Morozov Children's Hospital Odintsovo regional hospital headed by Igor Koltunov Round-the-clock interdisciplinary team of doctors on duty

Medical care should be timely and of high quality, and medical facilities should be accessible to patients. Governor Andrei Vorobyov sets such a task for regional healthcare.

About what will change in the work of our medical institutions, we talked with the chief physician of the Odintsovo Central District Hospital, Igor Koltunov, who headed it in April.

Prepared by Maria BAKHIREVA

- Igor Efimovich, you have extensive experience in the capital's health care system, you have been the head of the Morozov Children's City Clinical Hospital for a long time. What is your impression of the Central District Hospital in Odintsovo?

– First of all, I saw a well-coordinated team of specialists who have been working together for quite a long time. This is important, because the most important thing in our ministry is devotion to the profession, mutual understanding of like-minded people. I can especially note the wonderful maternity hospital with modern equipment. Of course, there are problems - you can't get away from them. But we will work with it.

What is the Odintsovo Central District Hospital today? The institution is on the path of great development. Now a unified healthcare system is being formed, the main principle of which is: one municipality - one legal entity. At the same time, all operating units will continue their work. Consequently, the responsibility of both the head of the medical institution and all doctors will be completely different. In fact, the institution directly becomes responsible for the health of every resident of the district.

- What changes in connection with the reorganization await the Central District Hospital?

- For us, the primary question is what the patient will get from such a reorganization. In fact, each of our residents will be able to visit any healthcare facility in the district without certificates and referrals. As a result of modernization, a single information space will be created. All medical documentation, all analyzes and studies will be in a single database. What is more important, thanks to such a system, in places where, for objective reasons, there are no or not enough narrow specialists, we will be able to open a queue and call a mobile mobile team within seven days or organize a consultation of any doctor via telemedicine.

- What will change in the work of doctors? Load, salary?

- The staff will receive at least new modern equipment, which is extremely important today. This guarantees more productive work of doctors, while reducing their current workload. Thanks to high-tech medicine, complications in the treatment of patients will decrease. As for salaries, we plan to raise the salaries of doctors and nurses by 20 percent during the year. I want to emphasize that this will not happen due to a reduction in staff, but due to logistical solutions for patient routing, modern equipment and new technologies.

Naturally, there will be an increase in the so-called completed cases, sorry for the professional terminology. Now we are “losing” patients with complex diseases, we are sending such patients to other medical institutions, more often to the capital. For example, today in the Odintsovo District there is not a single angiographic unit, so a patient with acute myocardial infarction cannot be provided with modern medical care. He is urgently sent either to Krasnogorsk or Moscow. The same is true for cerebrovascular accidents. For the treatment of such cases, a round-the-clock team of neurosurgeons is required, at least a neurosurgical room should work. As a result of modernization, we will have all this.

- Is it possible now to talk about specific terms for the implementation of the program?

– Yes, we have determined the deadlines, the modernization has already begun. The first stage in the next six months is to equip the traumatology, ENT department, pediatrics and the maternity hospital. The second stage is the regional vascular center, it will take nine months - a maximum of a year. And the third stage, which we expect to complete in a year and a half, is a centralized laboratory service that will serve the entire district. It is important that such a service will give us the opportunity to detect oncology and treat severe chronic diseases, for which there is currently no base.

I repeat - we are creating a district health care system. It gives the doctor a decent salary, the opportunity to use modern equipment, and therefore consistently achieve positive treatment results. Patients will receive not formal, but real accessibility of medical facilities, a real choice where to be treated, whereas previously it was possible only by referral. The attachment system will remain, but it will be attached to the Odintsovo Central District Hospital, and you can visit any medical facility in the district.

Our reference

Igor Efimovich Koltunov- Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation.

Born September 9, 1968. He graduated with honors from the Tashkent Pediatric Medical Institute with a degree in Pediatrics. He has the highest qualification category in the specialties "Pediatrics" and "Public Health and Health Organization", as well as valid certificates in the specialties "Cardiology", "Pediatrics", GCP, "Public Health and Health Organization".

Since 1994, he worked at the State Research Center for Preventive Medicine of the Ministry of Health. In 2011, he headed the Morozov Children's City Clinical Hospital in Moscow.

Since November 2018 - Director of the Scientific and Methodological Gerontological Center "Peredelkino" of the Department of Labor and Social Protection of Moscow.

Since April 23, 2019, he has been the chief physician of the Odintsovo Central District Hospital.

V. KARPOV: 20 hours 6 minutes. On the air is the program "Release".

About what's important now. At the microphone - Vladimir Karpov. Good evening everyone again. Now Igor Koltunov, chief physician of the Morozov Children's City Clinical Hospital, is joining us.

Hello, Igor Efimovich!

I. KOLTUNOV: Good evening!

V. KARPOV: Well, as you probably already guess, today we will talk about optimization, about the reform of the healthcare system in Moscow, if you can call it that. Well, of course, we will receive your phone calls, I will read your SMS, site messages ..

To begin with, let's dot the Y. Igor Efimovich, are you a supporter of optimization, an opponent of optimization? Who you are?

I. KOLTUNOV: Of course, I am a supporter of optimization.

V. KARPOV: Why “of course”?

I. KOLTUNOV: Because I am its participant, therefore, of course, I am its supporter.

V. KARPOV: As far as I understand, chief physicians can also fall under the same optimization, especially after we learned this week about 49% of allegedly unsuitable chief physicians in Moscow.

I. KOLTUNOV: You know, no one gets anywhere. I don’t know where you got the data about 49% of suitable or unsuitable.

V. KARPOV: The Moscow authorities...

I. KOLTUNOV: It's hard to say about the chief doctors in Moscow... We have slightly different data, I know. Yes, indeed, we were tested, regardless. We went through training, passed various tests, both psychological and general education tests, a test for professional suitability, and, of course, a number of specialists came to light who today do not meet modern requirements.

V.KARPOV: But 49% is, as I understand it, overstated in your understanding. You have some other data.

I. KOLTUNOV: I don't know what data and where you get it from. I do not think that every second doctor is unsuitable.

V. KARPOV: Chief Physician

I. KOLTUNOV: Yes, the chief physician. But in general, you know, in recent years the specifics of work have changed a lot, federal legislation, primarily at the level, has changed a lot. And, unfortunately, Moscow has been lagging behind for many years in terms of the compliance of its legislation with that of the federal level. There were very big differences, very big contradictions. If you remember, about 5-6 years ago there was a whole story about the instruction of our president - to bring the legislation of the constituent entities of the Russian Federation into line with the legislation of our Federation. And Moscow was in the lead in the discrepancies in the legislative framework.

V. KARPOV: Yes, but Yuri immediately retorts: “Unfortunately, was it lagging behind? Yes, it was fortunately lagging behind! Because, thanks to this discrepancy, Moscow received a little more, for example, than other regions. painful."

I. KOLTUNOV: What does “more” or “less” mean? These categories are not applicable in medicine. There is an understanding of quality, there is misunderstanding, lack of quality. Everything that has taken root in a person's life, again, I repeat, more or less - does not happen. We must do everything to the maximum. As much as possible exactly as much as is necessary for the patient to save his life, cure him or alleviate his condition.

V. KARPOV: Again, here it turns out - as much as possible, but only within clearly defined limits that limit that very maximum. Here are the restrictions that will be introduced, how much they can affect your capabilities?

