Learn about the exciting events from the autobiography of the popular Russian doctor - MD, MD, a hereditary doctor Myasnikov Alexander Leonidovich. Extracts from the book "How to live longer than fifty years. An honest conversation with a doctor about medicines and medicine. "An impressive interview, the opening of some answers to the most that there are very serious questions.
CONTENTS
How to treat in the US, France, Africa and Russia
It so happened that during my fairly long medical career, I was lucky enough to work in many countries. I worked in Africa, in France, in America.
How I got to war and desire to make money
I remember my first patient in the war well. How did I get to the war? I worked first for a while in residency, then in graduate school, then at the cardiology institute named after my grandfather, and finally defended by radionuclide cardiology. And then I wanted to improve my financial situation, work abroad.
Then, in the Brezhnev era, you could go only to the belligerent country, and then - for a lot of trouble! And now I soon get on a plane that flies to Mozambique. I got to Mozambique without imagining what civil war was. I learned about this only when I boarded the plane. My neighbor asks me: "Where are you going?".I say: "To Mozambique!".He told me: "It's good, just shoot."
And I did not care! I already thought how much money I would make and what I was spending.
Under the contract, I was to receive 382 foreign currency rubles a month. And I thought that these were checks that were sold on the black market at that time, one to two. The amount turned out to be enormous - my father-professor did not receive so much. The highest salary in the USSR was at that time 500 rubles. And here almost three times more! Then my neighbor said that you need to multiply not by 2, but by 4.8.I began to count, I got a fantastic sum, which I could not even imagine. In short, I flew to Mozambique in high spirits.
War, captivity and miraculous rescue
As a result, got into the military situation, saw that there really shoot and people are dying. I worked with a group of geologists, who all, in full force, was captured. Some died. Of the whole group, only two people remained - the translator and I.But this did not stop me: I marked out on the calendar what and when I would buy for a huge salary: a leather jacket, a tape recorder, a TV set.
In African developing countries, there has been no talk of any quality of medical care. They were happy with everything they were offered, so I just worked as well as I could.
In Africa, I first saw a man with his legs torn off. I did not understand what was happening. He took a stethoscope and put it to his chest. But, apart from the sound of his frantically knocking heart, he heard nothing. After a while, I felt that he was cold. In front of me lay a corpse! I was very scared.
Then, of course, I'm used to it. On the ramp to the hospital drove a truck filled with dead and wounded. He dumped them and left, and you wandered around like a hyena, and searched for the living. .. Sorted. In those days there was no such revelry with weapons, as now, nevertheless the eighties. So seeing it all was wild.
The reality difference from the film
There I learned a lot and learned a lot. For example, we look at the cinema, as the hero is tied behind his back. He rubs the rope for a long time and is released. Then, with a heroic blow, someone knocks down and runs. In fact, I saw what happens to the hands when they are pulled together. I was led by six people. They were tied up in the morning, and after dinner they brought to us. So, all six had to amputate brushes, as gangrene immediately formed. Ropes squeeze the artery, the nerve, so much that the blood circulation stops, everything dies.
Africa, the notion of good and evil, other psychology
In general there was a lot of cruelty on both sides. Moreover, a black person treats pain and death in a different way. They have other concepts of good and evil. Once we saved the black man. Cured, fed. And he, having strengthened himself, brought bandits against us!
They have a feeling of gratitude for such situations does not apply, for them the enemy is the enemy.
When they watch our old movies, there is Homeric laughter in the room. There, for example, they show how a soldier falls, gets up, takes a grenade and rushes under the tank. We have tears in our eyes, and they are laughing! They can safely carry a bird or an animal, having turned out its wings or a paw, and thus they are not sadistic.
They eat monkeys, removing the skin from the living. They are different. Therefore, it is necessary to treat them as to others.
France offers a strange treatment
In France, I served as a doctor at the embassy, but did not really understand what was happening around. It seemed to me that the doctors there treat somehow strange. I did not understand that they work by other standards, and I came from a world where there were no standards, where medicine is art. And for them medicine is an exact science, and it is necessary to do it only and in no other way.
