Nurse as a participant in the medical and social examination. Job responsibilities of specialists of the Bureau of Medical and Social Expertise Social work in the Bureau of Medical and Social Expertise
The nurse, like all participants in the process of medical and social examination, is in a difficult position: she often has to deal with patients who are quite difficult to establish contact with, whose personality traits have little to communicate, make it difficult.
These features include: low level of education; defects in mental activity caused by the disease; unfavorable personality traits (emotional instability, vulnerability, resentment, explosiveness, low self-esteem), which are exacerbated in an examination situation (which is stressful for most patients). And yet, even when working with the heaviest contingent of those being examined, adherence to the principle of partnership, treating a person without prejudice, as an equal person, is the key to the effectiveness of the communication process.
It should be emphasized that the optimization of the communication process is possible only when a person really wants to achieve this.
Simply memorizing the techniques and techniques of communication is ineffective.
Success depends on how much the medical worker tends to choose the best ways of behavior in relation to persons who come for examination. The stability of such aspiration in people for whom working with people is their professional business may turn out to be one of the most important conditions for the success of their activities. Communicative competence includes motivational, cognitive, personal and behavioral components. It is the ability of a person to interact effectively with other people.
It includes: the ability to navigate in social situations, the ability to correctly determine the psychological characteristics and emotional states of other people, the ability to choose and implement adequate ways of interaction.
Communication skills include: active listening skills, the ability to express one's thoughts, taking into account the partner's level of understanding, reflective tracking of the communication process, conscious control over emotions. The communicative competence of a medical worker is manifested in mercy, tolerance, stress resistance, professional empathy, contributing to the relief of suffering, rehabilitation, and restoration of the patient's health.
Thus, the requirements for the personality of a nurse in an ITU institution are quite high, it must be remembered that we work for the patient and for the patient.
A feature of communication in the situation of examination is its short duration. For 10-15 minutes of communication, the nurse and the examined make an impression of each other.
It must be remembered that in no case should the escalation of the conflict be allowed. Patients should be treated calmly and kindly.
People with illnesses are extremely sensitive to the emotional climate in their environment. Therefore, you need to pay attention to your behavior and gestures. It is necessary to be respectful, try to be consistent and direct, maintain a friendly distance, take into account that the person is sick, and attribute the symptoms not to him, but to the disease. Such tactics are due to elementary common sense.
It is worth noting separately the features of communication with mentally ill people. There is no single correct line of conduct in dealing with mental patients. It all depends on the specific situation, the situation and the personality of the interlocutors.
Although the average person is not able to accurately determine the degree of danger posed by a mentally ill person, he can recognize some of the symptoms of the disease and behave accordingly. If the interlocutor has difficulty concentrating, you should try to be brief, if necessary, repeat what was said. If he is overexcited, a conversation with him will not work. You should limit the information, do not try to explain anything, speak briefly, do not exacerbate the discussion. "Uh-huh", "yes", "goodbye" - this is the nurse's tactic.
It is necessary to be calm and open in communication with patients. In conversation, remain calm, clear and direct. Remember that the patient can hear strange voices and see strange things, his thoughts are jumping, at the same time he experiences a wide variety of feelings. So verbose emotional phrases are likely to confuse him, and short phrases and calm speech will be more understandable.
Suppose you were indignant at his behavior and expressed it very emotionally - most likely he simply will not hear you or will not remember what was discussed. And it is quite likely that next time it will behave in the same way.
Mental illness seriously affects how a person thinks and behaves and what he is able to do. However, for those of us who associate with and love such people, it is vital to always remember that these are not only "mentally ill." They still remain PEOPLE with their feelings, are very vulnerable, easily lose their individuality and therefore especially need those who love and understand them. Not realizing how much could be given to them, others simply label them as mentally ill. Friends and families must resist this trend, remembering to separate the person from the disease.
Nurses should not:
Laugh at the patient and his feelings;
Be afraid of his experiences;
To convince the patient of the unreality or insignificance of what he perceives;
Engage in a detailed discussion of the hallucinations or who he thinks they come from;
Pay attention to your own emotional state. It must be remembered that fear and resentment are usually hidden behind external anger. The situation is easier to take into your own hands, subject to a calm and clear behavior. Often a calming, confident voice makes it possible to quickly eliminate the irrational anger and fear that overwhelm the patient.