I. KOLTUNOV: You know, I don't understand what restrictions are. I understand what medical standards are.

V.KARPOV: Single-channel financing is a limitation, in my understanding.

I. KOLTUNOV: Single-channel financing is not a limitation. Single-channel financing is, first of all, bringing it into line with the standard of providing medical services. Without an appropriate standard, you will not be able to control the quality of medical services in any way. Medicine is an exact science. And it is impossible to constantly interpret certain events and interpret them individually. In this way, we will not have medicine, we will have fortune-telling on coffee grounds. In order to guarantee the quality of the service to the patient and not just guarantee, but guarantee the quality in any medical institution is approximately the same, with a minimum degree of error, for this it is just necessary to switch to single-channel financing, and to the introduction of medical standards and to bring everything in line .

V.KARPOV: This optimization, which is talked about so much, has a lot of opponents. What do you associate it with? If this is so long overdue?

I. KOLTUNOV: You know, it is natural for a person to love a certain constancy, it is natural for a person to oppose any changes, especially if these changes are not clear and not known to a person. There are such areas as sports, like medicine, like politics, in which absolutely everyone understands. You know, if optimization were carried out in the nuclear power industry or in heavy engineering, I think there would be fewer opponents of such optimization.

V. KARPOV: It is enough, for example, to say that some scientists or some enterprises will be laid off; this will always excite society. Therefore, even if this concerns nuclear energy, one way or another, the words that they will be fired, will be reduced, will be engaged in incomprehensible re-profiling, they will in any case raise questions.

I. KOLTUNOV: You know, I would compare the modernization of healthcare today with the reform that we had in our time in the army. In the army in the 90s, a large number of people were dismissed, and there was a whole program that you mentioned - about retraining, retraining officers and so on. I would probably compare the same thing that is happening now in medicine. Dismiss a huge army of medical workers who are not very qualified, not qualified at the time they started working, but who do not meet modern requirements. Not meeting the requirements for modern medical equipment, which Moscow received as part of the modernization - modernization, which was not. Those polyclinics that were equipped and equipped today with equipment that never existed there. And, of course, there are people who need to be taught, on the one hand, and there are people who, unfortunately, need to be retrained or prepared for something else. Maybe to lighter activities, maybe to slightly different stories. The same thing as at one time was carried out in the army - reform and modernization. As you can see, we have moved away from a large, unwieldy, huge machine and have come to rather mobile, multidisciplinary, absolutely qualified such medical institutions.

V. KARPOV: We have yet to come to medical institutions.

I. KOLTUNOV: Yes, we must come to high-tech medical institutions, which must provide standard high-quality medical services to everyone, to all patients.

V. KARPOV: As for the army, for a very long time its reform was called "the collapse of the Russian army." As far as I understand, such characteristics will also apply to Moscow medicine. Do you think patients will feel better?

I. KOLTUNOV: Of course, they will.

V. KARPOV: Why all of a sudden?

I. KOLTUNOV: Absolutely. You know, there was a very quiet revolution in the city, when vascular centers, vascular surgery centers were created. It was very quiet in the city when we reduced the time of delivery of patients with acute coronary syndrome from the disaster site to the medical institution. Quite quietly now it happened, when we have dramatically increased life expectancy in Moscow. It is due to the provision of qualified timely medical care. Nobody shouts about it?

V. KARPOV: Maybe it's bad just that they don't shout? As a result, we only hear about the deterioration?

I. KOLTUNOV: But this is a fact, but it exists. And today, the life expectancy of a Muscovite is growing, today the quality of medical services is growing. And the number of deaths from acute coronary syndrome in our country is much less, at times, than it was literally 4-5 years ago. This is also a fact. Today, medical examinations are being carried out in Moscow, preventive examinations are being carried out in Moscow today. Today we are approaching preventive medicine, preventive medicine, we are moving towards something that has not been in place for decades, we have today in urban healthcare.

V. KARPOV: And, finally, it should appear. Due to the fact that the wrong ones will be removed? But before that, it was impossible to do this?

I. KOLTUNOV: You know, I don't know what is right, what is wrong, what is possible, what is impossible.

V. KARPOV: You yourself say that it is necessary to get rid of specialists who are non-specialists.

I. KOLTUNOV: There is no need to get rid of anything, there is no goal to get rid of someone, there is no goal to fire someone. The goal is to create high-quality, qualified medical care. Accordingly, it consists, as we ourselves understand, of three components: the first is the need for modern technological equipment, the second is the need for trained, competent, skilled professionals, the third is adapted buildings, structures and the logic of the treatment process, competently built from the point of view of organization healthcare. Thanks to these three components, we get a quality, guaranteed, standardized medical service.

V. KARPOV: From my point of view, as an average person, the more of these three components, the better it will be for us, patients. But we are told that in order to become better, you need to become less.

I. KOLTUNOV: You know, more is not always better.

V. KARPOV: I agree.

I. KOLTUNOV: There should be as many as necessary. And therefore, if we are talking about the number of medical institutions, we understand perfectly well that we have such things as the population of the city of Moscow, we understand that we have the prevalence of certain most common diseases, such as infectious, and non-infectious. Based on this, there is an understanding of how many medical institutions should be, what profile, what their bed capacity should be, what equipment and throughput should be, the number of services they provide.

V. KARPOV: Is this understanding clear? Again, the news of today is that the plans for the reduction of Moscow physicians should be prepared by the chief doctors and sent to the Department of Health by the New Year. That is, it seems that today there are no such clear data.

I. KOLTUNOV: Of course, there is an understanding, absolutely. And of course, we clearly know what we want and what we want to achieve. I will tell you that in childhood, in pediatrics, it is probably easier than for adult doctors, since we have about 1 million 800 thousand small patients in the whole city. Of course, there are many more adults than children. And the range of diseases in adults is much wider than in children. It is probably easier for us in children's health care in this regard. If you pay attention, fortunately, there are not so many complaints about pediatric care today, if we take it in relation to adult patients. And to date, not a single small patient has been denied medical care. Moreover, we have an absolute breakthrough in pediatrics - we now nurse children from 500 grams and above. What today corresponds to the European standards of the World Health Organization. And this again became possible thanks to the modernization and equipment of medical institutions.

V. KARPOV: This has already been done.

I. KOLTUNOV: Made just now. This was done 2 years ago. These children are now nursed, they move on to the second stage. They then move on to the third stage, to rehabilitation. This is all, understand, not one-day stories. The healing process has its own logic, its own sequence of events. And, of course, there are a number of diseases when it is very good, very beautiful, as they say, cut off and sewn on, and everything is in order. Often this does not happen, often the diseases are cyclical, often we begin to provide treatment for diseases for many years. And this is the phasing, phasing, phasing of treatment in order for the patient to be healthy.

V. KARPOV: I am still trying to understand: right now, as part of this optimization, as part of this reform, you are required to do more as a doctor or as a manager. Do you have to achieve efficiency in financial terms or something else, or meet the needs of citizens?

I. KOLTUNOV: You know, there is a whole specialty in healthcare, it is called “Health Organizer”. This is its own specialty, it is taught, it is given a diploma of this specialty. This specialty combines the skills of management management and the medical part and everything related to the medical process.

V.KARPOV: But what is your priority right now? What is required of you specifically?

I. KOLTUNOV: The priority for us now is the organization of specialized, highly specialized medical care. The hospital should get away from providing a simple medical service, something that should be provided in the clinic. Not to engage in small, let's say, not life-threatening, often reproducible medical service that can be provided in an institution that is simpler, less equipped.

