PAEDIATRICIAN OR GENERAL PRACTITIONER?

From examples in classical literature we are familiar with what has become a text-book image of the middle-aged family doctor with a grey beard, wearing glasses, who knows not only about the health of all the members of the family in his charge, but also about the ups and downs in their life. The domestic god of healing or country expert was thereby recognised as a professional in all cases of illness.

With the development of society as well as the emergence of the Soviet Union, when medicine became "universal and free of charge", and, what is more important, accessible to everyone, it was not at all difficult to find the necessary specialist in regional polyclinics. The Soviet Union has long ceased to exist, but the scheme has remained the same in principle. Except that the standard of medicine has drastically declined, and many people are already familiar with the numerous "trips" around the polyclinics in search of a good specialist. It is not only adults who have to deal with this problem, but children too. The paediatrician is an inseparable part of our everyday lives and the life of our children. It is no secret that parents are not always satisfied with the quality and range of services offered by the doctors. What is the specific nature of the treatment of children in our country and what is the state offering us?

Trust and check

Because people do not trust the regional practitioners, they are often forced to turn to the "luminaries" in private medical centres, the choice of which is based on the recommendations of acquaintances. Moreover, replacing one specialist by another complicates the establishment of a correct diagnosis and prescribing the subsequent treatment, since the doctor is not always familiar with all the patient's records. Taking into account that the services offered by private medical centres are usually extremely expensive, this means that relatively qualified medical care is only accessible to a limited number of patients. How can an optimal variant be found for this system and how can the population be provided with timely and, what is most important, professional health care.

The head of the teaching department at Azerbaijan's State Medical University, Nasimi Qasimov, has said that integrating the national system of education, in particular medical education, into a European-style model, will lead to the dying away of the old Soviet system and the introduction of new circumstances. One of these is the two-stage system of medical education: six years of general education and four years of residency training (international world standard of education ensuring a more in-depth study of a specialised branch of medicine). Thus, the faculty which is training paediatricians would merge with the medical faculty. Those wishing to specialise in paediatrics need to enrol for residency training.

On the whole, the student who only gets a six-year general education, will only be able to work as a district doctor or general practitioner. But, N. Qasimov stressed, but the eventual aim is that all doctors should graduate from the residential training and the entire system of medicine and health care should go over to being on a professional basis.

The essence of the general practitioner's practice is that he is "managing" the whole family, monitoring the state of its members' health and, where possible, carrying out preventive measures and spotting the first signs of disease. Besides this, the general practitioner can administer preliminary medical aid, but the basis of his function is organising the right professional care by a dedicated specialist, to whom he sends the people in his charge. At the moment, Nasimi muallim says, some patients are getting treatment at district polyclinics, some are getting it from highly qualified professors and some from private doctors. The introduction of the new standards will initiate an approach to treatment for all patients, each of whom will be sent to the appropriate specialist.

An individual approach or a "superfluous" link in the chain?

What is the attitude of the public to the potential introduction of this innovation?

A number of respondents were not against it on the whole. Asmar Haciyeva, the mother of a seven-year-old boy, recounts that she consults the district paediatrician: "We've been lucky. My son has got a doctor who used to be my doctor. This is an intelligent, well-informed doctor who keeps abreast of the latest developments in medicines and methods of treatment. She always takes into account the financial situation of the family and tries not to prescribe expensive medicines. Besides that, I myself can consult her if something suddenly crops up with my health." Essentially, according to the mother, she is sort of unofficially observing the general practitioner tradition.

Aysel Babayeva, the mother of a 10-year-old girl, thinks that a doctor who keeps track of the health of the child and not only his health, but that of the remaining members of the family, should be a more efficient than a district paediatrician. The latter is swamped with a huge number of patients during the day and simply is not physically able to pay to them the attention he should and examine all their aches and pains. "I don't go to the doctors from the state polyclinics, because I am not sure about their qualifications. I'm quite happy to consult a private doctor, who makes home visits, carries out a careful examination and prescribes the medicine needed." What is more, when you take into account the official "free of charge" situation, it is difficult to believe that the district doctor will be particularly interested in the health of the patient.

But there are people who think differently. Alena Salimova, a mother of two, admits that she is not too impressed by a "multi-tasking" doctor. "There are emergencies, when a diagnosis needs to be made straight away, and only a specialist can do that. I think that the general practitioner who deals with all kinds of illnesses is a superfluous link in the health care chain."

Naturally, in circumstances where people are dissatisfied with the state of health care at home, the question arises of whether future general practitioners will have a sufficiently high standard of knowledge and the qualifications of those that can "be consulted" by all members of the family, ranging from big to small. Here there is a purely "technical" element. A child is not simply a smaller copy of an adult, the symptoms in a number of illnesses vary in children and adults, as well as the approach to treatment and the dose of medicinal preparations. Even "simple" adenoid treatment is different in adults and children, not only in the approach, but owing to the different physiology.

Paediatrician Naila Sadraddinova thinks that it is not expedient to abolish the Paediatrics Institute itself and hand children over to general practitioners: "The approaches to treating children and adults are fundamentally different. Whereas children are prescribed medicinal preparations according to their body weight, it is quite a different matter when it comes to adults. The same is true of surgery. A paediatric surgeon can operate on an adult, while a surgeon 'specialising in adult operations' cannot operate on a child." Paediatrician Marina Vetkina confirms: "A paediatrician can diagnose what is wrong with an adult, while a therapist would not venture to make a diagnosis on a child just like that. Moreover, the approaches in adult and child neurology are different. Even at the Medical University paediatrics' students studied for a year longer than those in the general treatment faculty."

What do the others do about it?

Our fellow country woman living in Europe, the mother of two children, tells us about the principles governing health care and medicine which have been adopted in almost all western countries: "The system of treatment consists of many stages. To begin with, no matter what the problem is, I consult the general practitioner with whom I am registered. After that, he sends me to the necessary specialist. Then we go to see the specialist at a strictly appointed time when our turn comes, but that does not guarantee an immediate diagnosis. To begin with, you have to go through all the necessary checks and wait for week for the results to come through. On the whole, health care for children under 18 years is free of charge. After the age of 18 years, a certain percentage is paid, while many take medical insurance. The general practitioner cannot always render the necessary assistance and make the right diagnosis, so we have the right to choose another doctor."

As you can see, the new system is generally in line with that adopted in Europe, but the main factor is, for all that, the timely training of well-qualified staff and professional specialists. Taking into account everything mentioned above, the conclusion may be drawn that patients are not opposed to general practitioners, but prefer that the general practitioner, the family doctor, is capable of rendering qualified medical assistance, without multiplying the number of links in the health care process.