It is necessary to avoid all physical contact and not to arrange a crowd around the patient. When communicating with a patient, even the very physical presence is important. The patient may lose his temper if he feels he is cornered or trapped. Therefore, it may be a good idea to leave him free to leave the office or to position yourself so that you can move away if emotions get too hot.
It is worth being as attentive as possible to the causes of the patient's anxiety. Do not minimize or ignore the fact that the patient may have strong feelings. During a fit of anger, the most important thing is to help the patient focus on what can calm him down. It is necessary to study the causes of his anger in a calmer period.
Be aware of the limits of acceptable behavior. If the patient screams in anger, throws objects, disturbing other examinees and employees of the ITU institution, it is necessary to calmly but firmly make a remark. For example, to say that if he does not stop, then you will be forced to report the situation to the head of the bureau (expert team).
If the examinee in the process of communication assessed the nurse as a formal person, hurried, indifferent to his situation, then if the expectations of the examination are not met, the likelihood of filing a complaint with higher authorities about the rudeness and incompetence of doctors, nurses (even in the absence of an immediate reason for such accusations) increases, and vice versa, if the person being examined is imbued with trust in the employees of the institution, he saw people who are not indifferent, trying to understand his problem and do everything to help him, then he will make a decision not in his favor more calmly, as he will feel objectivity.
The right style of communication will help reduce the conflict of the certification procedure. In social psychology, there are a number of reasons that provoke interpersonal conflicts.
1. Personal characteristics of the parties.
Personal prerequisites for conflict
such features as intolerance to the shortcomings of others, reduced self-criticism, incontinence in feelings, as well as a tendency to aggressive behavior, dominance, selfishness, selfishness can serve. The behavior of a nurse in an ITU institution should not be aimed at emphasizing her authority, significance in deciding the fate of another person. The authoritarian style of communication usually enhances the aggressiveness of the conflict patient. It is not necessary to consider the patient from a subjective position, that is, in each patient to see either the features of a friend or relative and behave in proportion to this.
The nurse should be confident enough, but not haughty; quick and persistent, but not fussy; resolute and firm, but not stubborn; emotionally responsive, but reasonable. She must remain cool and sincerely involved, optimistic with a certain amount of skepticism. The balanced harmonious personality of the nurse is an important factor in establishing optimal contact with the examinee.
2. Barrier of negative emotions.
Emotions can influence the perception of a communication partner. Feeling hostility, anger, disgust, it is difficult to expect that it will be possible to correctly evaluate and understand a communication partner.
3. Barrier of perception.
There are a number of postures and gestures that cause a negative attitude of the interlocutor. So, crossed arms on the chest speak of alienation, some aggressiveness, closeness to communication. Hands clenched into fists - an openly aggressive posture, etc. The first impression of a person creates an appropriate attitude towards relationships, it can be negative or positive.
There are different types of conflicts to be distinguished. Realistic (objective) conflicts. They are caused by dissatisfaction with the requirements and expectations of the participants, as well as unfair, in their opinion, distribution of any duties, benefits and are aimed at achieving specific goals. The reason for the confrontation can be the behavior of medical personnel (rudeness, impoliteness), the nature of the procedure for registering a patient (negligence), the sanitary and hygienic conditions of a medical institution (object, noise, smell), errors in the preparation of expert documentation.
Pointless (unrealistic) conflicts. Their goal is to openly express accumulated negative emotions, resentment, hostility, when acute conflict interaction becomes not a means to achieve a specific result, but an end in itself. This type of conflict is often due to the biased attitude of the examined to the medical service in general and to a particular physician in particular.
The success of a contact is sometimes determined, at first glance, by insignificant moments. For example, excessively rich, fashionable clothes, an abundance of jewelry, cosmetics can create a negative impression.