V. KARPOV: In other words, efficiency, financial indicators?

I. KOLTUNOV: Financial performance is a consequence. This is not the goal. There is no task to earn some money, to get this money. We are a government agency. And, of course, no one will let destroy or bankrupt any large medical institution, in particular, the Morozov hospital. It is clear that if the management in the hospital is ineffective, the administrative apparatus, accordingly, will be changed, the state will help financial holes, and put another more competent specialist. But no one will ever let the hospital collapse, it is out of the question.

V. KARPOV: Let's receive phone calls. You will be more comfortable wearing headphones 73 73 948. Now we are listening to you carefully. Hello, hello!

RADIO LISTENER: Hello, hello! You know, I am afraid of various reorganizations in the country, I will explain, for example, they recently reorganized the police into the police - there is zero sense. Now we are going to reorganize medicine. I'm sorry, I didn't listen to your program from the very beginning. But I want to know what kind of your interlocutor tells fairy tales, that everything will be fine. In my understanding, it will only be terrible, getting worse and worse and worse. If our medicine becomes commercial, then this is generally a disaster.

V. KARPOV: Here it is important to understand why, in your understanding, medicine should become worse?

I. KOLTUNOV: At the moment she is, in my understanding, in a critical condition. My father was in the hospital, in Botkinskaya, there are good buildings where people do not lie, excuse me, like cattle.

V. KARPOV: Yes, thank you, accepted.

Why should we get better if we have examples of other reforms that do not show themselves so brilliantly.

V. KARPOV: Let me remind you that Igor Koltunov, chief physician of the Morozov Children's City Clinical Hospital, is with us.

I. KOLTUNOV: Of course, there are good buildings, of course, there are bad buildings somewhere. It is precisely this interlocutor who very correctly says that it is necessary to undergo a health care reform, namely that it is necessary to create institutions that will provide only specialized clinical care, such as, for example, the Botkin Hospital, as the Morozov Hospital. To do this, these services need to be concentrated there, both human resources and equipment, and, as a result, state, OMS, and our funds will go there, which will enable this institution to develop further.

V. KARPOV: When talking about medical institutions for adults, they most often remember grandmothers who should not come, just lie in the hospital, because they are provided there, including some kind of social services. And when they talk about a children's hospital, is it also about reducing the number of beds, about the fact that children should not just lie in the Morozov Children's Hospital? Just explain.

I. KOLTUNOV: Let's talk in numbers.

V. KARPOV: Come on.

I. KOLTUNOV: Three years ago, when we started the reorganization of the Morozov Hospital, the number of treated patients in the institution was about 32-34 thousand people. Today, in the same medical institution, this year we reach 72,000 treated patients.

V. KARPOV: Twice as many.

I. KOLTUNOV: Absolutely exactly. Twice as much, only due to a change in the logic of the treatment process, the routing of patients who are directly tied, again, I repeat, to modern equipment, which makes it possible to provide medical care at a completely different speed. When we say that we are changing the speed of medical care, this is not a desire to earn more and faster, it is a desire to help the patient faster, therefore, the patient's time is often calculated in minutes and a maximum, maybe hours. The doctor does not think about money, he thinks about how to quickly provide the patient with qualified medical care. Of course, remembering the stories with you, when patients went to receive treatment, to be examined, some time passed, in order for the patient to be diagnosed, it took 7-10-12 days. Why? Because there was only one tomograph, it worked twice a week, the record was huge, because the analyzes were done only on Tuesdays and Thursdays, and the results were issued only on Monday and Friday, and so on, and so on, and so on. I remember all these stories very well, today there are no such stories. Today, at the level of the emergency room, from 300 to 360 people apply to our institution for emergency reasons, 120 people bring ambulances from the substation, about 200 people themselves seek medical assistance in some kind of emergency. For the first time, we have discovered such a concept as "beds for overnight hospitalization", when today a child with his mother comes to the emergency room and within 2-3 hours the patient receives modern equipment that works around the clock, which has never been in our institution: this is computed tomography, this ultrasound examination, if necessary, X-ray and complete laboratory diagnostics: biochemical tests, clinical tests, etc. Thus, in 2-3 hours the child leaves us, the so-called "beds for overnight hospitalization", while still being fed. The mother is with the child.

V. KARPOV: I'll clarify: will there be a reduction in the number of beds in the Morozov Children's City Clinical Hospital or not?

I. KOLTUNOV: In the Morozov Children's City Clinical Hospital, the number of beds has long been reduced

V. KARPOV: That's it, that is, you will not cut anything additionally?

I. KOLTUNOV: No. By the time the mass discussion began, all these conversations, reforms, in the Morozov hospital, all this had long been completed.

V. KARPOV: Then what will happen? What changes do you have in particular?

I. KOLTUNOV: When will it happen? What do you mean?

V. KARPOV: Well, now, in the course of this optimization, when they talk about reducing the medical staff, the number of beds? How will it affect you?

I. KOLTUNOV: We have already gone through a reduction in the number of beds, we have already gone through a reduction in medical personnel, and, unlike many other medical institutions that are now only involved in this process, we can already talk about the results of this process. Summing up the result of this process.

V. KARPOV: That is, you, as an experimental site, have already worked out your own.

I. KOLTUNOV: Yes, we are like a pilot project. There were 4 hospitals in the pilot project, the children's hospital was Morozovskaya, and by this period we had completed all our optimization

V. KARPOV: I would like to ask those people who have come across the Morozov Children's Hospital in the last, probably, year, to call now. Please, let me remind you the phone number of the live broadcast is 73 73 948. And you can say: Yes, there are noticeable tangible changes, and you like it or don't like it. Therefore, you are welcome to our broadcast. We are listening to you carefully now.

Hello, hello!

RADIO INTERVIEWER: Hello, good afternoon! In a nutshell: I didn’t run into Morozovskaya, I ran into Filatovskaya lately. But I want to tell you about the children's clinic. The situation is such that a reduction is coming, doctors are all nervous. Making an appointment, coupons that they give, it does not work. The time that is calculated, but still you sit in line, you sit still. Tellingly, a moment has appeared recently: if earlier, six months ago, all the tests that were prescribed were all done. Now - no, we'll do it all for you, but this one, excuse me, is paid. The doctor explains this by optimizing this process.

V. KARPOV: Well, thank you! A slightly different example, but still close to you, please.

I. KOLTUNOV: You know, not quite close to us. We do not have a polyclinic in the hospital, there is no attached contingent, so I cannot tell you now what the comrade is talking about. I don't work at the Filatov Hospital, so I can't say anything either, I can't comment on this. Yes, indeed today there are a number of services that are not included in the system of compulsory health insurance, as in all countries of the world: acupuncture is not allowed ...

V. KARPOV: Let's clarify: before it was free - now it's paid, for example. Are you talking about these services?

I. KOLTUNOV: You know what happened before, I'll tell you now. Previously, a patient came to the doctor, the doctor didn’t care how he treats him, the doctor didn’t care how many tests he would prescribe, what he would do with him in general. There were no criteria for evaluating the work of a doctor, nor was there any understanding of what the patient is doing and whether he needs to do it all or not to do it all. Today, now they are trying to get away from such situations. Moreover, we have an electronic record in polyclinics, an ambulance has appeared. In theory, I think that this is all a temporary story, that doctors go around nervous. In our country, everyone goes nervous for various reasons, and not only doctors in the hospital. But over time, all this will pass, we are still only moving towards such civilized things as psychological support for doctors.