America and Russia: Literate and Wild Medicine
Then I was lucky to work in America.
At us medicine divide into American, our Russian and former Soviet. And this is wrong! Medicine is one. But it is literate and illiterate.
In our country, preaching medicine is wild, illiterate. At us the doctor for any clear reasons to him or him names treatment, at times simply absurd. All over the world, not so! Treat according to accepted standards. This does not mean that everyone is the same.
Treatment standards provide you with protection from a fool doctor. And this is the minimum medical care you receive. If the case is more complicated, and medical standards are not provided, the diagnostic thought will develop further, but it is logical.
Doctors in New York will not say that you were treated to idiots in Chicago. All wrong! In New York, the doctor will look at what you were treated in Chicago, look at the results and, based on the standard, try other medications, then the third, if the previous ones did not help. If something goes wrong, he will think about what has been done wrong and why he helps thousands of patients, but this concrete one does not. And work will begin on standards, that is, a further diagnostic process. It is right. It should be so!
I'm still haunted by a dream that I forgot the patient in the ward - I did not look it! And that he lay unconscious for several days. And in America I had a dream in reality. Double rooms, in which patients of different doctors lie.
For example, one patient is led by Team A, and the other by Team B.And then one day a doctor from a neighboring group comes to me."Alexander, your sick man lies there, lies for a week, but you do not approach him!".And there, indeed, a man entered with a poisoning and a strong stomach disorder. When he did, I prescribed him to pour in liquid four liters a day and not feed. And that's all! I thought that he would be treated further by another doctor. He lay, lay, then caught a sister and said that he had long wanted to eat. And she came up to me and asked - and then what to do? I understood that this was really a matter of jurisdiction, but I quickly realized. I came to him in the ward, took out a dropper from him, said that he was absolutely healthy, that he would now be fed and discharged. He was so happy!
Diploma confirmation, passing exams in America
I remember the episode that happened to me in America. I had to confirm my diploma, take medical exams. The fact is that all your previous work experience in other countries is not taken into account here. And I came to America as a doctor with almost 20-year medical experience! He is a Candidate of Science. I had pupils. In short, he considered himself a competent doctor. But that's just what I thought.
Nothing to do, went to take exams. I paid the money and did not prepare, thinking that I would not give it up, but I would score a decent score. He opened examination papers, saw about 700 questions, which must be answered in three hours. And I was surprised to find that there are no talk about usual and common things, such as myocardial infarction, pneumonia, stomach ulcer.
Exam questions were situations, from which you can not immediately find a way out. There were four variants of the answer, you must choose the right ones. But sometimes I did not really understand what was going on. Although there were also simple, for example, how should a pregnant woman fasten in a car.
First, I realized that I did not require fundamental knowledge that would help me all my life. Secondly, I saw that the American spends on reading the question, 50 seconds. And we must read, take a decision and answer in 40 seconds. And if I read every question to the end, I will not have time to pass the exam. Therefore, he created for himself a system of keywords. I did not read the whole question, I just looked for the age of the patient and the main symptom. For example, if an elderly person with bloody diarrhea, look for ischemic colitis in response.
Job search in the US
Finally passed the exam and started looking for work. It turned out to be very difficult. Huge competition - many, many thousands of people for one place! People go for interviews for months. Preference is given to white Americans.
I can not say that this is racial discrimination, it's just that first of all white graduates of prestigious schools are taken. This is very important: if the hospital starts to take Indians, Russians and other foreigners, its rating drops.
Graduates of medical schools do not rush to a hospital where foreigners work. Therefore, we, the newcomers, are admitted only to large hospitals that work like an ambulance. They do not really want to go to work here, they have to plow, plow and plow. Therefore, cheap slaves are employed here, who in return receive an American medical license and irreplaceable experience.