Openness for communication can be shown by eye contact, a slight smile, friendliness, gentleness of manners and intonation. A slight inclination of the body, head towards the interlocutor, an interested and attentive facial expression, etc. is possible.
The pace of speech should be slow, calm, words clear. For the effective work of the nurse of the ITU bureau and the expert teams of the Main Bureau, the ability to listen to the interlocutor is necessary.
The next stage of communication is getting out of contact. The ability to get out of contact is just as important as getting into it. The role of the last impression is as important as the first. The inability to restrain one's dislike leads to resentment, a negative impression of the examination procedure, and a feeling of dissatisfaction.
A good way to end contact is the technique of "paraphrasing" (i.e., reformulating the interlocutor's thoughts - "as I understand you ...", "in other words, you say.,") and summarizing - summing up the main ideas and feelings of the patient. The patient, making sure that he was understood correctly, leaves with a sense of satisfaction, and he will perceive even a negative decision more calmly.
In each office, it is necessary to create such an environment that would spare the psyche of patients and generate an atmosphere of trust. This can be achieved by proper organization of the work and rest regime, high culture of employees and clear labor and professional discipline.
Already the first meeting in the registry should create an atmosphere of positive mood of the patient, an atmosphere of goodwill.
It is necessary to maintain order and cleanliness in the waiting room, in proper form there should be a stand indicating the work schedule of the bureau, the list of documents required for the examination, the procedure for appealing the decision of the ITU bureau, information on benefits for the disabled and other information related to the examined.
The patient must be recorded for examination individually. The treatment of the patient during the recording should be friendly and patient, since from the first moment the patient begins to form an opinion about the correctness and quality of the examination.
In the absence of the necessary documents, it is necessary to patiently explain the need to provide them, the emerging issues (which are not in the competence of the nurse) should be resolved with the head of the bureau. After recording the patient, information about him is provided to the head of the bureau, who determines the sequence of the examination procedure.
Social issues (household, family relations, employment, etc.) should be clarified delicately.
It is unacceptable in the presence of patients to address each other on "you", by name. If the specialist collecting the anamnesis is forced to be distracted, you should apologize to the patient.
Summarizing the above, it follows that with a disease with relatively rare seizures and minor personality changes, the ability to work practically does not suffer.
Patients are able to work mainly with mild (absences, simple partial seizures, etc.) and rare seizures, without distinct mental disorders, with moderately pronounced characterological features, who are able to continue working in their specialty with restrictions or a change in the profile of activity (mainly people in the humanities, teachers etc.). Patients with prolonged remission of seizures on the background of maintenance therapy, without significant personality changes - with the possibility of employment in affordable professions.
Indications for referral to BMSE are contraindicated types and working conditions, a progressive course of the epileptic process (frequent, therapy-resistant seizures, mental disorders, personality changes), after insufficiently effective surgical treatment.
It should also be noted that the situation of certification in the ITU institution is one of the potentially conflictogenic. If the work is carried out convincingly, competently, in compliance with all regulatory documents and ethical standards for the performance of professional duties, conflict situations will not arise.
Thus, having considered the principles of organization, tasks, functions of the medical and social examination, as well as the characteristics of disability in epilepsy and the participation of a nurse directly in the examination, we can conclude that the diagnosis of epilepsy does not necessarily mean disability, with relatively rare seizures and minor personality changes, work capacity practically does not suffer.
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1. General Provisions
1. GENERAL PROVISIONS
1.1. A doctor for medical and social expertise (hereinafter referred to as the "Employee") refers to specialists.
1.2. This job description defines the functional duties, rights, obligations, responsibilities, working conditions, relationships (positional relations) of the Employee, criteria for assessing his business qualities and work results when performing work in the specialty and directly at the workplace in "____________________" (hereinafter - " Employer").
1.3. The employee is appointed to the position and dismissed from the position by the order of the Employer in accordance with the procedure established by the current labor legislation.