V. KARPOV: You will also have this provision, and if you have already completed the modernization, you already have it.

I. KOLTUNOV: We also come to the conclusion that doctors need to take a psychological exam. You understand very well that people who are constantly faced with the suffering of people, with seriously incurable patients, people who see death every day, of course, this psychologically affects them. Of course they can be irritable, of course they can be rude. To prevent this from happening, we are now engaged in psychological support for doctors, psychological relief for doctors. We are also starting to do this.

V.KARPOV: In other words, you don't have it yet, but you are in the process now.

I. KOLTUNOV: In the process, we are now testing this system. In the next 2-3 months, this will be constantly functioning with us.

V. KARPOV: A question I had yesterday about the compensation that Sergei Semyonovich Sobyanin promised to the doctors who will be fired during this optimization. Doctors - half a million rubles, nurses - 300 thousand rubles, lower medical staff - 200 thousand rubles. Who is this for? What is this for?

I. KOLTUNOV: It's hard for me to say, I listened to the speech of our mayor just like you. So far, we do not have a regulatory document that would spell out the procedure for paying this compensation, how it will be, to whom, we do not yet have it on hand. Therefore, I cannot say for sure, I do not have any documents.

V. KARPOV: Why is this being done? You probably know, you just don't want to talk about it on the air.

I. KOLTUNOV: No, I don't want anything. But we are well aware that there are terms for training and advanced training, change of specialty. We are well aware that there are a number of highly demanded specialties for which we cannot find a person. Today the problem is to find a very competent ultrasound specialist, the problem is with specialists who can do echocardiography. Unfortunately, unlike foreign specialists, our cardiologists cannot do an ultrasound of the heart themselves, they cannot interpret it themselves. Our general practitioners cannot interpret the cardiogram themselves, and for this we need technological assistants - other doctors, narrow specialists in diagnostics.

V. KARPOV: Will they be retrained somewhere, pay 300,000 rubles?

I. KOLTUNOV: And the person who studies does not receive a salary.

V. KARPOV: And those who will receive half a million, it looks like an attempt to appease the doctors so that they do not become very indignant.

I. KOLTUNOV: No, I do not agree with you. Today, to become a specialist of a different profile, you need to study for more than six months, this is more than 540 hours according to the standard. In fact, a person does not receive a salary for a year. You and I are well aware of our average monthly salary in the industry. This is actually the money that is given to a doctor so that he retrains for the specialty that is in demand.

V. KARPOV: Let me remind you that Igor Koltunov, chief physician of the Morozov Children's City Clinical Hospital, is with us today. Now an information release. We'll come back and continue.

V. KARPOV: 20 hours 36 minutes. Rebound program. At the microphone Vladimir Karpov. Igor Koltunov, chief physician of the Morozov Children's City Clinical Hospital, is with us today. Naturally, we are talking about reform, we are talking about optimization. Your questions are accepted: live phone 73 73 948, SMS +7 925 8888 948.

V. KARPOV: Yuri writes: "Yes, so that the doctors keep silent. Your guest does not want to tell how a document has already been sent to all the chief doctors so that all doctors who come to the rally will be handed over."

So is it or not? They sent you a document stating that you must, firstly, warn everyone not to go to the rally, and secondly, lay everyone down after that.

I. KOLTUNOV: You know, so far I have only seen a document that came to our trade union organization with a call to go to a rally, but I did not receive a document with a call "not to go" to a rally from our department.

V. KARPOV: Will you go to the rally?

I. KOLTUNOV: I will not go to the rally, of course.

V. KARPOV: Why? Your doctors will go.

I. KOLTUNOV: I don't know, maybe they will, maybe not. I can't speak for every specialist.

V. KARPOV: But you asked them not to go out?

I. KOLTUNOV: No, of course not. Absolutely.

V. KARPOV: Why don't you go? Do you support this rally? Do not support the fears of doctors and patients?

I. KOLTUNOV: I do not support the fear that everything will be bad, because we cannot say that we do not know that we do not see. In order to judge something, it is necessary, firstly, to understand it at least. If we want to get some kind of constructive approach to this whole story, please, there are special public organizations, including medical ones and non-medical ones. You can create any working groups, and discuss and watch all this at a qualified level. There are indicators, there are methods that have been tested absolutely all over the world, and you understand that the health care reform that we have today was one of the first, at one time, made by Margaret Thatcher in England. Then Obama spent it in America, Schwarzenegger in California was one of the first to propose health care reform in his state. Now we are in Russia. This is a fairly normal, natural process that follows the growth of new technologies. New technologies are emerging, a new approach to providing medical care is emerging, completely new medical techniques are emerging. Of course, this requires some very different logical approach to the healing process.

V. KARPOV: Correct me. But I have the following feeling: now they are trying to turn medical institutions into some kind of factories to provide medical care for patients. In other words - at a strictly fixed time, the patient must come, in a strictly allotted few minutes, he must be consulted, made a primary diagnosis. After that, he must go to the hospital, where he will undergo the prescribed operation at the strictly allotted time, after which, even for 2 days, he must be carried out. I understand correctly?

I. KOLTUNOV: Partly.

V. KARPOV: What am I doing wrong?

I. KOLTUNOV: With the transition, in accordance with the healthcare reform, to per capita financing, today there is no understanding of the time of admission, in particular, in the outpatient department, as such. Since a certain amount of the population is attached to the polyclinic, and it, this population, may or may not apply for medical help. The capacities of the polyclinic are calculated in such a way that the entire population living, and the frequency of calls is clear to us, these capacities must meet all the needs of the population. And therefore, the time allotted for the reception of the patient, in principle, no longer plays any role. The doctor works calmly, he knows that he will serve all patients, if not today, then tomorrow he will definitely serve them, give them all the qualified assistance.

V.KARPOV: Is there any plan for the shaft?

I. KOLTUNOV: There is no plan for the shaft.

V. KARPOV: To see 20 patients a day - does his salary depend on it?

I. KOLTUNOV: There is no such thing.

V. KARPOV: And what is there? As it will be?

I. KOLTUNOV: I'll tell you again: there is per capita funding. For each person, certain money is allocated for a year in this medical institution. We ourselves understand that we will assume 100 people out of the population, well, I am exaggerating, 50-60 people will ask for help, nothing more.

V. KARPOV: In a year?

I. KOLTUNOV: In a year, yes. That money, which is allocated in aggregate per capita financing, should be enough to serve all those in need. Accordingly, as you and I understand, the more the population is attached to some highly specialized, highly equipped, outpatient diversified institution, the more likely it is to receive qualified medical care there as quickly as possible. There are no regulatory documents on the time of admission of patients.

V. KARPOV: I have a feeling that they did exist before that, because the doctors complained all the time: I don’t have time for you, I have 15 minutes per patient there according to the schedule. That's it, I can't do it anymore.

I. KOLTUNOV: Yes, indeed, it was before the healthcare reform. We did not have a unified computer system in polyclinics, which the Department of Information Technologies of the Moscow City Hall developed and implemented. You and I did not have an electronic record, we did not have the opportunity to sign up via the Internet, we did not have many, many things. You and I did not have equipment that was not just a tomograph, not just an ultrasound, not just an X-ray, but it was all directly connected to a single local computer network. This is an exchange of information, this is a completely different qualitative approach.

