The catastrophic deterioration in people's living standards, high mortality, demographic crisis prompted the state to pay close attention to the health of citizens. A prophylactic medical examination plan was introduced, providing for a comprehensive examination of the body of the patient who applied for the detected diseases. The system works recently, few know about the procedure. Free prophylactic medical examination for adults and children in 2018 - what is included in the survey, many citizens who care about the state of health would like to clarify.
What is prophylactic medical examination
Many citizens seek medical help when the disease is at an incurable stage, and it is almost impossible to help the patient with anything. If you identify an ailment in the early stages of development, when it quietly smolders in the body, then you can effectively cure a person, improving the quality of life. Comprehensive examination of the body with devices, consultations of specialists of different profiles, sampling of tests includes medical examination. You can get an examination free of charge once every three years. Certain categories of citizens can be tested annually.
Russians do not like to visit the clinic for no reason - to push in lines, to be among patients with the risk of catching an infection, no one likes, so many want to know what is included in the prophylactic medical examination of an adult, which doctors should be visited, what tests to take. Dispensary examination is a voluntary matter, no one will force a person to undergo screening, the state simply encourages people to monitor their health by providing free medical services.
Objectives
Comprehensive diagnostics is aimed at identifying chronic diseases by various examination methods. Statistics say that Russians of different age groups die from cardiovascular, cancer, endocrine and pulmonary ailments in descending order. The initial examination is aimed at detecting diseases of this type. Early diagnosis makes it possible to successfully treat ailments, take preventive measures against the development of diseases, and form the correct attitude towards the health of adults and minors in society.
Program
Medical institutions that have the right to engage in prophylactic medical examinations are guided by the order of the Ministry of Health of Russia dated 03.02.2015. for No. 36an, adopted on the basis of Articles 6724, 6175 of the Federal Law No. 323 of November 21, 2011, establishing the right to diagnostic examinations once every three years for the following categories of adult Russians:
- working;
- unemployed;
- full-time students in secondary specialized and higher educational institutions.
Some citizens may have a physical examination annually. These include:
- invalids of the Second World War, military operations;
- residents of besieged Leningrad, who have the appropriate certificate;
- prisoners of Nazi concentration camps.
The procedure for passing the examination of the body includes two stages of medical examination. At the first stage, patients are identified who have a tendency to develop chronic ailments of a non-infectious nature. If a patient has a disease or a tendency to it due to an unhealthy lifestyle, alcohol consumption, genetic predisposition, and other factors, then a second, in-depth, stage of the study is carried out to clarify the diagnosis. According to the results of examinations, which are part of the general medical examination system, a person is issued a Health Passport.
Organization
Within the framework of the compulsory system of medical insurance for the population, a clinical examination is carried out in a polyclinic, a hospital, an ambulance point, participating in the provision of free medical services to the population. A citizen can appear for screening to identify chronic ailments in the polyclinic department at the place of registration. Responsible for the provision of services are the head of the medical organization, doctors, paramedics participating in the program.
What is included in the prophylactic examination
Children aged 1-17 years undergo a compulsory medical examination in 3-year increments. For adult Russians, the approach is different. Doctors check at the prophylactic medical examination the likelihood of the subject entering the risk category, therefore, you will have to undergo a comprehensive examination, including various screening procedures, at the first stage of the medical examination. The second stage includes an in-depth study of the body, carried out according to medical recommendations with specific procedures and consultations of narrow specialists.
Planned
The method of passing a preventive examination includes a systematic study of the work of human vital systems. Doctors are looking for the "weak link" that can lead to serious illness. At the first stage, the medical examination includes the following studies:
- establishment of anthropometric data (height, weight, mass index);
- checking the levels of upper and lower pressure;
- blood sampling for clinical, biochemical analysis, as well as for glucose and cholesterol;
- ECG for men over 35 years old, women over 45 years old;
- smear for cytology from the surface of the cervix in women under 69 years of age;
- fluorogram;
- Analysis of urine;
- mammogram of the mammary gland of women aged 39-75 years;
- Ultrasound of the abdominal cavity of persons over 39 years old, of the abdominal aorta for people who have worked in hazardous conditions, smoked, inhaled vapors of toxic substances;
- taking feces for blood;
- measurement of intraocular pressure;
- consultation of a therapist.