Russian savvy
I also went long enough for interviews. And then one day there was such a case. We were 11 applicants, and all - men. The interview lasted a long time, everyone was tired and, of course, wanted to go to the toilet. And he was on the coded lock. Only for staff. The girl-secretary said, they say, will manage, and if you can not, go to another building. All have reconciled, except for me. I waited until a man in a white coat walked along the corridor, followed him and spied the code in the men's room. And when my turn came for the interview, the director of the hospital began to explain why I did not really fit in: the accent of me, age, scores and points could be higher. I said in response that the language will be tightened in the process of work, of course, of course, can not escape. But I'm the doctor they need! He asked - why do I think so? Compare: before you are well-read students who need to develop and develop reflexes, and I am a person who understands. Ask all 11 applicants for the toilet code on this floor. No one knows, but I'll say: 4-5-1.He laughed and took me out of the competition! So my Russian savvy helped me.
A year later, the same director almost drove me out after the certification committee concluded that I was inclined to make diagnoses based on intuition, and not on strict analysis of all clinical and laboratory data. That is, again it sounded that we Russians are susceptible to intuition, to some kind of sophisticated feeling, not analysis. And in the West, this is considered a major drawback, because of which you can lose your license.
The activities of a Western doctor strictly according to the regulations of
So, the activity of a doctor in the West is strictly regulated. On all there is a scheme of treatment, which you must adhere to. Moreover, if you make the first, second, third, then fifth steps in the treatment, and then you return to the fourth and thereby save the patient, then you will be responsible for deviating from the standards of treatment.
With this there is very strict. This is a serious reason for prosecution. Argument: "But I saved a man!" - does not work, you will be dealt with by a harsh commission. If you treat strictly according to the scheme: one, two, three, four, five, and after that the patient died, no one will say a word to you. It's okay - you did everything you could!
Of course, we, not accustomed to this approach, at first glance it seems that this is complete nonsense. But believe me: deviating from the standards sometimes can really save one, two, three people, but massive non-compliance with the accepted algorithms can kill more than one thousand patients. Therefore, standards in the United States are mandatory.
All doctors can be mistaken and everywhere
Of course, mistakes are done everywhere and everything. For example, in America or in any western country can cut off the left leg instead of the right and cut out the wrong kidney. Unfortunately, there is a problem with paired organs. The frequency of such errors is 0.1%.
Once again I repeat: in America they can cut off the right kidney instead of the left kidney, but they will never prescribe the wrong antibiotic!
At us antibiotics treat all without analysis: it is necessary - appoint, it is not necessary - too appoint or nominate!"Simple and reliable!" - think negligent doctors and naive patients. It's a disgrace that such medicines are sold without a prescription.
Antibiotics started to be created only 50 years ago, and the name of the first patient, cured of severe endocarditis by several injections of penicillin, was preserved. Since then, the uncontrolled use of antibiotics has led to the fact that the greatest discovery of the twentieth century can be reduced to nothing. But we will return to this later.
In America, they can cut off the right kidney instead of the left kidney, but they will never prescribe the wrong antibiotic!
So, in the western medicine there are certain standards, which are followed by all the doctors. For example, everyone is vaccinated: adults and children. The population is annually examined for the purpose of early detection of the risk factor for cardiovascular diseases and cancer.
Once in the USSR, preventive examinations were the norm. Advanced Western doctors have adopted from us such a simple and effective way of taking care of public health. To my great regret, everything that was important in Soviet medicine went to the West, and we have nothing left. In a new country, in Russia, it is not accepted to take care of health. And as a result, I see a lot of fat people in the streets of our cities with a metabolic syndrome on their face.
Metabolic Syndrome
What is metabolic syndrome? This is primarily an increased waist size. If a man has a waist larger than 108 cm, he is at risk of an early death from a cardiovascular disease. Most likely, he has increased sugar, cholesterol and blood pressure. Look at the gray faces of compatriots! Bulging bellies, saggy cheeks and a cigarette in the mouth. Open the refrigerator. What do you see there? Our favorite products: sausage, sausages, sausages. The most naive things!
Meat is a product that is ambiguous and at times dangerous. Red meat( what is not a turkey, not a chicken and not veal) can not be eaten more than twice a week. It is the "red" meat that provokes the development of prostate cancer, intestines and a host of other diseases. Alas, the carcinogenic effect of our favorite sausages is also well known.