V. KARPOV: And now these 15 minutes per patient are being taken away?

I. KOLTUNOV: Yes, there are no 15 minutes per patient, there is no such thing.

V. KARPOV: Well, there were, I didn’t invent it.

I. KOLTUNOV: All that was, it was. Well, you know, a lot that happened.

V. KARPOV: Good. 73 73 948 - live phone. Especially welcome on our air are those people who have recently come across the Morozov Children's City Clinical Hospital.

V. KARPOV: Please, 73 73 948, we are listening to you. Hello!

RADIO INTERVIEWER: Hello!

V. KARPOV: Yes, you are on the air. Please.

RADIO INTERVIEWER: I would like to say that the person you have in the studio literally deviates from all questions, to be honest.

V. KARPOV: Ask the question like this. so that Igor Efimovich does not evade, please.

RADIO LISTENER: Is he for or against the reform?

V. KARPOV: He answered yes at the very beginning. Yes, next.

RADIO INTERVIEWER: But I don't know how to express it, that is, he is for leaving as few polyclinics as possible, as few doctors as possible. What does he stand for?

V. KARPOV: Thank you. Received. That is, look: the time of the broadcast goes on, but the questions remain, but the questions remain the same. So what are you specifically?

I. KOLTUNOV: I am for high-quality, timely medical care.

V. KARPOV: If they reduce the number of polyclinics, will you welcome this or will you rather not like it?

I. KOLTUNOV: You see, I repeat once again: there is no task to reduce something and fire someone. The task is to bring medical care into line with the one that exists today in the modern world, in modern technology.

V. KARPOV: I accept. Here, in order not to go far from the clinics, you need to come to re-register before December 1st in order to clarify for all our listeners. Is it necessary for clinics or for patients, in the end?

I. KOLTUNOV: You need to come to re-register in order to understand how many people we have living in this territory. Unfortunately, in our country, in our city it is not clear: how many are registered, how many are not registered, how many of those registered live, how many of those registered do not live. We have an example of the Central Administrative District of Moscow, where, in fact, the population lives 2 times, probably less than prescribed. Because people rent, offices, etc., etc. Today we have the Central District - the most sparsely populated district. And literally 10-15 years ago it was the most populated. Could you please tell us about polyclinics in the Central District, are they needed there when this population is not there?

V. KARPOV: Probably, for those people who still live there, they are needed one way or another.

I. KOLTUNOV: But in a different amount, probably. And in South Butovo or North Butovo, or, in general, in the south, where new districts have appeared, polyclinics are needed there, they must be opened. Do you think it would be right to reduce the number of polyclinics in the Central District, bringing them to the population that actually exists today, and in that district, southern, southeastern, where there are big problems today, deploy additional polyclinics, create new jobs for the same doctors.

V. KARPOV: Okay, let me clarify. You and I are well aware that not everyone is re-registered, but potential patients of these very clinics. So in the end, how can you trust these data?

I. KOLTUNOV: You know, I'll tell you, they re-register, they don't re-register, how we once solved one problem in the Morozov hospital with compulsory medical insurance policies. A few years ago, when patients were brought in, they often did not have a policy on hand. And what happened: if we go into a single database and see that patients do not have a policy, we cannot provide assistance to them within the framework of compulsory medical insurance, because they are without a policy, they are not insured. But we cannot refuse a patient. What to do? And it is done very simply: we hired a registrar, put him on round the clock, and today in our hospital any patient who comes to us without a policy is issued a temporary policy during the course of treatment, which is then changed to a permanent one. And there are no problems. Directly without leaving the walls of the institution.

V. KARPOV: The problem is being solved this way so far only in Morozovskaya.

I. KOLTUNOV: I speak only for the Morozov hospital, I can't tell you anything about others.

V. KARPOV: Why such a difference between different hospitals, respectively, different attitudes, different treatment programs and everything else?

I. KOLTUNOV: Treatment programs are the same everywhere. The attitude should be the same everywhere, this is what we started today's conversation with. And we started with the qualifications of chief doctors, we started with the standard of medical services and with an assessment of the quality of the treatment process. Now, if we fulfill all this with you, these commandments, these postulates, then everything will be the same with you.

V. KARPOV: So, there is a feeling that these commandments do not yet exist. The same 49% of chief doctors, who were recognized, as if, inappropriate competence. But there is a feeling that there are still no standards that should be met, and if there are those standards, then it is very difficult to meet them.

I. KOLTUNOV: You know, there are standards, it is probably difficult or not difficult to meet them, it all depends on the professional skills of a single person. But really, the process of retraining, including the chief doctors, the process of bringing them into line with qualification skills - this takes time.

V. KARPOV: 73 73 948 - live phone number. We listen to you.

Hello, hello!

RADIO INTERVIEWER: Hello!

V. KARPOV: Good evening! What is your name?

RADIO INTERVIEWER: My name is Olga.

V. KARPOV: We can hear you very well, and Igor Efimovich is already listening to you.

RADIO LISTENER: I want to directly ask Igor Yefimovich a question. Recently, I had a question about the Morozov Children's Hospital.

V. KARPOV: Excellent! We were waiting for you.

RADIO LISTENER: My child is 3.5 years old, he has adenoiditis of the third degree. Decent degree. A planned operation is required. We were given a referral to the Morozov City Children's Hospital. I called there, the nearest help, which can be provided to us free of charge under the MHI policy, is around June-July, not earlier. If I want to do it for a fee - the price is about 80 thousand. Question to Igor Efimovich: He considers this type of assistance timely in this situation, please tell me.

V. KARPOV: Good question. Again, when did you apply?

RADIO LISTENER: The appeal was literally the other day - either yesterday or the day before yesterday. We were diagnosed yesterday.

V. KARPOV: Excellent. Thanks for the question. Igor Efimovich!

I. KOLTUNOV: But as for the cost - open the hospital's website, you will see that the cost is at least three times less, and not the amount that our listener voices.

V. KARPOV: But she did not take it from the ceiling, our listener.

I. KOLTUNOV: There is an official website. You can now open and see.

V. KARPOV: Good.

I. KOLTUNOV: I'm not interfering with the site, you see. The second question, regarding the queue - we have a queue today for the month of January. Indeed, there is a queue, adenoiditis is not an emergency surgical intervention. Removal of adenoids - calmly for a month, two, there is a queue.

V.KARPOV: But, this is not summer. And here we were told that June-July, that's just the listener. If she called the Morozov hospital, someone consulted her, probably by phone, they named the amount of 80 thousand, they also named the term, if free of charge, June-July. And you say that this does not happen.

I. KOLTUNOV: I'm not saying that it doesn't happen. There is such a service, but it costs at least 2-3 times cheaper than the patient announced the amount, you will see on the website. There really is a queue, but for today it is no more than 2 months.

V. KARPOV: No more than 2 months.

I. KOLTUNOV: Yes.

V. KARPOV: And then who to believe, who to contact, how to avoid such consultations if they are not true. How is this problem solved?

I. KOLTUNOV: I think that in this case it is necessary to understand where, what number the patient called. It would be better if the patient contacted me directly. I would gladly accept it and solve this problem.

V. KARPOV: In general, I do not argue. It is always convenient to contact the head doctor directly if you can contact the head doctor.