Additional
If a person has deviations from normal indicators, then an additional medical examination is carried out. The second stage includes the following procedures, according to the testimony of the therapist, who made conclusions at the first stage of clinical examination:
- gastroduodenoscopy;
- diagnostics of the arteries supplying the brain with oxygen;
- colonoscopy;
- spirometry;
- specific blood tests.
What doctors are undergoing medical examination
The initial stage of clinical examination includes a consultation with a therapist, a district doctor, who decides on the analysis of the person who applied for the need for further examination. You may need to contact the following specialists:
- urologist, men 42-69 years old with suspicion of prostate cancer;
- cardiologist;
- endocrinologist;
- neurologist;
- pulmonologist, citizens working in hazardous industries;
- surgeon and (or) coloproctologist over 45 years old;
- gynecologist, women with pathological changes in the tissues of the cervix;
- ophthalmologist, persons over 39 years of age with reduced intraocular pressure, citizens over 75 years of age - with increased.
Adults
People who work in hazardous and hazardous industries may require examination by an oncologist, pulmonologist, and gastroenterologist during clinical examination. If a woman of 35-75 years old has unfavorable breast examination data, then an examination by a mammologist is indicated. Examination of the surgeon is included in the procedure of the second stage of clinical examination, if a person has deviations in the work of the body that require urgent surgical intervention.
Children
Children undergo medical examination, which includes a visit to a pediatrician, neurologist, cardiologist, orthopedist, otorhinolaryngologist, ophthalmologist every quarter until the babies reach 1 year of age. After three years, you will have to go through the above specialists, an andrologist - for boys, a gynecologist - for girls, a psychologist, a speech therapist when entering preschool institutions. Further, every 3 years the child undergoes a compulsory medical examination organized by the school institution.
What tests are passed during the prophylactic medical examination
The planned procedure includes standard, biochemical blood tests, glucose and cholesterol tests, urine collection for clinical analysis. Women take a vaginal smear for a histological examination of tissue cells. The secondary check includes tests according to the testimony of a doctor. These may include the following types of blood tests:
- diagnostics of the lipid spectrum;
- the degree of concentration of glycohemoglobin;
- the level of prostate-specific antigen.
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Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can diagnose and give recommendations for treatment, based on the individual characteristics of a particular patient.
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Clinical examination 2018 - what is included in the examination, doctors and analyzes
Clinical examination is a set of measures, including a preventive medical examination and additional examination methods, carried out to assess the state of health and carried out in accordance with the legislation of the Russian Federation.
Despite the fact that some Russians are skeptical about prophylactic medical examination, so far this is the only free way of early detection of diseases.
Since 2018, examinations have been focused primarily on the diagnosis of cancer and. Neither young people nor the elderly are insured against them, and such an examination helps to prevent the development of diseases or to identify them at an early stage.
It is especially important that risk factors are checked: that is, signs that do not yet indicate the development of the disease, but predict that it may begin. These include high blood sugar levels, off-scale cholesterol, high blood pressure, and other abnormalities. If you correct these violations in time, take them under control, then the development of serious diseases can be avoided or at least greatly delayed.
Recently, an imbalance of cholesterol in the blood is increasingly common in the young population. This does not give any early symptoms, therefore, clinical examination helps in identifying these disorders. In addition, there are congenital and hereditary dyslipidemias (imbalance in blood cholesterol levels). At the first stage, you can identify an increase in total cholesterol, then examine its fractions and prescribe treatment.
Kenan Agayev, general practitioner “Polis. Euromed Group "
How to undergo medical examination
The procedure for undergoing medical examination and the research that it includes is spelled out Order of the Ministry of Health of the Russian Federation of October 26, 2017 No. 869n "On approval of the procedure for conducting clinical examination of certain groups of the adult population" in the Order of the Ministry of Health of the Russian Federation dated October 26, 2017 No. 869n.