1.4. The employee reports directly to ____________________.
1.5. The employee must know:
the Constitution of the Russian Federation; laws and other regulatory legal acts of the Russian Federation in the field of healthcare, consumer protection and sanitary and epidemiological welfare of the population; theoretical foundations in the chosen specialty; modern methods of treatment, diagnosis and drug provision of patients; basics of medical and social expertise; rules of action upon detection of a patient with signs of especially dangerous infections, HIV infection; the procedure for interaction with other medical specialists, services, organizations, including insurance companies, associations of doctors, etc.; the fundamentals of the functioning of budget-insurance medicine and voluntary medical insurance, the provision of sanitary and preventive and medicinal assistance to the population; medical ethics; psychology of professional communication; fundamentals of labor legislation; internal labor regulations; rules on labor protection and fire safety;
____________________.
1.6. The employee must meet the qualification requirements for the specialty "Medical and social expertise", established by order of the Ministry of Health of Russia dated 08.10.2015 N 707n "On approval of the Qualification requirements for medical and pharmaceutical workers with higher education in the direction of training" Health and medical sciences ":
- Higher education - a specialist in one of the specialties: "Medicine", "Pediatrics";
- Residency training in the specialty "Medical and social expertise" or professional retraining in the specialty "Medical and social expertise" in the presence of training in internship / residency in one of the specialties: "Pediatric surgery", "Neurology", "General medical practice (family Medicine)", "Oncology", "Otorhinolaryngology", "Ophthalmology", "Pediatrics", "Psychiatry", "Therapy", "Traumatology and Orthopedics", "Phthisiology", "Surgery", "Endocrinology";
- Advanced training at least once every 5 years during the entire career.
2. Job responsibilities
Employee:
conducts a medical and social examination of citizens based on an assessment of life restrictions caused by a persistent disorder of body functions;
develops individual programs for the rehabilitation of disabled people, including determining the types, forms, terms and volumes of measures for medical, social and vocational rehabilitation;
establishes the fact of the presence of disability, the group, causes, date and time of the onset of disability;
determines the degree of loss of professional ability to work (in percent);
determines permanent disability;
determines the need for medical, social and professional rehabilitation of victims of industrial accidents and occupational diseases and develops programs for the rehabilitation of victims of industrial accidents and occupational diseases;
determines the causes of death of a disabled person, as well as a person injured as a result of an accident at work, an occupational disease, a disaster at the Chernobyl nuclear power plant and other radiation or man-made disasters, or as a result of injury, concussion, injury or disease received during military service, in cases when the legislation of the Russian Federation provides for the provision of social support measures to the family of the deceased;
determines the need for health reasons in constant outside care (assistance, supervision) of a father, mother, wife, brother, sister, grandfather, grandmother or adoptive parent of citizens called up for military service (contractual military servicemen);
gives citizens undergoing medical and social examination explanations on the issues of medical and social examination;
participates in the development of programs for the rehabilitation of disabled people, prevention of disability and social protection of disabled people;
forms a data bank on citizens living in the served territory who have passed the medical and social examination; carries out state statistical monitoring of the demographic composition of disabled people living in the served territory;
submits to the military commissariats information on all cases of recognition of persons liable for military service and citizens of military age as disabled.
3. Rights of the Employee
The employee has the right to:
providing him with a job stipulated by an employment contract;
a workplace that meets the state regulatory requirements for labor protection and the conditions provided for by the collective agreement;
Last year, the administration of the President of the Russian Federation received more than 130,000 complaints about the work of the medical and social expertise: about the incompetence and bias of specialists, about corruption and increasing errors. Every week, the Public Chambers of the regions register dozens of appeals from citizens.
The situation in the ITU system is out of control, according to the chairman of the Commission on Social Policy, Labor Relations and the Quality of Life of the OPRF, Vladimir Slepak. The head of the Interregional Center for Independent Medical and Social Expertise, Doctor of Medical Sciences Svetlana Danilova agrees with this. Before the interview, Svetlana Grigoryevna sent a letter to the editorial office from a young woman with a disability, telling about her trip to the next commission. Showed that journalists understand what people with disabilities face. There are no generalizations and analysis of problems, but there is resentment, frankness, and just real life ... We immediately contacted the author: is it possible to publish it? "Why not? I don’t mind,” said Ludmila Simonova, a wheelchair user from Bashkiria.