I. KOLTUNOV: I consider all complaints every day. Every day. Every day I receive an overview of complaints on the Internet from the site, complaints in general from the Internet and written appeals too.

V. KARPOV: That is, if a patient complains about a specific treatment through your website on the Internet, will you consider this complaint?

I. KOLTUNOV: In four days she will receive an answer.

V. KARPOV: All right, accepted. In general, this story with the money that is taken from the patient, how will it be resolved?

I. KOLTUNOV: We pay for the service when the patient starts choosing a doctor. There are cases where people want to see a particular specialist. We pay for the service when it is performed on a convenient day and time for the patient. As you know, every specialist has an 8-hour working day. But the doctor can go to work on Sunday, and on Saturday, on weekends and holidays. As you and I know, there are New Year holidays from the 1st to the 10th, but we don’t have these holidays in our hospital, people go to work, and who wants to earn money, the patient can quickly receive this service. It happens that the patient pays for some additional conditions of stay, this also happens. But today the volume of paid services in our hospital is about 6-7% of the total income of funds.

V. KARPOV: The main thing is transparency. This transparency, in general, is somehow controlled so that it is clear - for what you should, or rather, you can pay extra, and for what - in no case should you, even if someone asks you something?

I. KOLTUNOV: Absolutely exactly. There is a clear understanding, everywhere there are stands with explanations, with laws about what is paid, what is free. Everywhere there are lists of services included in the CHI, not included in the CHI. Each patient signs a consent, an agreement on the provision of paid medical services. Today in the institution we do not have such an understanding about the service as a doctor's home visit. It's only paid. This does not exist in our country and never has. If a person wants - he can go after his working hours, a doctor - I mean, he calmly takes a paid order and goes to the patient's house.

V. KARPOV: No. 686 or 6 writes the following. Our daughter was rescued in the ophthalmology of the Morozov hospital this summer flawlessly and professionally. I don’t know thanks to the reforms or in spite of it, but a deep bow and sincere thanks.

73 73 948 - live phone. We listen to you. Hello!

RADIO INTERVIEWER: Hello, my name is Vladimir. I'm calling about the Morozov hospital. I applied there too. I also have a child with adenoids, they were in the Morozov hospital. We were told that we needed to do an operation, they called the amount. The amount, of course, is not the one that your guest tells you. She was much more. As a result, we were afraid, or rather, we did not have such an amount and decided to apply to another institute. We did not have any surgery, cured and no problems. If they got to Morozovskaya, we would definitely have had an operation, and they would have given us good money.

I. KOLTUNOV: Tell me, you can ask the name of the doctor.

RADIO INTERVIEWER: I can't tell you the name of the doctor, because it was 1.5 years ago, and it's absolutely happening exactly the way the previous person called you.

V. KARPOV: Thank you!

I. KOLTUNOV: First of all, I did not name any amount, if you paid attention, I did not name figures at all.

V. KARPOV: But you said that this is several times less than 80,000.

I. KOLTUNOV: This is the first thing you can see on the website. Second - I don't know which doctor the friend went to, so...

V. KARPOV: Good. For 1.5 years something could change.

I. KOLTUNOV: Yes, of course. We have been reforming for only 3 years, and 1.5 years ago there could have been one of the specialists who would like to make money not quite honestly.

V. KARPOV: Did you carry out any cleansing?

I. KOLTUNOV: No cleansing, this is too harsh a word. But in the Morozov hospital, cash registers appeared already 2 years ago.

V. KARPOV: You said at the very beginning that you had already carried out the reform that the Moscow authorities are now carrying out. How many doctors have you laid off, fired or sent for retraining? How did it happen?

I. KOLTUNOV: The process is quite flexible - layoffs, dismissals, hiring, retraining. I think it's in total. We started with a thousand beds, then we got two thousand beds, then we went back to a hundred thousand beds. We started somewhere with 2600 employees, now we have come to the point that we have 2000-2100 employees. Someone left, someone came. It was a soft, latent process. Roughly, harshly, we did not lay off anyone. Some were not happy with the working conditions. As an example, we have a big problem in Moscow with middle and junior medical staff. Unfortunately, residents of Moscow do not want to work in the hospital as nurses and nurses, especially nurses. And we had to attract residents of other cities: these are Tula, Ryazan, Voskresensk, etc. And they all wanted to work day and night. But you can imagine when a nurse comes to work for you, works for a day, and after three days she reappears. How to control it, what to do with it? It is not even possible to assemble the team of the department. Because they can't come.

V. KARPOV: People from another city, I understand

I. KOLTUNOV: Yes. With the transition to a multi-shift 8-hour working day, newcomers refused such working conditions.

V. KARPOV: That is, Muscovites are working for you now, or are you again accepting some of those who constantly arrive here?

I. KOLTUNOV: There is no understanding - Muscovites or not Muscovites. There is a task for a permanent team to work in the hospital. And to be able to ask this person. And if the nurse worked the night today, I can come and ask in the morning what she did at night. And not so that she already passed the 8th shift and went to her place, and will appear only after 2-3 days again in the hospital.

V. KARPOV: And here is the last clarification. You say that in your Morozov hospital the reform that is being carried out now has been carried out for 2-3 years, and now they are trying to put before the fact that everything will be different from 2015. There are fears that such sudden movements lead to a sharp reaction and unpredictable consequences. There's no such thing?

I. KOLTUNOV: You know, you are probably right that it was necessary to carry out explanatory work with the population. Or maybe this reform coincided with some general tension: the events in Ukraine, now we have refugees in the country. More than 80 people, refugees, received treatment from us this year. And of course, for us this long-forgotten story would be, fortunately, but again we recall the Patriotic War. Of course, there is tension among the people, some economic situations, and everything coincided. It seems to me that now there will be more and more explanations, explanations. And little by little it will all come together.

V. KARPOV: Igor Koltunov, chief physician of the Morozov Children's City Clinical Hospital, was with us. Thank you! Come again!

I. KOLTUNOV: Thank you!

Today, at the weekly planning meeting, the Head of the Odintsovo city district, Andrey IVANOV, announced that on November 6, the regional Ministry of Health appointed Igor KOLTUNOV as the chief physician of the Odintsovo regional hospital. Previously, he worked in the status of acting.

Koltunov himself confirmed this information in an interview with an Odintsovo-INFO correspondent.

Koltunov's big farm

Under the guidance of Doctor of Sciences Igor Koltunov now 4 medical institutions of the Odintsovo district, which were merged into a single structure. Odintsovo Central District Hospital, District Hospital No. 2 (Perkhushkovo), District Hospital No. 3 (Nikolskoye) and Zvenigorod Central City Hospital. All of them now form the united Odintsovo regional hospital. Thanks to the restructuring, all residents of the municipality will be able to receive outpatient and inpatient medical care in a single medical facility.

Governor's Decision

The initiator of the merger of medical institutions is the Governor of the Moscow Region Andrey VOROBYOV. He signed the corresponding order on July 8, 2019.

The base institution will be the Odintsovo Central District Hospital.

The first stage of the transformation is the merger of the four largest medical institutions:

• GBUZ MO "Odintsovo Central District Hospital"
• GBUZ MO "Odintsovo RB No. 2" (Perkhushkovo)
• GBUZ MO "Odintsovo RB No. 3" (Nikolskoye)
• GBUZ MO "Zvenigorod Central District Hospital".