There are rules and terms here. The first clinical examination is available at the age of 21, then every 3 years. For children under 17, war veterans and disabled people, an annual set of examinations is provided.
In those age periods that do not fall under the prophylactic medical examination, you can Order of the Ministry of Health of the Russian Federation of December 6, 2012 No. 1011n "On approval of the Procedure for conducting a preventive medical examination" undergo a preventive examination - once every 2 years.
In 2019, it will be the turn to go for medical examination for those who were born in the following years: 1920, 1923, 1926, 1929, 1932, 1935, 1938, 1941, 1944, 1947, 1950, 1953, 1956, 1959, 1962, 1965, 1968 , 1971, 1974, 1977, 1980, 1983, 1986, 1989, 1992, 1995, 1998th. It doesn't matter what month your birthday is: even if you turn 45 only in December 2019, you can go for free examinations right now.
Medical examination is carried out in the clinic to which you are attached. You can get all the necessary information at the reception, in the office of medical prevention or from your local general practitioner. When you go with you, you must have a passport and a compulsory medical insurance policy.
What procedures are available in 2019
For each age group, a set of tests and examinations has been selected that is most likely to help detect serious diseases.
A complete list of procedures carried out as part of the first stage of clinical examination at certain age periods can be found in the Appendix Order of the Ministry of Health of the Russian Federation of October 26, 2017 No. 869n No. 1 to Order 869n.
Here is a list of important studies that are available in 2019 for people of different ages.
- Mammography. For women 39–48 years old - every three years, 51–79 years old - every two years.
- Analysis of feces for occult blood with a sensitive immunochemical method (this analysis allows you to detect intestinal cancer as early as possible). For men and women 49–73 years old - every two years.
- Pap test, that is, examination of a smear from the surface of the cervix (for early diagnosis of cervical cancer). For women 30-60 years old - every three years.
- Determination of prostate-specific antigen (PSA) in the blood (for the diagnosis of prostate cancer). For men aged 45 and 51.
- Measurement of intraocular pressure - from the age of 60.
- Electrocardiography (ECG) is prescribed for men from 36 years old, women - from 45.
You have the right to refuse any procedures and examinations during the clinical examination if you wish. This will not deprive you of the right to other consultations and analyzes. Ours today does not establish any sanctions for those who miss the prophylactic medical examination.
If at the first stage of the complex of examinations the doctor suspects some diseases, he will send you to the second stage. It may include the following procedures:
- Duplex scanning of the brachiocephalic arteries. This is a costly study of the main arteries that supply blood to our brains. It is prescribed for men over 45 and women over 55 if they have three risk factors at the same time: high blood pressure and cholesterol levels, as well as overweight. It is determined by the doctor during the examination by measuring the height, weight and waist circumference.
- Colonoscopy. This bowel test is done if colorectal cancer is suspected - usually if there is a hereditary predisposition and / or occult blood is found in stool tests.
- Consultations of additional specialized specialists and referral for additional analyzes and according to indications.
What examinations have ceased to be included in the clinical examination
Since 2018, general and biochemical blood tests, general urinalysis and ultrasound of the abdominal cavity have been canceled.
These studies were dropped due to their low information content and lack of scientific evidence of benefit. General and biochemical blood tests reflect a large number of changes that can occur in a person very often and are not necessarily associated with serious diseases. Ultrasound of the abdominal organs was removed due to the fact that it detects cancer only at the third or fourth stage, and this, unfortunately, does little to prolong the patient's life.
How is the passage of medical examination regulated by the Labor Code
For most employed people, the main problem with undergoing medical examination is that you need to take time off from work: it takes place during working hours. Therefore, not everyone who is eligible for this service actually receives it.
In 2018, Federal Law No. 353-FZ "On Amendments to the Labor Code of the Russian Federation" was adopted, which supplemented the Labor Code with an article Federal Law of October 3, 2018 No. 353-FZ "On Amendments to the Labor Code of the Russian Federation" (did not come into force) No. 185.1. According to this article, once every three years, one day of dismissal from work is allocated for undergoing medical examination. It will be paid in the amount of average earnings.