“Grandma is disabled, she has diabetes, and she has been in line for 7 hours ...”
“I have a disability group I since 2008. Injury to the cervical spine, dysfunction of the pelvic organs, explains Lyudmila Simonova. - I live in the village. I recently went to my doctor and got tested. He wrote a letter and sent it to the city to see a urologist, a neurologist, and so on.
I'm going to the city of Beloretsk for a hundred kilometers. Doctors receive at different times and on different days - whoever is lucky to make an appointment. I had to live in the city for a week to get around everyone. I did not find a proctologist, so I went to the next city - Magnitogorsk. Another hundred kilometers… The building is not suitable for wheelchair users, the premises are old, the plaster is falling off, it is damp and cold inside. People wait in line for hours. From one in the afternoon until seven in the evening we sat with the thought: “When will we be invited?”. One grandmother came at 11 and left after eight hours. She said: "How to plow the shift." The other was crying, begging to be accepted. The old woman is disabled, she has diabetes, she wanted to eat, and she stood in line for 7 hours. ITU workers walked past with stone faces and pretended not to notice anything.
There has been no ITU in Beloretsk recently, experts from Ufa come to us on certain days. I had to live in Beloretsk, wait for the specialists to arrive. Well, relatives let me in, and it's good that I have a friend who dragged me to the 3rd floor. Otherwise, I can’t imagine how much it would take to dangle from the village to the city on impassable roads (we don’t have asphalt), to rent a car, because our buses are not equipped for wheelchair users.
This time, employees of the ITU Bureau No. 6 of Ufa came to us. According to my ideas, I should have been invited to the office at the appointed time. Ask what problems I have, give advice and recommendations on the entire list of technical means of rehabilitation that would make life easier and help to adapt and adapt. It is not for nothing that the word “habilitation” was added to the individual rehabilitation program. I thought that the ITU should work for the disabled, but I was wrong. I sat in line, they called me, looked at me and said: “If we redo the IPR, then we remove half of what you have entered, you are not allowed to do this according to the new rules. Better leave the old program and go home.”
How are they removed? By what law? It turned out that I was not supposed to have an electric wheelchair, but I am a "neck", my hands do not work well. Yes, I move around the house in an active wheelchair, it is easy to put it in the trunk, lift it up the stairs with me to the third floor when I visit my sister in the city, but for walking around my village without asphalt with pits and bumps, an electric wheelchair is needed. And in 2012, she entered the program for me. Now they said: "We don't care where you live."
The experts did not agree with many decisions of the attending physicians and ignored their recommendations. They treated me and other disabled people as if we had come to them to ask for alms, they were rude. The commission gave a friend a disability group, and then called her to Ufa for a second examination. I was given a month to appeal the decision to the main bureau of the region. But this will be a huge problem - you will have to drive not a hundred, but three hundred kilometers, spend your money hiring a car. This is how people with disabilities are helped to live in our country, everything is for them.”
“When I first heard that the II disability group costs 450 thousand rubles, I didn’t believe it”
We are talking with the head of the Interregional Center for Independent Medical and Social Expertise, Doctor of Medical Sciences Svetlana Danilova .
- Svetlana Grigorievna, everything that Lyudmila Simonova writes about is true?
- Certainly. Russian disabled people overcome so many obstacles in order to pass a commission, get a status or receive subsidized drugs, that mom does not cry. Now it is impossible to get an appointment with a narrow specialist, bypassing the therapist - he gives directions. First you go to him, then to the doctors, then - again to him with the results. A disabled person travels 100 kilometers to one city, another 100 to another. And, in theory, should be examined and receive assistance at the place of residence. The task of the ITU is not to challenge the diagnoses established by clinicians, but to determine the limitations of life. In our country, experts change diagnoses, cancel the recommendations of doctors, they say: "The patient has no pronounced disorders."
In the Federal Law of November 24, 1995 No. 181-FZ “On the Social Protection of Disabled Persons in the Russian Federation”, disability is interpreted as “social insufficiency due to a health disorder with a persistent disorder of body functions, leading to a limitation of life and the need for social protection.” In accordance with this, in addition to expert examination, ITU institutions are responsible for developing individual programs for the rehabilitation of disabled people and determining their needs for social protection measures.