At the second stage, four more institutions will undergo the procedure:

• GBUZ MO "Odintsovo City Polyclinic No. 3"
• GBUZ MO "Golitsyn Polyclinic"
• GBUZ MO "Ershov outpatient clinic"
• GAUZ MO "Clinical Center for Restorative Medicine and Rehabilitation".

As a result, a single "Odintsovo Regional Hospital" will serve more than 350 thousand patients.

Who is Igor Koltunov?

Igor Efimovich Koltunov - Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation.

Higher education, graduated with honors from the Central Asian Pediatric Institute with a degree in Pediatrics. He has the highest qualification category in the specialties "Pediatrics" and "Public Health and Health Organization", as well as valid certificates in the specialties "Cardiology", "Pediatrics", GCP, "Public Health and Health Organization".

Igor Koltunov has been working at the State Research Center for Preventive Medicine of the Ministry of Health since 1994. In 2011, he headed the Morozov Children's City Clinical Hospital (DGKB). He stepped down from his position as head physician in September 2018. At the end of November, he became director of the Scientific and Methodological Gerontological Center "Peredelkino" of the Department of Labor and Social Protection of Moscow.

According to the declaration of income published in 2015, Igor Koltunov earned for 1 year more RUB 8 mln. Then he headed the Morozov children's hospital. Today, when asked by an Odintsovo-INFO correspondent on what conditions he signed an employment contract, the head physician refused to name the amount of wages:

I will fill out a new declaration of income - look at my salary. Now I am not ready to name this figure. Understand, this is not a secret, I just don’t know what my salary will be. But this amount will definitely not be less than now.

ATTENTION!!

You are on the unofficial website of the hospital. The information on this site is outdated and is not a public offer.

For up-to-date information, please visit the official website http://morozdgkb.rf

Doctors of the Morozov Children's Hospital:

Chief physician of the Morozov Children's City Clinical Hospital: Igor Efimovich Koltunov
Deputy chapters medical doctor parts: Elena Efimovna Petryaykina
Deputy chapters doctor for clinical and expert work: Elmira Rastyamovna Samitova
Deputy chapters doctor for infectious diseases: Andrei Evgenievich Angel
Deputy chapters surgeon: Sergey Granitovich Vrublevsky
Deputy chapters doctor for work with nursing medical staff: Yulia Sergeevna Arkhangelskaya
Deputy chapters doctor for civil defense and MR: Alexander Nikolaevich Korolev

Head of the Ophthalmological Department: Leonid Borisovich Kononov
Head of the Department of Neurology, Neonatology, Eye Microsurgery for Infants: Igor Mikhailovich Donin
Head of the Department of Oncology and Hematology: Konstantin Leonidovich Kondratchik, candidate of medical sciences, doctor of higher qualification
Head of the Department of Neurology: Irina Mikhailovna Drozdova
Head of Therapeutic Department No. 1: Natalya Alekseevna Drozdova
Head of Therapeutic Department No. 2: Dmitry Yuryevich Korneev
Head of the Surgical-Boxed Department of Combined Pathology for Infectious Patients: Yulia Valerievna Romanova
Head of the Department of Emergency Surgery and Urology-Andrology: Oleg Sergeyevich Shmyrov, candidate of medical sciences, doctor of higher qualification
Head of the Pediatric Department of Combined Pathology: Inna Romanovna Samsonovich
Head of the Otorhinolaryngological Department: Yuri Lvovich Soldatsky, Doctor of Medical Sciences, Doctor of Highest Qualification
Head of the Department of Gastroenterology: Elmira Ibragimovna Aliyeva, Doctor of Medical Sciences, doctor of higher qualification
Head of the pediatric department: Inna Aleksandrovna Pugacheva
Head of the Department of Traumatology, Orthopedics and Neurosurgery: Mikhail Anatolyevich Petrov, candidate of medical sciences, doctor of higher qualification
Head of the Infectious-Boxed Department for Young Children: Natalya Lvovna Valts
Head of the gynecological department: Elena Viktorovna Sibirskaya, doctor of medical sciences, doctor of higher qualification
Head of the Department of Pulmonology and Cardiorheumatology: Anastasia Aleksandrovna Glazyrina
Head of the Hematology Department: Viktor Yuryevich Petrov, Doctor of Medical Sciences, Doctor of Highest Qualification
Head of the Department of Endocrinology and Hereditary Metabolic Disorders: Irina Georgievna Rybkina
Head of the Department of Clinical Oncology with the Resuscitation and Intensive Care Unit for Hematological Patients: Olga Borisovna Polushkina, Candidate of Medical Sciences, Doctor of Highest Qualification
Head of the admissions department with emergency medical beds. short stay assistance: Nikolai Nikolaevich Kuleshov

Head of the Department of Resuscitation and Intensive Care for Surgical Patients: Dmitry V. Gorokhov
Head of the Department of Resuscitation and Intensive Care for Therapeutic Patients: Lyubov Petrovna Semenova
Head of the Department of Resuscitation and Intensive Care for Newborns and Premature Babies: Konstantin Pavlovich Chusov

Head of the Department of Emergency and Urgent Radiation Diagnostics: Alexander V. Gorbunov, Doctor of Medical Sciences, Professor, Doctor of Highest Qualification
Head of the Department of Anesthesiology and Resuscitation: Evgeniy Vasilyevich Poduskov
Head of the Department of Ultrasound and Functional Diagnostics: Yanina Anatolyevna Galkina, Candidate of Medical Sciences, Doctor of Highest Qualification
Head of Clinical Diagnostic Laboratory: Artem Vladimirovich Bullikh
Head of the pathoanatomical department: Aleksey Nikolaevich Kislyakov, candidate of medical sciences, doctor of higher qualification
Head of the Department of Dentistry: Olga Petrovna Boltova
Head of the Department of Dietary Nutrition: Victoria Petrovna Brovko, dietitian

Head of the Advisory Center: Elena Anatolyevna Zhidkova
Head of outpatient service: Georgy Mikhailovich Zinker, candidate of medical sciences

Branch №1
Head branch: Alexander Alexandrovich Bugulov
Head of the Trauma Rehabilitation Department: Irina Fedorovna Mayorova
Head of the Department of Orthopedic Rehabilitation: Galina Ivanovna Gribova
Head of the Rehabilitation Department: Irina Nikolaevna Ovcharova

Branch #2
Head branch: Natalya Vladimirovna Nikitina
Head of Therapeutic Department: Andrey Alekseevich Sharko
Head of the Department of Neonatology: Vadim V. Anisimov
Head of the Resuscitation and Intensive Care Unit: Oleg Nikolaevich Nakovkin
Head of the Department of Emergency Pediatrics: Natalya Viktorovna Lagutina
Head of the Department of Emergency Surgery: Kozlov Mikhail Yurievich Kozlov
Head of the Department of Radiation and Ultrasound Diagnostics: Vera Ivanovna Lazarenko
Head of the Department of Palliative Care: Nikolai Aleksandrovich Denisov
Head of the admissions department with emergency medical beds. short stay assistance: Sergey Stanislavovich Alekseev

Medicine and society Interview with an expert

Igor Koltunov: "The Morozov hospital is honest, diversified, modern"

He wanted to be a doctor since childhood. He entered medicine in 1985. He believes that a general practitioner and a cardiologist are the specialists who should have the widest range of knowledge. Chief Physician of the Morozov Children's City Clinical Hospital, Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation Igor Efimovich Koltunov tells MED-info about the hospital, medicine and life.