But, unfortunately, in today's world these products can not be fully replaced with fish, which is much more useful for health. The fish floats in our seas, and we have already poisoned everything we could. In marine fish, especially in predatory, the one that eats another fish, the content of mercury is very high. So much so that in America, special instructions have been developed, according to which pregnant women are advised not to have sea fish on certain dates more than twice a week. But we digress. Let's go back to medicine!
Differences between medicine of Western and Russian
We continue with the distinctions of medicine in the West and in Russia.
You can argue to the point, and some colleagues do so, figuring out where it's good, and where it's bad. But there are facts that cover all the arguments: people live there longer, and the quality of their lives is higher than the .And we boast that we can drink a bottle of vodka, eat a lot of meat, pack a cigarette and so on. And at the same time we forget that we are dying to fifty, and the average American by this time is only going to get married.
The average American by the age of eighty likes to fiddle around in his garden. His youngest children are of the same age as his grandchildren. His life is full of events - interesting, pleasant and not very much. He travels the world in the 80's and 85's. And at us on a tomb of the person of the same age in Russia children come.
His grandsons, alas, did not wait.
Of course, their tremendous progress in the fight against diseases became possible thanks to the standardization of treatment. And we are just beginning to understand that treatment according to the standard is, in fact, the only correct approach.
Although there was time, and standards existed for us, only they were called differently - schools. School Tareeva, school Lukomsky, school Myasnikov. Around learned scientists, like-minded doctors gathered, developed certain standards of treatment. Once, 30 years ago, I was a young graduate student and I watched how it all began.
The average American by the age of eighty likes to fiddle around in his garden. His youngest children are of the same age as his grandchildren.
The main killers of people. How to treat hypertensive patients and cores in the US
Many years have passed, and the cardiovascular diseases remain to be the main killers of people: heart attacks, hypertension.
Americans quickly figured out what to do. For example, high blood pressure is one of the most important risk factors for the development of coronary heart disease and, as a consequence, heart attack. So the Americans began to give diuretics to all patients with hypertension. Everyone, regardless of who has hypertension. They did not understand, Vasya he or Petya, fat or thin, elderly or young - all diuretics.
It is interesting that 60% of patients had normal pressure, and 40% did not. At repeated visits to the doctor of the second category of patients beta-blockers were added. Again, everyone else. After some time they again came to the reception, and it was found out that uncorrected hypertension is present in 20% of patients. They added vasodilators. As a result, 95% of the pressure stabilized, but for this they had to take all the prescribed tablets of the tablet.
Unified treatment has led to the fact that in the West, hypertension has ceased to have the nature of an epidemic and, as a consequence, the curve of cardiovascular diseases, heart attacks and deaths has gone down. This is just one example of the benefits of standardized therapy. Today, of course, for our doctor this sounds wildly.
I came to America as an experienced cardiologist, and there I was re-trained as a general practitioner. But cardiology has always been close to me. And I was a little jarred, as the Americans understand their work and how they taught me."Alexander," they said, "forget all the research and take it for granted: there are four drugs that are supposed to have any core."That is, if the diagnosis is "ischemic heart disease accompanied by rare attacks of angina", then all such patients, indiscriminately, prescribe beta-blockers, statins that lower cholesterol, aspirin, and ACE inhibitors. All! And we write out all the polls. ""And if someone does not help?" - I asked incredulously."And whoever does not help, you can add a little or two extra drugs. But this is at your discretion and if necessary, "the American colleagues replied.
They are sure of their rightness, because behind them are real results. And we treat our sick patients badly, and therefore we have an average life expectancy of 55 years .This not normal! And they, with their standards and, as it seemed to us at first, a soulless attitude towards the patient are treated well, so they have an average age of eighty.
The average age of an American is 80 years! Oh, what are we bragging about? With his weapon, inflated by "superiority"?- note of the author of the Rainbow.
Is our medicine "correct" and there are none?
Again I repeat: any disputes about the fact that our medicine is correct, but they are not, are broken about the facts. Yes, American doctors are dry, they will never regret the patient as our doctor does.
