here Today our meeting with the Minister of health of Russia, Professor Mikhail Murashko. We are also in masks. In a conversation without end burst phone calls. And phones in the Ministerial office – not mobile, ordinary – thirteen. Dismiss their call impossible. Idle calls, apparently not. And it is necessary not only to listen to, and it is necessary to take a decision, not shelving them.
ant has become accustomed to this extreme situation? He’s in it? He was appointed Minister almost on the eve of a world pandemic.
Michael Albertovich! You chicken in oschip was in the Ministerial Cabinet at a time. How to feel?
Michael Murashko: How do you feel? The times did not choose – they have to live and work. I probably helps that I worked all my life in emergency medical care. Although today it is necessary to create conditions so that the situation moved from emergency to a manageable state.
in Fairness I must say that these halls are familiar to me: the first time I came here about 25 years ago, when we were given a task to prepare a document on the organization of perinatal care. These developments, by the way, then formed the basis of my doctoral thesis.
And then your specialized obstetric background helps organizing work? The health professional must be a specialist in the field of medicine? Or nowadays the so-called successful managers is optional?
Michael Murashko: Today it is fashionable to talk about the so-called soft-skills, the formation of competence models. But I think when it comes to the health professional, it is better that he was a professional in a clinical discipline. It provides a strong Foundation of knowledge about real life and a proper understanding of our profession. Many now argue whether we need such a profession as a health professional. In my opinion, such a profession should exist.
How do you assess our health?
Michael Murashko: In General, the healthcare system of Russia deserves the prizes, although there are many reasons for objective criticism.
And according to some rankings, we at the 55th place…
Michael Murashko: In different ratings for different evaluation criteria: somewhere estimated the ratio of the level of funding and results, where burden of certain diseases or factors. Here you have to say specifically: where there is progress and where extra effort is needed.
You as a Minister, as a doctor does not hurt when I say: I will go to Germany for treatment in Israel?
Michael Murashko: of Course, hurt. Although today there is a completely opposite trend: foreigners visitsyut to Russia for medical care. In the framework of the national project “Health” is even a separate index – the number of foreigners receiving care in Russia.
by the Way, health care or health service?
Michael Murashko: This is a very important focus. Today in our lexicon rightly returns the concept of medical care. In my opinion, it more correctly in relation to the patient and against the doctor. In the context of the pandemic is changing the perception of the physician: now, when the topic of health is relevant as never before, medical services are gone, replaced by medical care.
Forever? And will not pay the doctor less than, say, the driver of the trolley?
Michael Murashko: a presidential decree established that the payment of physicians should be two times higher than the average level in the region where he lives, is a dogma. If not complied with is the reason for the test and hard decisions.
But there comes information that, for example, promised a decent salary. However, the same nurse was transferred to the post of cleaner with all the ensuing consequences. It is possible to influence?
Michael Murashko: Not just possible – we need to influence! The physician must obtain the level of payment, which he put under the law. But I would like to mention another important point about traveling abroad to receive medical care. Remember, even 15-20 years ago there was a large flow of wanting to give birth abroad. Today this unit, and their motives are usually not associated with most medical advice.
the system of medical care for obstetric profile works well: a woman chooses a health facility for delivery, depending on the health status, risks, remoteness, etc. in Other words, the level of risk for the patient should match the level of the medical organization. We must pay tribute to the organizers of health care, including Veronika Skvortsova, who implemented this system.
are You a supporter of perinatal centres?
Michael Murashko: They are proven good. And I say this not because he was behind the formation of these centers. They really help to survive women and newborns in the most difficult situations.
was a few perinatal centers. I remember one new, beautiful, but empty. And the woman about to give birth, living within 150 kilometers from the city center, with horror, said that the medical center no, no paramedic, midwife there. And as off-road access to the perinatal center? It might be better to give birth in the special Department of the General hospital? Or is it a perinatal center is preferable?
Michael Murashko: Better when the perinatal centre is working in conjunction with multi-field hospital. But ��Menno perinatal center – the highest complexity level of medical care. Mild disease can and should be treated close to home. But when you need more skilled help, here without perinatal center is not enough. Especially if we’re talking about obstetric pathology, in some situations, it can develop at lightning speed. Therefore, the hospitalization of women who have a risk of developing this pathology should be conducted where they will be able to provide all the necessary aid.
So it’s good to have General hospital?