When did you realize that you wanted to treat people?
- Natural craving for knowledge, for knowledge, understanding of how the world works, probably, any person has. A, which gives the most complete and complete picture of how the universe works, how the human body functions and how it has evolved. I always wanted to be a doctor. Previously, for about 15 years I worked as a deputy director of a research institute, supervised medical and scientific issues. And after a while, in practice, he applied all the accumulated skills in organizing the treatment process.

How often do you have to see patients yourself?
“Almost every day I check children in the intensive care unit. I study their medical history in detail. Every day at the morning conferences, we analyze all the difficult cases admitted to the hospital.

Every day for 24 hours, from 150 to 500 children come to the emergency departments on the main territory of the hospital and its branches along with the "Ambulance" and independently apply, of which up to 80% need emergency and urgent specialized medical care.

— Tell us about the Morozov hospital.
- Currently, it is an emergency multidisciplinary children's hospital, providing round-the-clock medical care. Every day for 24 hours, from 150 to 500 children come to the emergency departments on the main territory of the hospital and its branches along with the "Ambulance" and independently apply, of which up to 80% need emergency and urgent specialized medical care.

At the 1st stage, emergency medical care is provided in the emergency department or, depending on the severity of the condition, in the intensive care unit of the hospital. Primary specialized medical care is carried out on short-stay ambulance beds of the admission department, if necessary, hospitalization is carried out in the specialized departments of the hospital. The use of ambulance beds in the admissions department can increase the speed of sorting incoming sick children and optimize the choice of conditions for organizing further treatment, as well as reduce unnecessary hospitalization. Nevertheless, up to 300 children are hospitalized daily in specialized departments of the hospital.

In accordance with the increased requirements for inpatient medical care, primarily high-tech medical care, several new departments have been opened at the Morozov Hospital in recent years: pediatric gynecology, gastroenterology, and modern endoscopy. This gives us the opportunity to treat the patient comprehensively. Thus, a patient hospitalized in a hospital no longer needs the advice of third-party specialists, but can receive all the medical care he needs in one place.

Morozov Hospital currently employs 5 main freelance pediatric specialists of the Moscow Health Department — an ophthalmologist, a hematologist, a gynecologist, an oncologist, and an endocrinologist.

The second task that our institution sets for itself in the near future is to reduce the number of people who are not directly involved in the provision of medical care. At the same time, our requirements for qualifications and training of paramedical personnel will grow. Our nurses must become much smarter and more efficient, be able to perform more technologically complex manipulations, which will allow us to free doctors from these duties, and thereby increase their efficiency. On the basis of our hospital, on the orders of the Department of the City of Moscow, city clinical centers were created, such as the city, the city Center for the treatment of cerebrovascular pathology in children and adolescents (children's stroke center), the city Center for Pediatric Endocrinology, the city Center for Pediatric Rheumatology and the city Center for Reproductive Health of Children and teenagers. Also in our hospital, the clinic of otorhinolaryngology, the clinic of ophthalmology and eye microsurgery, the clinic for urgent and elective surgery, the clinic for planned and emergency neurological care and the clinic for gastroenterology with an endoscopy room, the clinic for emergency and emergency radiation diagnostics are successfully operating. A full-profile advisory center is actively working within the walls of our institution. Moreover, 5 main freelance children's specialists of the Moscow Department of Health work at the Morozov Hospital today - an ophthalmologist, a hematologist, a gynecologist, an oncologist, an endocrinologist.

A year ago, by decision of the Moscow City Administration, it was decided to build a new 7-storey multidisciplinary medical building on the basis of the Morozov Hospital. The task was set to create a high-tech modern medical institution, which will provide all types of medical services in almost all profiles, equipped with the best technologies that we have today in children's healthcare. This will allow us to provide patients not only with the most modern medical care in accordance with European medical standards, but also to create an appropriate level of comfort. Now, unfortunately, this is far from always possible, since most of the hospital buildings were built according to projects from the middle of the last century, when other requirements were imposed on the organization of the medical process.

The main task of the head of any modern children's medical institution, in my opinion, is to make the child's stay in it as non-hospital as possible, to get away from everything that reminds us of the corridor system of Soviet times, when the patient was forced to lie in a 7-8-bed ward . This requirement must be met by interiors, design, and the level of communication with medical personnel. But all this can only be organized in an institution adapted for such purposes, in our case in a new modern building, to which we expect to move in the coming years.

"The main task of the head of any modern children's medical institution, in my opinion, is to make the child's stay in it as non-hospital as possible"

Is being a doctor a profession or a vocation?
— (thinks.) The doctor is both. In any profession. In any profession, a person with a vocation performs better than without it. In addition to human qualities (decency, honesty, conscientious attitude to their work), the doctor must have good basic knowledge and clinical thinking.

— Morozov Hospital is a children's city multidisciplinary emergency specialized medical institution. Continue the phrase "I'm going there because she..."
“Honest, diversified, modern... Over several years of the modernization program, the Morozov Hospital received a total of equipment and funds of about 900 million rubles. This is directly the money that was spent on the purchase of new equipment, and the money spent on the introduction of modern medical standards of treatment and care.

- How to motivate students of medical universities to go to work in the Morozov hospital or in general in free medicine?
— I think that students should first of all be motivated such that medicine is an eternal profession as long as there are people on earth. This is a fairly well-paid profession today. The state and society have already understood this. In addition to bringing good to people and helping them, you can still protect yourself and your family with medical knowledge.

Over several years of the modernization program, the Morozov Hospital received a total of equipment and funds of about 900 million rubles.

- In one of the interviews, you said that the higher the value, the greater the motivation and the higher the efficiency. How to achieve this understanding, confidence that this doctor can be trusted?
- First of all, it depends on the doctor, because the doctor must understand and evaluate the intellectual level of the patient, the complexity of the problem, the disease, and, based on this, select the key points in order to earn his trust. And the patient, accordingly, should not have a deliberate rejection, hostility or aggression.

— I read that the hospital works with charitable foundations. How does communication take place?
— Funds make proposals, talk about their capabilities. When we have an emergency, we turn to them. Or, on the contrary, patients from the fund come and say that the fund will solve such and such issues for them. Or the fund turns to us with a specific patient, whom it is ready to financially support, and sets us a task that we solve.

- You have been the chief physician of the Morozov hospital since May 2011. What can you boast of?
- All achievements are the achievements of the entire team of our institution. In 2013, for the first time, the Morozov Hospital was awarded the title of "Best Hospital of the Year". We have been working towards this for several years. In 2012, we received our first Mayor's Commendation for Health Achievement. I think this is quite enough from the point of view of the administrative issue. As for what has been done for patients, we have completely solved the problem of being in infectious boxes: there is one child in one box. Previously, it was necessary to place two children in one box, because the number of beds declared did not correspond to the number of incoming children. We have completely solved the problem of finding: almost everywhere, except for intensive care, a mother can be with her child 24 hours a day, regardless of the severity of his condition. I'm not talking about the fact that the number of treated patients has increased by 50%. We have developed new technologies, opened new clinical departments. And over the past 2 years, we have joined 5 institutions that have helped us create a more high-tech, complex medical service that is more in demand.

— A parting word to our readers.
- Do not self-medicate and consult a doctor as soon as possible in case of any questions. Do not tighten.

Photos by Oksana Plisenkova
The main photo is provided by the press service of the GKU DZ CAO of Moscow