How to understand what you are spinning on unnecessary waste in a paid clinic
You are assigned too many tests
If you came to the doctor with a common cold, and left the office with a bundle of directions for expensive tests and examinations, it is worthwhile.
Often for an initial examination, a detailed blood test is sufficient.
And the study for hormones, the passage of MRI and ultrasound you are not required.
Check with your doctor for what to take this or thatanalysis. Doing them "just in case" and paying tens of thousands of rubles is definitely not worth it. Do not hesitate to ask questions. Specify, than the concrete purpose is proved. The doctor should explain in detail and understand why he recommends taking an analysis or taking a certain medicine.
If you do not trust the doctor, go to a reception to another specialist with a good reputation and see what tests he will assign. And only then draw conclusions.
You are rushed
"The problem is easily remediable, the operation can beorganize tomorrow, "" You're lucky, you can go through the magic procedure with a decent discount right now, "" If you go through a comprehensive survey, it will be much cheaper ... "
As a rule, the goal of such "beneficial offers" is to force you to say "yes." If, of course, it's not a life-threatening condition and urgent hospitalization.
Do not rush to give a positive response. Take a pause. If the staff of the clinic in response to this start to scare that you "miss a good chance," with a high probability of you are bred for extra money.
You are persistently advised to something
The procedure or examination that can be done"Exclusively in our clinic" - an occasion to ponder and be on the alert. It's one thing when an institution specializes in the treatment of certain diseases. But most private clinics have a wide profile, and therefore uniqueness is likely to be greatly exaggerated.
Before agreeing to treatment, study the market and prices in other clinics. Find out how much the examination costs in independent laboratories.
Also do not give in to the offer to buy "supercene" supplements, vitamins, phytopreparations. The main rule - look for an alternative, compare, read reviews.
What should alert
- You are treated for a long time, but the recovery is very slow.
- The doctor on each subsequent reception finds you new sores and appoints additional examinations.
- The clinic can not clearly explain why you were assigned this or that examination and procedures.
- After you give up the "superprofitable offer", the attitude changes dramatically, it becomes colder.
What the doctors say themselves
Dmitry Troshchansky
Doctor, Doctor of Medical Sciences
If the patient has turned to commercialorganization, it will inevitably be promoted for money. He does not stand a chance, he is defenseless. Everything will be reduced solely to the appetite of the clinic, the average check of marketers and the brand of the car on which the owner of this private center wants to travel.
A little better is the situation in dentistry, where a significant number of clinics work within the framework of market mechanisms, and therefore they must be competitive.
Dmitry Malykh
Practicing pediatrician, neurologist
Unfortunately, there is no reliable way to reliably understand that the medical institution will carry out the necessary amount of research and manipulation based on your state of health.
But there are some tips that will help to avoid a huge check for unnecessary services and get high-quality medical care:
Gather information about the clinics. Make a choice in favor of that medical institution, where doctors work on the principle of evidence-based medicine. This will give a chance to protect yourself from unnecessary expensive surveys. Everything will be done solely according to the testimony, based on the recommendations of the guideline of authoritative international medical associations.
Prepare to receive. In advance, write down a list of questions that you address to your doctor. From my point of view, the doctor should clarify any, even inessential nuances. This will help save money on repeated consultations.
At a basic level, try it yourselfto understand the problem with which you go to the doctor. Here the key factor is the choice of sources of information. I strongly advise against using Google search for keywords. This will only confuse.
As a proven and authoritative source for patients, I recommend:
Alexey Paramonov
Candidate of Medical Sciences, Head of the Expert Gastroenterology Center at the Dawn (Moscow)
In unnecessary surveys, there are two main reasons: the doctor's mistake and his malicious intent (or not very evil - a conflict of interest).
Once I happened to see the motivation systemdoctors of one of the largest in the country network of private clinics. They received 10% of the cost of a prescribed colonoscopy or gastroscopy. This by no means means that the doctor will automatically assign unnecessary studies.
But the employer tempts him with this opportunity. We are all people, the ability to resist the temptation of all is different.
The real story that happened to mypatient in one of the Moscow clinics of the business segment. He came to the reception to the gastroenterologist, but the administrator handed him a hefty bundle of directions for tests. The patient stated that he would prefer that the doctor appoint the tests.
However, at the reception the gastroenterologist immediately asked: "Where are the tests?"
"Perhaps you will appoint them?" The patient asked timidly.
- Did not the administrator give you directions? The doctor answered in amazement and indignation.
"Yes, but ..."
- Show ... Yes there and then half of the necessary tests there! - the gastroenterologist summed up. At the same time, he did not even know what the patient was complaining about.
Why is this happening? There are several systems of physician motivation. The simplest - the doctor receives a percentage of all prescriptions. It's more complicated - he gets a salary, but he has a percentage of high-yielding complex methods.
In another case, the doctor does not receive a percentage, butearns bonuses for the implementation of the standard. The problem is that self-written standards are used. At best, the standards of the Ministry of Health are taken as a basis, which have been developed for other purposes. The result is one: the patient receives appointments three times more than necessary.
These systems operate in most medicalorganizations, including the top-20 on revenue. In the Moscow market, I know only three networks where such a conflict of interests is not consciously created by management.
A universal reliable way to recognize that you are assigned extra, no. But there are some nuances.
A highly qualified and self-respecting doctor,who knows the international standards of treatment and follows them, deviates from them with great difficulty and under serious pressure. Work on international protocols is a component of evidence-based medicine. Such a doctor can always argue his appointment, referring to a clinical guide or a gaidline.
Such doctors, as a rule, willingly discuss withpatient testimony to a particular survey, they say how the further treatment tactics will change depending on the results. If it does not change, it is a sign of an unnecessary examination.
Identify a doctor of evidence-based medicine can be on several grounds:
- He does not diagnose "vegetative vascular disease"dystonia, dyskinesia of the biliary tract, chronic pancreatitis with exocrine insufficiency, dysbacteriosis, spinal osteochondrosis, discirculatory encephalopathy, increased intracranial pressure. He certainly will not find you these chronic viral infections: herpes, cytomegalovirus, Epstein's virus-Barr, multi-month chlamydia.
- He does not prescribe rheoencephalography, a studyFoleu points, echoencephalography, any physiotherapy on devices (electrophoresis, amplipulse, laser irradiation), plasmapheresis (with rare exception in very serious patients in the hospital), laser irradiation with ultraviolet light, courses of vascular and vitamin droppers. Do not prescribe the drug in injections, if there is an analog in tablets.
- From medications to a doctor("Derinat", "Anaferon"), vascular drugs (Stugeron, Cinnarizine, Vinpocetine, Cavinton, Sermion, Fezam, Piracetam, Nootropil, "Actovegin", "Cerebrolysin"), antiviral against ARVI ("Kagocel", "Arbidol", "Anaferon", "Amiksin", "Ocillococcinum", "Ingavirin"). The manifestation of epic ignorance is the purpose of systemic enzyme therapy (Wobenzym, Phlogenzym).
- He can not be a homeopath, anti-vaccination,HIV-dissident, deny the role of statins and anticoagulants in prolonging the life of cardiac patients. He can not prescribe drugs from cholesterol or from pressure courses: "Have a drink, and then break, let the liver rest." He also will not prescribe hepatoprotectors, since there is simply no such group of drugs in developed countries.
In this way, one can distinguish a literate physician from an illiterate one. What is important: it so happened that a competent doctor is usually also honest.