- This is according to the law, but as in life ?
— And in life, the main problem of medical and social expertise is the duration and complexity of obtaining a disability group and rehabilitation services for citizens with disabilities through the examination procedure in ITU institutions. Currently, people with disabilities often refuse to go through bureaucratic procedures and solve problems at their own expense. The legal rights of the disabled are being violated. The ITU forces people to undergo unnecessary examinations, collect unnecessary tests, arguing that they allegedly discipline a disabled person: “At least once a year he will pass a medical commission, otherwise you won’t force him.” But, in fact, the ITU bureau today is a complex bureaucracy that creates various obstacles and problems for people with disabilities.
The entry into force of the order of the Ministry of Labor of Russia dated October 11, 2012 No. 310n “On Approval of the Procedure for the Organization and Activities of Federal State Institutions of Medical and Social Expertise” called into question the need for the existence of the ITU itself as a separate structure.
According to paragraph 4 of this law, a necessary condition for the formation of the composition of the bureau is the presence of at least one doctor in the ITU. However, the specialty of the doctor is not indicated ...
- Is there really only one doctor included in the bureau, and who are the rest of the experts? Officials?
- When there were VTEKs, there were three doctors in the commission. Then they tried to include 5 specialists. Three experts are currently working, one of them is on medical and social issues. Moreover, clarifications about the specialization of the doctor were removed from the documentation. Specialists do not go to ITU, since it is impossible to get a category, it is not taken into account.
ITU General Bureaus examine citizens with a variety of diseases, and no matter how competent a doctor is in ITU, it is almost impossible to navigate well in all nosological forms. And the psychologist and rehabilitation specialist included in the bureau are not competent at all in the issue of establishing disability.
In addition, according to the rules approved by the Decree of the Government of the Russian Federation of February 20, 2006 No. 95, the decision to recognize a citizen as disabled or to refuse is made by a majority vote of the experts who conducted the ITU. If there is only one doctor for medical and social expertise, the objectivity of such a vote is doubtful - the main condition for recognizing a person as a disabled person to this day remains the type and severity of impaired body functions, which can only be determined by an ITU doctor (with the exception of mental functions).
In other words, the ITU bureau turns into a bureau for issuing disability certificates, which significantly increases the corruption component and significantly reduces the objectivity of the decision.
— Disabled people complain about the low professional level of ITU specialists in the regions. They say that they even confuse diagnoses. The mother of a child with a serious illness recently showed a copy of a document in which experts call adrenogenital syndrome ... diabetes mellitus. Where are they prepared?
- In Russia, experts are trained in internships in St. Petersburg - there is an advanced training institute for doctors. And in the ITU federal bureau. The level is really low. There are few professionals: the leaders are weak, sometimes it is embarrassing to listen to them - they do not know the regulatory documents, they are poorly versed in the legislation, and the experts in the regions do not have enough knowledge and competencies to understand and execute the orders of the Ministry of Labor of the Russian Federation. This is sad, because the ITU system is an absolute monopoly. Her decisions cannot be challenged. In the pre-trial procedure, an appeal is carried out in the service itself: with one composition, with another, and then it is necessary to apply to the federal bureau, where often the documents sent are not opened at all. I defended my candidate and doctoral thesis there and repeatedly saw how meetings are held, how experts do not see the patient, do not study the documentation, but immediately take the decisions of the main bureau of the region as a basis. Decisions rarely change. Sometimes the courts, considering the claims of the disabled, decide: undergo an examination in any region of your choice. And which region will change its mind after the federal bureau?
No independent expert can approach the service, since there is no independent ITU by law - the license is given only to federal agencies. Therefore, no matter how objective and fair the conclusion of an independent expert is, it will not affect the change in the decision of the federal institution ITU.
- The Public Chamber of the Russian Federation proposes to consider "ITU errors from the point of view of the Criminal Code of Russia" and gives examples of corruption in the Ulyanovsk, Volgograd regions ...
