In his message to the Federal Assembly, Russian President Vladimir Putin instructed to expand the prophylactic and medical examination programs for citizens of all ages from July 1, 2021. This is a very important and timely decision. The coronavirus pandemic was not in vain both for human health and for the entire system of routine medicine.
A number of medical institutions in Moscow and the regions have been redesigned into covid hospitals. This circumstance alone imposed restrictions on routine medical care, its availability and timeliness.
Self-isolation also made itself felt – during the quarantine period, people postponed going to doctors until better times, because they were afraid of getting infected. This means that our chronic diseases during this period could have worsened.
Unfortunately, COVID-19 is not one of those diseases that I “had had and forgot”. Postcoid syndrome often makes itself felt with a whole bunch of neurological consequences and problems with the respiratory system. People have exacerbated cardiovascular diseases, which are “hit” by the coronavirus – coronary heart disease, arterial hypertension. The situation in oncology has also worsened. In remote regions, especially in rural areas, people sometimes had to queue because hospitals were overwhelmed with coronavirus patients or were completely closed for covid hospitals. To get help, one had to go somewhere – often to another city or regional center, and this was not always possible. People preferred to postpone visits to doctors.
Not only the treatment block suffered during the pandemic, but also the diagnostic one. All examinations have faded into the background, and this is fraught with consequences. Late detection is especially dangerous in the oncological field – this can lead to a surge in cases in advanced stages. And only one positive exception was brought by the pandemic – injuries, most likely, have decreased. This happened due to the fact that people stayed at home more.
But I would not link the need for medical examination directly with the pandemic. Preventive examinations are always necessary and relevant. We had problems with them even before the pandemic. What was the strength of the Soviet health care system? The fact that a rigid system of medical examination was in place there – clearly organized, informal, and this made it possible to detect diseases at an early stage and treat them in time.
Unlike the Soviet one, our current health care system is heavily focused on money. And you won’t earn much on medical examinations, so they dropped out of this system. And it is a pity, because the disease is much cheaper to identify and prevent on time than it takes long and hard, and most importantly, it is expensive to treat. The medical examination, which the president is talking about, is also important from the point of view of saving money in the state.
How to set up this system? How to make it work again? It is necessary to introduce an element of compulsion – medical examination should be carried out in workplaces, in schools, and in universities. And most importantly, it must be informal, a person must be examined not for the sake of a tick in the medical record.
Unfortunately, preventive medicine is an area that is difficult to establish at once. It requires resources on the ground, good work of the polyclinic link and separate mobile teams of doctors who would travel to hard-to-reach places and examine patients there. It requires an element of coercion and motivation.
Unfortunately, this is how we are – until the trouble happens, we do not go to the doctor. In order for a person to go for medical examination, he needs to be motivated and pushed.
Finally, it requires a solution to the personnel issue, and there are not enough primary care doctors in the regions.
The subjects and the pre-covid had problems with the availability of health care and staffing, and the pandemic exacerbated these weaknesses. Diseases have accumulated, and now, where treatment could be dispensed with, an operation will be required. Where minimally invasive surgery was previously sufficient, a full-fledged surgical intervention may be required.
But no one knows the exact figures of damage yet. Clinical examination will reveal this picture. Although it is not a fact that it will be possible to compare the well-being of Russians before and after the pandemic, we have not had good initial data for a long time, because there was no good and high-quality medical examination.
The President speaks about the importance of medical examination not only in connection with the pandemic. He recalled about hepatitis C, and about a number of other diseases, the delayed detection of which can lead to death, and about the entire health care system and population policy.
There is a certain continuity in his messages. Last time he instructed the government to strengthen primary care. Now the second step is clinical examination. The next can be an emphasis on the system of rehabilitation and sanatorium-resort treatment – this industry has accumulated no less problems. Medicine has three pillars – prevention, treatment and recovery. And these tasks need to be addressed sequentially.
I think that the health care system will cope with the influx of visits that will happen during medical examination. Still, a global, unbearable defeat of the system during the pandemic did not happen – many hospitals worked in their own mode. In Russia, we went through this period in a more organized manner than many other countries. The strict quarantine in Russia was not so long (and for many it continues to this day). And now, even against the background of a slight rise in morbidity, we still manage to live a normal, full-fledged life.
The author is the head of the Department of Sports Medicine and Medical Rehabilitation of the I.M. THEM. Sechenov, Doctor of Medical Sciences, Professor
The editorial position may not coincide with the opinion of the author