They will never give a patient more than fifteen minutes of time, unless it is caused by a cruel necessity.
They always tell the patient the truth, they will never regret and deceive, because they do not see the point.
They will talk very harshly and, probably, will not answer additional questions if they consider that everything has been said.
When I was working in an American hospital, my wife and all my friends said that I seemed to be serving in a canned factory. In general, this soulless institution, where sick people are working material. And with unconcealed anguish, I and our Russian-speaking patients, if they got into the hospital, remembered our Soviet, Russian doctors. Our doctors will hold your hand, they will talk and promise.
But, you see, they are probably good nurses, good nurses, but not doctors. Compassionate people who want to help and console. Perhaps, for the best of reasons, they are trying to prescribe a drug, the effectiveness of which is not sure themselves.
In America - no sentiment! Hard, pragmatic approach. The relationship between the doctor and the patient is similar to the relationship between the mechanic of the car service and the client. The doctor says: take this and this, come back in two weeks. He understands: if he has appointed something wrong, the client will sue him and charge him big money. Therefore, no experiments. Quality service for money at a professional level. Get paid-up. If the client has doubts in professionalism - he will not remain silent, and then the professional will not find it very much.
Aspiration of Americans to keep abreast of new advanced technologies in medicine
What is still surprising is the desire of American doctors to be always aware of everything new and advanced. If you want to earn a name and money, then you must constantly learn, develop, improve your professional level.
You are sent daily to the e-mail news of medicine, where you can read about all the latest developments, methods, research. Throughout the world, not only in America, there are many clinical trials of various drugs, and various methods of treatment are being tested. The advanced minds of medicine analyze the retrospective, ie, the situation with the treatment of various diseases over the past years.
As a result, we sometimes get paradoxical, sometimes mutually exclusive results, which, in fact, gives a lot to doctors.
In America - no sentiment! Hard, pragmatic approach.
Cardinal change of viewpoints on treatment with
drugs Let's say that we doctors know that there is such a group of drugs as beta-blockers slowing the pulse and reducing heart contractility. Once, when I first started my practice, they were contraindicated in heart failure. Now with heart failure, this medicine is No. 1 in the world.
But the view on another medicine from the group of cardiac glycosides - digoxin, which was used for centuries has changed. One famous English doctor said: "I would not want to be a doctor if there were no glycosides."But here studied hundreds of thousands of patients who used this drug. It turned out that those who were treated with a glycoside die earlier than those given the beta-blockers .
There are many such examples. Some studies say that beta-blockers have side effects, provoke bronchospasm, narrowing of the bronchi, coughing. Therefore, these drugs were contraindicated for asthmatics and patients with chronic obstructive pulmonary disease.
But from today's point of view, we can and should even give patients these drugs. It is not entirely clear why, but patients with chronic obstructive pulmonary diseases receiving beta-blockers die less often .
These are the clinical trials conducted for several years on a very large number of people, tens of thousands! These studies cost gigantic money, often they are paid by pharmacological companies.
The results sometimes reveal our eyes to the drug, make us look at it completely from the other side, turn our usual notions about treatment. And because these tests, this analysis is constantly, the information also comes uninterruptedly, endlessly. And all the information is posted on the Internet.
And now a patient comes to the doctor who read about all this. And if he sees that you are not guided by novelties and developments, he will not believe you. Such patients in Russia are called omniscients and do not like them very much. We say: "They do not understand anything in medicine, where they are going, this is my medical education!"You know, you do not need to understand the tailoring art to see that the sewn suit is bad on you. If the suit has different buttons on different levels, different lengths of the sleeves, the pants are bubbling on the back, so the tailor is bad. The same with treatment. The patient may not know the subtleties of medicine, but he has the right to ask: why was he prescribed such a medicine while he was ill, and does he have such contraindications that he, the patient, just has? If a doctor starts to fool a person's head or tries to disguise ignorance with highly scientific terms, the patient will believe it very quickly. And run to another doctor.
What should a doctor?