- And there is corruption, and, unfortunately, the regions have their own rates. I'll probably put up tariffs for the card soon - there are a lot of complaints from people with disabilities. I remember when I was first told that in Vorkuta the II disability group costs 450 thousand rubles, I did not believe it. And then people confirmed. In the same Vorkuta, a surgeon was caught red-handed. It is especially scary when they extort money from real people with disabilities. Alas, this is also part of the system. It needs to be changed, but I no longer believe the talk about the reorganization of the ITU. Three years ago, this question was already raised, the Ministry of Economic Development of the Russian Federation was asked to calculate how much the reforms would cost. They counted a lot, wrote a lot and did not offer anything specific.
No reorganization of the ITU at this stage will be able to solve the problem. Examples are the largest regions, such as the Krasnodar Territory, Rostov-on-Don. The leaders were removed a few years ago, and on the ground the specialists of the primary bureaus both worked and continue to work. Nothing has changed in the service. The monopoly was and remains.
I believe that the determination of disability groups can be carried out by the medical commission of a medical organization on the proposal of the attending physician on the basis of data from the primary medical documentation, without filling out a referral to the ITU. Currently, the attending physician presents to the medical commission a patient with temporary disability, a disabled person with a deterioration in condition for the purpose of prescribing and correcting treatment, therapeutic and diagnostic measures. Therefore, the chairman of the commission is usually aware of the peculiarities of the course of the disease of such patients. And the specialists of the ITU bureau determine the disability group without knowing anything about the patient (if we are not talking about re-examination) and rely only on the submitted medical documents and a single examination of the patient within a few minutes.
I consider it expedient to abolish the ITU service, and entrust the conduct of the ITU to the medical commissions of healthcare organizations, especially since the medical commission currently performs most of the functions to one degree or another. The reform will require a change in the procedure for medical institutions to conduct an examination of disability, a revision of the functional duties of medical commissions of primary care medical organizations. On the other hand, it will make it possible to shorten the route of movement of citizens with disabilities, simplify the examination procedure, improve the quality and expand the volume of medical and social rehabilitation services provided to the disabled.
The liquidation of the ITU service by transferring its functions to medical commissions of medical organizations will allow:
reduce social tension among the disabled and citizens who are initially sent to the ITU (the long procedure for filling out referrals to the ITU and subsequent examination at the bureau will be excluded);
reduce federal budget expenditures on the maintenance of the ITU service;
reduce the burden on specialists of the medical commission and doctors of a medical organization by eliminating the need to fill out a referral to the ITU;
increase the availability of expertise for the population, because medical commissions exist in all medical organizations, while the ITU bureau is created at the rate of 1 bureau per 90,000 people, and citizens of small settlements are forced to travel considerable distances at their own expense to get to the ITU bureau;
eliminate the corruption component on the part of the ITU bureau specialists;
to legislate an independent ITU.
Hello! The doctor of the ITU bureau in Moscow is writing to you. Everyone, of course, knows what kind of atmosphere of evil rumors, and sometimes outright lies, has developed around the doctors working in this department. Like, you sell disability groups, and take bribes, and the like. It’s a shame to hear this for expert doctors who have devoted their years to the cause of medical and social rehabilitation and helping sick people. There is no need to talk about a meager salary: Everyone knows how ridiculous it is. I would like to talk about something else, namely, our leaders. Why should honest workers be constantly humiliated by their superiors? For example, why can Oleg Aleksandrovich Vasiliev, a lawyer at the FKU GB ITU for Moscow, afford to accuse almost everyone working in this system of corruption? Why does Oleg Alexandrovich allow himself to speak inadequately, if not rudely, with people who are much older than him? Has Oleg Alexandrovich, a lawyer, forgotten that there is such a thing as the presumption of innocence, and in this case he himself can be accused of slander? It is simply pointless and useless to talk with our higher authorities: he has one answer for everything: "I don't like it, no one is holding you!". And they leave. People who have devoted decades to helping the sick are leaving! It even got to the point that at the expense of their own funds from a meager salary, ITU employees are forced to purchase office equipment necessary for work! " No money!" - all one answer from our leadership. In addition, in 2017, the management loaded the ITU bureau with overwork! Not only that, branches receive many more people every day than it is planned! Doctors were given the task to enter into a computer database all disabled people who have been examined since 2005 in a new database, the so-called FRI. And now the elderly are forced to sit literally until night, doing what is essentially unusual for doctors! Needless to say, there is no compensation for overtime? And they gave the task to manually enter several hundred thousand people! People who work around the clock at a computer lose their sight and health, And all because the management, having decided to save on paying IT workers, entrusted doctors with an unusual task for them! With such an attitude, there are fears that almost all doctors will leave the system of medical and social expertise! But then socially unprotected people will suffer first of all! But the leadership, perhaps, needs to destroy the system, it seems that everything is going to this.