Michael Murashko: Well, when you quickly take a person where he will do all that is necessary. But the hospital does not mean the full amount of aid. We should not forget the level of preparedness of medical personnel: in order to be able to work in all clinical situations, the flow of patients should be large and permanent. In some countries even set a limit on the number of operations that produces a clinic to meet a certain level. If it is five births per year, even in the General hospital, its staff will be less willing than in the clinic, where hundreds of them. This, of course, applies not only to obstetrics. For example, certain operations in ophthalmology. The clinic performs more than 1,000 operations a year, or it performs them 100. This is a very different level of agencies.
Medical care is really attractive new technology. A modern doctor should be able to listen to a patient’s heart, knock on his back? Or, to make a diagnosis, it is completely tied to CT, MRI, ultrasound?.. Is this really necessary?
Michael Murashko: Is one of the cornerstones of telemedicine. The Ministry of health in the position that the first visit to the doctor should be personal. The doctor needs to look, listen, patient, to evaluate his skin, to palpation, to communicate with the patient. It is not always possible to understand the man, his problems, passing only a CT scan or laboratory tests. You cannot get away from the classics of medicine – from initial examination of the patient.
the Doctor should be good?
Michael Murashko: Needs. In any case, patients perceive a doctor better. Should be compassion for the patient, empathy. Physician taught.
And the standards of assistance that does not interfere with?
Michael Murashko: Standards in medicine algorithms that allow to minimize errors and risks for the patient. Medical care may incur not only benefits but also danger, especially if it turns out incorrect. This is the basis of quality management. Maybe this phrase seem formal, but today without it anywhere – it is a culture of orgaorganization. But this approach does not replace the basics of medicine and their complements. I don’t like the approach when requested to “either way”: we need to approach systematically.
And if so, why the patient can’t decide where to be treated? Why often this requires a quota?
Michael Murashko: the Patient, of course, must face the questions of quotas. It is an economic parameter that is used in the system of payment. Directly the patient should be interested in how quickly he gets the help and how well. And when talking about choosing a clinic, the patient is more have to choose from those who can provide this type of assistance in full.
the First stage of selection – outpatient care. You need to choose the nearest clinic. Because if you are going car “ambulance”, it should be close. If a situation arises that needs further examination, more in-depth expert advice, then you have to send and send back, where to do it. The quota is, again, the economic setting, it does not relate directly to the patient. The patient receives this quota-direction to the organization got financial compensation.
As a patient to get a quote?
Michael Murashko: First you must go to the local doctor. This is the doctor who best knows you. He has all the possibilities to you to determine at a particular clinic, to define the scope of the survey. You can not jump over this link.
All the best, the most modern technology are meaningless if they are not available. How to make medical care available? What is your Minister, the main task?
Michael Murashko: Two primary objectives: accessibility and quality. These two components are the basis for all medicine. Accessibility starts with the clinic to which you are attached. You cannot get away from the classics of medicine – from initial examination of the patient.
But we destroyed primary care?
Michael Murashko: say So, of course, impossible. But the fact that the modernization of primary care needed, is a fact. This is a very important part of the system because the bulk of complaints of the patients – about half a billion a year – treatment in primary care. In fact, the population forms an opinion about the medicine from the clinic with the local doctor. And the format of mistrust is also formed there. Hospitalized 30 million a year. It figures of different orders! Unfortunately, because of the pandemic, we were forced to postpone the modernization of primary care, but this year we’ll begin.
Optimization is now acknowledged was a mistake. And the current conversion was really Stol necessary?
Michael Murashko: Here are a few highlights. When we faced the first blow of a coronavirus, in the hospitals of natural causes have pockets of the disease. So we had to distribute the flows: patients with coronavirus infection, which was operated on and the surgeons and the transplant had to be separated from those from whom virus was not.
Next, to rapidly deploy bed is possible only in a medical organization. Because, firstly, there are conditions throughout the cycle of care: diagnostics, including laboratory and ultrasound, plus trained staff, the system of the premises. In critical situations, we certainly know how to deploy the beds in other institutions: in the period of hostilities or emergencies this experience was. But they need to prepare.
We must be ready for unforeseen events. Coronavirus infection around the world have shown that calm with infectious diseases is impossible. Many countries that have good national immunization schedule, including our country, to a certain extent felt protection from many infections. In addition, there are rules of hygiene, the system of epidemiological surveillance, etc.