With the new amendment, people will become more active in routine examinations. It will also help to identify diseases at an early stage more often.
For retirees and those who have no more than five years left before the exit date, additional opportunities are provided. They will be able to take not one, but two paid working days to undergo medical examination, and every year.
To take advantage of the exemption, employees will need to submit a written application. In this case, the day or days of the medical examination will be determined by agreement between the employee and the employer.
Is there liability for refusal to grant such a day? A special rule has not been established, however, for such a violation, the employer may be held liable under article 5.27 of the Administrative Code of the Russian Federation and a fine may be imposed: for an official - from 1,000 to 5,000 rubles, for a legal entity - from 30,000 to 50,000 rubles.
Clinical examination is a complete examination by medical specialists, in which a predisposition to common diseases is revealed, and the onset of non-infectious diseases and neoplasms is detected.
It is advisable to undergo medical examination every three years. Children are recommended to be examined once a year.
So far, medical examination is being carried out on a voluntary basis, but the Ministry of Health is already planning to make medical examination compulsory.
Medical examination is so important that it will soon be made mandatory for all Russians
What is the global meaning of clinical examination
Health screening is a necessary procedure for every person. Now in Russia, mortality is breaking all records. In terms of mortality per thousand people per year, our country is as disadvantaged as some South African countries.
Why is the mortality rate so high in our country? As a specialist and expert in health psychology, I note that there is a widespread belief among Russians that doctors and officials are responsible for their health, and not themselves. This line of thought leads to dire consequences. Due to irresponsibility and dislike for one's own body, obesity has become common, and even "younger" by about 20 years.
The health of Russians is undermined by the low quality of life, high prices for medicines, difficult working conditions, inability to relax and a vague understanding of the laws by which the human body works.
That is why it is especially important to find time to undergo an examination and get reliable information about your state of health - especially if the state has already provided such an opportunity. The more people undergo medical examination, the healthier the nation will live in Russia.
However, clinical examination, like any large-scale phenomenon, has both pluses and minuses. I propose to get acquainted with the advantages and disadvantages of clinical examination and finally decide how much this procedure is needed for you and your children.
Pros of clinical examination:
- Self-care, development of consciousness, understanding of responsibility for health.
- Awareness of the current state of health.
- Receiving recommendations, consultations for maintaining health.
- Early detection of diseases, prevention.
- The ability to recover without leading to operations and expensive treatment.
Cons of clinical examination:
- Loss of a working day (while a paid day off is not legally established for these purposes).
- You can hear what you don't want to hear; not everyone is pleased to hear that they, for example, have caries.
- Not all tests can be done as part of a free clinical examination (mammography is not always available).
- You need to come back for the test results.
- You may encounter organizational problems: spend more time on examinations, or you will have to go to the diagnostic center in the direction of the polyclinic (for example, for an ultrasound scan or mammography).
How to undergo medical examination
So that as many people as possible undergo medical examination, the state has introduced special conditions for all holders of compulsory medical insurance.
From now on, examinations by the most important doctors can be passed without exhausting waiting in lines. For this purpose, in most polyclinics, medical prevention departments are organized, which can be contacted in order to undergo medical examination.
If your clinic does not have a department of medical prevention, seek the help of a therapist. The doctor will give you a "slider" with the numbers of the rooms that you have to visit in order to undergo examinations, receive marks and signatures of doctors.
What is included in the prophylactic examination
Clinical examination is divided into two stages. Everyone goes through the first stage. The doctor decides who to send to the second stage on the basis of the results of the first stage.
The first stage of clinical examination includes:
- filling out the questionnaire by the patient;
- measurement of height, weight, calculation of body mass index;
- measurement of vascular pressure;
- blood sampling for a clinical blood test;
- collection of urine for a general clinical analysis of urine;
- blood sampling to determine the level of total cholesterol and blood glucose levels;
- blood sampling for a biochemical blood test (for patients over 39 years old, the frequency is every 6 years);
- collection of feces for research on occult blood (from 48 to 75 years);
- fluorography;
- mammography for women aged 39 and older;
- measurement of intraocular pressure for people aged 39 and older;
- Ultrasound of the abdominal cavity and pelvic organs in patients who have reached 39 years of age and older - every 6 years;
- reception of a therapist.