There is more than enough evidence for that. So, since 2016, a certain Sergey Petrovich Zapariy from Omsk has headed the FKU GB ITU. It is not known in what ways Sergei Petrovich was appointed to this position, but there are suspicions that it was not entirely honest. It is known that for some of his actions Sergei Petrovich was taken in Omsk under the increased control of journalists,
Which has not yet been removed.
With his arrival, unfounded accusations of corruption, systematic humiliation of expert doctors, both working in the FKU MAIN BUREAU of ITU and in district divisions, unjustified dismissals of employees without explanation, and other illegal actions began with renewed vigor.
It is also known that the daughter of Sergei Petrovich, Zapariy Natalya Sergeevna, works at the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia. From a legal point of view, I think this is doubtful.
And the last thing: this is how Sergey Petrovich parks near the FKU GB ITU building. How can a wheelchair user get through? It seems that this is also a manifestation of disrespect for sick people?
With sincere respect, Vitaly Sedov. Honored Doctor of the Russian Federation
Important update!
How to pass the commission: algorithm
Step 1
First you need to get from the therapist on the basis of the data entered in the outpatient card.
Step 3
During the examination itself, specialists first of all get acquainted with all the documentation, then they already conduct an examination and a conversation with the patient, analyze his condition. All actions and conversations during the work of the commission are recorded.
Step 4
Step 5
Important! The decision made by the commission is communicated to the patient on the same day on which the examination took place. In the case of a positive conclusion, the person is given the original certificate, as well as a scheme for future rehabilitation and treatment developed specifically for him.
Step 6
The appeal of a citizen with this very certificate to a pension fund or other social organization to receive a pension and other assistance. This must be done within three days after receiving the papers..
In total, in about two months it is really possible to successfully apply for a disability.
However, this does not mean that a visit to the ITU bureau can be forgotten. Depending on the assigned group, people with disabilities in Russia must confirm their status with a certain frequency:
- the first group - every two years;
- the second and third - annually;
- children with disabilities - once during the validity of this status.
Before the deadline is also possible. If this is due to a noticeable deterioration in the state of a citizen, then at any time, if not, then the disability should be valid for no more than two months.
Decree of the Government of the Russian Federation of 20.02.2006 N95 gives citizens the right to challenge the decision of the commission. A period of one month has been allotted for the local ITU center in the main office. The same period applies for a complaint against the decision of the main bureau in the federal center.
At the same time, documents for appeal must be brought to the office where you have already been examined. It is it itself that is forced to transfer the applications of dissatisfied citizens to higher authorities within no more than three days. The last body to which you can turn in such proceedings, and the decision of which is no longer subject to appeal, is the court.
Possible difficulties
- The patient himself is in a non-transportable state or in intensive care. The doctors of the medical institution, his relatives and the company in which the patient is employed are then required to collect papers. His collected documents are transferred to the ITU bureau on the basis of a special certificate confirming the citizen's inability to deal with everything personally.
- The clinic in which the patient is located is a psychiatric one, and the situation is similar to the previous one, that is, the person’s condition is very difficult. At such moments, a notarized power of attorney is usually issued, and his relatives have the right to speak on behalf of the patient.
- A citizen is able to independently deal with the registration of disability, but in a medical institution he was denied a referral. The solution to this problem is to require a form in the form