, they do happen!"
"I tell and prove my point to patients who diagnose themselves!"
However, it's not in the family doctor nature to give up: "Despite everything, it's easy for me to work with everyone! Adults trust me, children charge me with energy. And to patients who diagnose themselves, I tell and prove my point!" Of course, there were complaints. You can't please everyone, but in all cases, Ruslana Omelianchuk proved her right. Therefore, she doesn't take negative things at her own expense. Sometimes they come to complain about other doctors: "They say, take me because that doctor is bad, but I don't take them, first, I don't have spots anymore, and secondly, I don't like when my colleagues are insulted! Sometimes it may seem that everyone dislikes family doctors! Patients, doctors of other specialties, people who don't have a family doctor. But we're not $100 to please everyone. I don't accept any criticism at my expense. I talk to patients. He who hears changes his mind. I suggest my colleagues come and sit at the appointment for at least one day. I won't object, some people appreciate and respect it, and it's inspiring, but many people think that you owe something to someone and will definitely remind you of the Hippocratic Oath at the first opportunity, so I advise these people to read it at least once in person."
What has the pandemic changed?
With quarantine for the Mykolaiv family doctor, little changed. After all, she always had a lot of patients. Diagnoses have changed. She takes all covid patients; they then communicate with different contact methods, but when the condition worsens, Ruslana Omelianchuk insists on a mandatory visit of the patient to the center.
This winter, Ruslana also fell ill with covid. A constant stay in the infection's epicenter wasn't in vain. She had to worry about her family. "They are far from me and I couldn't protect them. They also fell ill. I treated them all remotely. Relatives are a separate category! I treat all relatives via phone. And there was never one that I didn't cure. Apparently, I'm a bit of a psychic, but of course, it's more of a joke. They just call me and I have to name a miracle pill, which doesn't exist, but which should definitely help everyone at once :-)"
The latest wave of coronavirus has brought doctors a lot of new patients. The virus is mutating, began to affect the young and strong. "Everything happened instantly. Hospitals were overcrowded, it was difficult for everyone. Doctors were on the verge of complete emotional burnout. Patients are worried and very scared. Those who've fallen ill still suffer from the corona's effects. There were days when even I, a positive person, was scared to go to work in the morning. I believe that only vaccination can be the only way out of the situation. I was vaccinated! I felt good after the vaccination (it was CoviShield) and with my example, I wanted to show my wards that you shouldn't be afraid of vaccination."
To people against vaccination, the doctor asks a single question:
"You or your family were sick with covid, do you want it again?" And after that people change their attitude; the first anti-vaccine supporters are already on the waiting list.
Not only do patients listen to Dr. Omelianchuk's opinion. Ruslana has an active position in the team: out of 30 doctors she was recognized as the best doctor of the State Primary Health Care Centre 1. And in December 2020, right "under the Christmas tree," she received the keys to her new apartment; the chief physician made every effort to keep the professional in Mykolaiv. Mayor Oleksandr Senkevych handed over warrants for official housing on behalf of the Mykolayiv community to family doctor Ruslana Omelianchuk and neonatologist Olena Kril of the maternity hospital №2.
Ruslana Omelianchuk isn't intimidated by the challenges that constantly arise before family medicine. Traveling, meeting friends, yoga, sports, sometimes a glass of wine in good company save her from stress. "I haven't watched TV series about doctors for a long time; I have my own TV series here. I didn't want to be a family doctor, but I became one. I've had a goal to become the best family doctor, I became one! I took matters into my own hands! I have no regrets about what happened. I never fell to my knees, I got up and flew! Nobody can stop me now."
National Health Service of Ukraine explains that the family doctor is not an around-the-clock service, no need to call in the middle of the night or on the weekend
Today, the patient is at the center of the health care system. But you can't exercise your rights without neglecting the rights of others. Some patients call their family doctor, physician, or pediatrician on a cell phone during apparently non-business hours. But, unlike emergency care, the services provided by primary and secondary care physicians aren't emergency.
- If your doctor has provided your mobile number, you need to ask what time it's convenient to call or write and with what questions.
- Before calling a doctor, you should look at your watch.
- Ideally, the time of calls should coincide with the time of the outpatient clinic.
- You need to think about questions before dialing the doctor's number. After all, it's not uncommon for the patient to remember the most important things after the conversation and call back again.
- It is recommended to start a conversation or text message with a reminder of who's addressing. After all, the doctor can't remember all the patients and immediately get to the heart of the matter.
- You shouldn't send audio or video messages unless you have agreed to such a format in advance.
- If an emergency requires urgent care, either call 103 or visit a hospital that provides medical care around the clock. There you will be accepted without electronic referral in case you cannot wait.
- On weekends, holidays, and non-working days, you should only bother a doctor as a last resort, call the doctor on duty or call 103.
- Don't confuse a family doctor with a psychologist. It's necessary to respect the doctor's right to rest and not to disturb the doctor to "talk."
Family doctors are important to the life of every family. But take care of those who need to take care of you! National Health Service of Ukraine reminds that the family doctor:
- is a person, not an around-the-clock service;
- has certain working hours and days off;
- has the right to choose the method of communication with the patient and decide when to answer calls and messages;
- may assign a time and date of appointment for the patient;
- has the right to decide whether there's a real need for a home call or whether it's possible to consult the patient remotely.
If you haven't yet signed the declaration or you need to change the doctor, you have this opportunity at any time. At the same time, Ukrainians aren't limited in how many times they can change doctors. You can sign a new declaration with a doctor an unlimited number of times. You can do this during a personal visit to the selected institution or online.
How to create or re-sign a declaration with a family doctor:
- Choose an institution or a doctor according to personal criteria. You can take the advice of friends or visit the nearest facilities and learn about doctors there.
- Look at the map and see if you can already sign the declaration at the selected institution. Also, medical institutions connected to the system can be identified by the sticker, "Here you can choose your doctor."
- Bring your passport, identification code, and mobile phone. If you need to sign a declaration for a child under 14, also take the child's birth certificate.
- Contact the registry of the medical institution and say that you want to sign the declaration. An employee of the medical institution will enter your data into the electronic system. The mobile phone will receive an SMS with the code. Report this code to the employee.
- A declaration with your data will be printed out from the electronic system. Carefully check that all data is correct. If necessary, the employee will make changes to the system and print the declaration again. Sign two copies of the printed declaration. You take one with you, the other one stays in the institution.
- The employee will then confirm your declaration with the electronic signature and send it to the electronic system.
To re-file the declaration online you need:
- Call the newly elected doctor (phone numbers are in the relevant sections of the websites of clinics and primary health care centers), and the procedure for signing the contract will take place online.
- To sign the declaration online (using Viber messengers, Telegram, WhatsApp, e-mail, etc.), you'll need to send the selected family doctor a scanned electronic copy of your passport, identification code, after which he/she will enter your data into the electronic system.
- After entering your data, your mobile phone will receive an SMS with a code that will need to be reported to the family doctor.
- Keep in mind that then you'll still have to come to the medical institution where the doctor of your choice works to sign and pick up your copy of the declaration.
After signing the declaration with the new doctor, the cancellation of the previous one (which the person previously signed with another doctor) will happen automatically.