The second stage of clinical examination may include:
- duplex scanning of the brachycephalic arteries (these large vessels are involved in the blood supply to the brain and arms);
- esophagogastroduodenoscopy (examination of the esophagus, stomach and upper duodenum using a special device);
- consultation with a neurologist;
- consultation with a surgeon or urologist: for men aged 42 to 69 years - according to indications; for men, regardless of age - if there is a suspicion of prostate cancer based on the results of ultrasound;
- consultation with a surgeon or coloproctologist - with a positive fecal occult blood test;
- colonoscopy (examination of the inner surface of the colon) or sigmoidoscopy (examination of the mucous membrane of the rectum and sigmoid colon)
- determination of the lipid spectrum of blood - for those whose cholesterol level is elevated);
- consultation with an obstetrician-gynecologist - for women with identified pathological changes based on the results of a cytological examination of a smear from the cervix and (or) mammography, ultrasound of the uterus and ovaries;
- determination of the concentration of glycated (that is, glucose-bound) hemoglobin in the blood or a glucose tolerance test - if there is an increased glucose level;
- consultation with an otorhinolaryngologist is indicated for people aged 75 and older - if there are medical indications based on the results of a questionnaire survey or examination by a therapist;
- a blood test for the level of prostate-specific antigen content - as prescribed by a surgeon or urologist for men with suspected prostate cancer based on the results of a survey, examination, digital examination or ultrasound of the prostate gland;
- ophthalmologist consultation - for people aged 39 and older with increased intraocular pressure, and at the age of 75 and older with reduced visual acuity.
Changes in the rules of medical examination in 2018
From January 1, 2018, a change in cancer screening is “coming” - that is, “cancer screening”. In the age group from 50 to 75 years, clinical examination will take place more often - once every 2 years
In addition, the population of older age groups will be more likely to be tested for oncology. For diagnostics, they plan to use a new immunochemical method, which is more effective in detecting tumors at an early stage.
The most important thing about prophylactic medical examination
Please remember that medical examination is an investment in health, which will not allow you to "start" the disease and bring yourself to the stage of the disease when money no longer solves anything.
Don't waste your time! Sign up for a preventive medical examination, ask questions to specialists through the Medical Note application and be healthy.
The popular dictum that it is easier and cheaper to prevent a disease than to treat it later has rational scientific confirmation. In order to timely diagnose pathological conditions and maintain high indicators of the level of health of the population at the state level, such a concept as clinical examination was formed. What is included in it, why it is carried out, as well as other topical issues on this topic - in this material.
Clinical examination: what is it?
First of all, you should figure out what a clinical examination is. According to the specialized medical dictionary, this term denotes a certain system of treatment and prophylactic work in medical institutions. Such activities are regulated by regulatory documents that determine the volume of medical consultations and research, the timing of their conduct. In addition, the enterprises write an order on prophylactic medical examination for workers who require the specified medical examination.
It is carried out in the clinic at the patient's place of residence. A person has the right to refuse such an examination in whole or in part by writing a written refusal according to the established model and presenting the document to the district therapist (family doctor).
Clinical examination in our country: the history of formation
What is clinical examination, how was such a concept formed in our country? For the first time, preventive examination of employees was introduced into the system of medical services for the population back in 1986. It was during this period that an order from the USSR was issued, according to which so-called preventive rooms were equipped in polyclinics. The essence of the activity of the medical examination departments of the polyclinic was in the annual standard examination of working citizens.
Unfortunately, the organization of such work turned out to be not up to the mark, which led to large expenditures of budget money and their irrational use. As a result of the high employment of district therapists due to routine examinations, the work of the polyclinic as a whole was hampered. Also, importantly, the main purpose of these activities was considered exclusively to diagnose diseases. The development of a treatment regimen and monitoring of the patient's condition were not the responsibility of the prophylaxis offices.