In a normal situation it allowed us to exist peacefully with a certain reserve hospital bed network. Approaches to rendering infectious care were reviewed, of course, the emergence of new infections and new challenges, but not dramatically, as happened today. During an outbreak, kovida, we are faced with a large number of patients in whom the lung is affected, this means that each bed of patient with moderate severity or serious condition should be an eyeliner of oxygen. This is one of the norms that never existed. And we have stipulated that 70 percent of hospital beds in helping this category of patients should have oxygen connections.
depending on how the infection occurs, we must be ready to provide resuscitation care. Seeing what happened in other countries, we had to prepare the resuscitation system of protection so that in no case had any of the problems: who to help and who not to help. This is a terrible choice, which you can not bring.
Now everyone is waiting for the vaccine from kovida. Is it possible that, as usual, someone will refuse vaccination after it is created? Will the vaccine introduced in the national immunization schedule?
Michael Murashko: There are vaccinations that are made on epidemiological indications. And there are those that are included in the list of national immunization schedule. We are now working on a vaccine and evaluate the epidemic process. Everything will depend on these estimates. But one thing is clear: vaccination should become the norm. Ignorance in the approach to inaktivacii must now be perceived as misbehavior.
Will there be a second wave of kovida?
Michael Murashko: the Probability is large.
it will be easier to cope with it?
Michael Murashko: Absolutely. We have the experience and willingness.
will Digress from the topic of the day… You are inbred?
Michael Murashko: My grandmother was a pharmacist, pharmaceutical worker. But my family are mostly engineers. But the wife is the doctor of functional diagnostics. A large part of his life he worked in the regional cardiology center. Qualified specialist-diagnostician. One son was a pharmacist, second son graduated from the University in the field of “Biophysics”. By the way, a straight-a student.
how much is the Minister Murashko comes in and what goes?
Michael Murashko: Arrive at 8.30. But the work begins early. Finish it later.
what eats the Minister during the day?
Michael Murashko: Soup and vegetables. In any age a lot of meat is not necessary. I’m at that age when meat eating is enough in order to run faster.
Michael Murashko: I Love the oatmeal in the water or rice.
Michael Murashko: Vegetables or fish.
the Minister loves to dance… am I Right?
Michael Murashko: I even took dance classes for seven years. In childhood.
What do you like to dance?
Michael Murashko: Probably more modern dances. But at the time, we were taught ballroom.
a pandemic is overdue, but… do you have the opportunity to go to the theatre? When was the last time I was in the theater?
Michael Murashko: my family was in a Large theatre, watching the ballet “Jewels”.
Like to listen to music?
Michael Murashko: Yes, very. I graduated from music school in Sverdlovsk – now Yekaterinburg. Even when played in an ensemble. We then won a prize at a rock festival.
And secondary school and graduated with a medal?
Michael Murashko: No. I graduated from high school with physics, chemistry and mathematics. He studied in the class, who was more concerned with mathematics.
Why go into medicine?
Michael Murashko: And in medicine don’t need to know math? At the time, wrote in the school posters: “the Mathematics of the mind in order leads”.
Now medicine is unthinkable without mathematics. Mathematics even included in the staffing of hospitals. Of all the professions which is best in your opinion?
Michael Murashko: Medicine. Over the years I just made sure that I was not mistaken with a choice.
what dreams Of the Minister of health? Or once dreamed of?
Michael Murashko: Why? Dreaming is necessary and very important. Dream goand in a more planned format. We have to return it, because in a very short period of time they made those rules, regulations, orders, clinical practice guidelines, which are now working. Easier to work with us in the Ministry, and doctor of practical management in the clinic.
Repeat: the doctor will receive a decent wage?
Michael Murashko: We’re going to this. The salaries of doctors have risen.
Only the main physicians or the district, too?
Michael Murashko: And the district and doctors in hospitals. Here, because a lot of different tasks. We must first create a new system of remuneration, which would be consistent with the physical and emotional costs of each doctor. Doctors of different specialties and different – it also needs to be considered. Together with the Ministry of labour we’re working on it.
A paid and a free clinic? The leaders of many paid dream that they could be treated at the MHI. Is this possible?
Michael Murashko: It is already implemented. But look at the situation objectively. What amount of assistance are public hospitals and some private.
If would have given them that right, maybe things would have been different?
Michael Murashko: has given. And in some regions today, private organizations involved in the provision of medical assistance under the MLA. A modern clinic should provide assistance for different profiles. Multiprofile clinic loses. Win multispecialty practice, when there are all kinds of help, ranging from anesthesiology and intensive care, to consultation of endocrinologists and surgeons. In another way it is built can not be. The patient should be protected. And priority for multidisciplinary clinics that can provide care.