The doctor must read every day, learn everything new. I confess: when I return to work after a two-week vacation, I feel insecure on the first day, because I do not know what has changed during this time. I understand that I lost certain skills, sharp points. This is not so noticeable at the polyclinic reception, but during the watch in the intensive care unit it affects very much. In America, for example, on the first day after leaving the vacation, the doctor is not allowed to the patient. He must adapt, being caught up with colleagues. And it is right.
About America can talk for a long time, there are many things that are useful for patients. For example, they immediately set them up to the fact that they should not engage in self-medication. The doctor is a professional, and if he makes a mistake, he can be deprived of a license and put on trial. It is so firmly in the mind of the population that no one is going into details, knowing that if a doctor has prescribed a pill, then he has good reasons. The patient takes the necessary medications, if they do not help, again comes to the doctor. He appoints another treatment, if it does not help again, then the patient is already attending a lawyer.
In America it's hard to work with Russian patients
It's very hard in America to work with our compatriots. It seems they already live in another country, but the mentality is the same, the Soviet-Russian mentality. They prescribe treatment, and they start asking: "Why do you need this?"How much will I drink this? And if I have a bad stomach? And this will not cause me an allergy? "
For Russia these are natural questions, they are not surprising. And for America it is nonsense.
Sometimes American colleagues asked me to help deal with Russian patients, but I tried to escape them. Because to explain for the hundredth time that everything written out is thought out, that the allergy arises extremely rarely, that yes, the medicine can be dangerous for the stomach, but it is much more dangerous not to drink it. Endless conversations, dreary and useless, interfere with both work and treatment. In Russia, unfortunately, this is in the order of things.
If the doctor has prescribed a pill, then he has good reason.
What happens in Russian medicine?
What is happening in our country is visible to all of us. It is enough to open newspapers or just look around. It is enough to reach any clinic or, God forbid, get to the hospital.
Recently there was a case when "First aid" with a sick baby was not taken by any hospital. Doctors of the ambulance know how difficult it is to hospitalize a patient if he is heavy or non-core.
Once I served as the head physician of the Kremlin hospital and tried to change the situation. There they did not want to take the patients for urgent reasons, they were taken for treatment only by the permission of the chief doctor. All refused, and if someone insisted, they offered to call the head physician - if he gives permission, then we will accept.
I tried to do the opposite. I said: you have the right to refuse only with my permission, that is, with the permission of the chief doctor. Should accept all, and if you want to refuse, then without my sanction can not."With any disease?- doctors asked."And if the craniocerebral trauma, poisoning or something else?" I answered: you must take the patient, stabilize, and then call neurosurgeons or transfer the patient to a specialized department, just without haste.
After all, there were situations when people were brought after a car accident that happened at the gate of the hospital. People were bleeding, but they were not hospitalized, because they coordinated with various instances. Or the patient is a diabetic with a purulent infection, and he is not taken either.
I will not talk about the troubles of our medicine now, it will take too much space. But what you want to talk about is what to do and how we should be pulled to the normal level of medical development. And most importantly - how we ourselves begin to behave a little smarter in relation to their own health.
Practical notes
I worked in a large emergency clinic in the USA.Ordinators - a multinational team: Chinese, Jews, Indians, Russians, Englishmen, French. We work hard, for 36 hours, non-stop, for wear and tear.
I spoke all languages, but I said that I think about some people and their actions, in pure Russian, that is obscene. And here it is necessary to me to start to express the opinion: «Yes what, tra-that-that!». .. The colleague approaches me: «Alexander, called?»."No," I say. Then the situation repeated, and again, and more. One day my other colleague says to me: "Do you know what the name of this Chinese is?" - "No!" - "Just our favorite three letters! And it also sounds. This is his name! ".Horror!
We, of course, laughed. Then I spoke to the Chinese doctor, apologized. He did not take offense, he also laughed. In general, the Chinese are very close to the mentality.
Source: author - Alexander Leonidovich Myasnikov. The book "How to live longer than 50 years: An honest conversation with a doctor about medicines and medicine."Chapter two.
Source of thumbnail-image http: //consult.okpress.ru/ doctor-butcher-destroys-stereotype /