Thus, this system turned out to be ineffective and costly. In this regard, the development of a modern form of prevention of diseases of the population was required. A new era of medical examination began in 2006 - it was then that a new structure and innovative methods of work for medical examination of citizens began to be developed.
The purpose of the medical examination
As mentioned above, the main purpose of the prophylactic medical examination of the population is to preserve the health of the nation. Based on this, the following tasks of such a preventive medical measure can be distinguished:
- diagnosis of diseases at an early stage, determination of the main risk factors for the development of health disorders;
- identification of the facts of the use of narcotic and psychotropic substances by citizens without indications and prescriptions of a doctor;
- professional patient counseling;
- determination of the patient's observation group when health disorders are detected or risk factors for their development are present.
Features of the organization
In the new modern structure of the organization of medical examination, there are the following features:
- A citizen of the Russian Federation who has a medical insurance policy has the right to undergo a free examination.
- A clinical examination is carried out at the place of residence once every three years (you can find out from the therapist what years are allotted for such an examination by an individual patient). In addition, every year you can undergo a preventive examination, which is characterized by a smaller amount of research.
- Responsibility for organizing and conducting medical examination is assigned to a local therapist or family doctor.
- The survey is carried out in 2 stages: standard and in-depth.
- The criteria for defining the concept of "risk factors for the development of diseases" have been developed and specified. This group includes citizens who have the following health abnormalities: poor diet, alcohol abuse, high blood pressure, confirmation of the fact of tobacco use, hyperglycemia, low physical activity, overweight or obesity.
- Expansion of laboratory research methods, which are included in the program of free medical examination of the population.
- The number of health groups has halved. At the moment, patients are divided into 3 groups instead of 6, namely: the first includes people with a low or medium risk factor for the development of cardiovascular diseases, the second - with a high level, and the third - with proven diseases requiring medical attention. Each group of patients is provided with the necessary amount of medical care.
How is the examination carried out?
Clinical examination of adults has 2 stages. A citizen who is sent for examination must have a passport and a medical insurance policy with him. It is also recommended to take the research results that were obtained during the previous examination.
The clinical examination begins in the office of the local therapist - what does it include? Here the doctor will ask the patient to answer some general questions, the results are recorded in the questionnaire. Then the specialist will measure the basic anthropometric data (height, weight, waist, body mass index calculation). After that, the patient is given a so-called route sheet, which contains information about which tests should be passed and which narrow specialists will need to be examined. Thus, the first stage of clinical examination takes place. What is primary medical examination, what examinations the patient will need to undergo at this stage of the examination, is described in more detail in the next paragraph.
The first stage of medical examination
The purpose of the first stage is to diagnose non-communicable diseases, including disorders of the cardiovascular system, diabetes, glaucoma, malignant neoplasms and others. In addition, an important task is to identify risk factors for a patient's health disorders, as well as his use of narcotic and psychotropic drugs without a doctor's prescription.
It will take at least two visits to the clinic to pass the first stage of the examination. For the first visit, you need 2 to 6 hours of free time. Despite the fact that if there is a referral for prophylactic medical examination, there is no need to stand in line, it will take a lot of time for the examination by doctors. What kind of specialists carry out the prophylactic medical examination? Doctors of the following profiles examine the patient at the first stage of a preventive examination:
- therapist (local doctor);
- obstetrician-gynecologist;
- surgeon;
- neurologist;
- ophthalmologist.
Laboratory and instrumental research
What is primary clinical examination, what laboratory and instrumental studies are carried out at this stage of the examination? The exact list of necessary medical procedures is indicated in the patient's bypass sheet. Since such a list is developed individually, taking into account the age of the subject and his anamnesis. The standard examinations for prophylactic medical examinations are as follows:
- blood pressure measurement;
- determination of glucose and cholesterol in blood by express methods;
- clinical and detailed blood test;
- general urine analysis;
- determination of the risk of developing cardiovascular diseases;
- coprogram;
- analysis of scrapings from the cervix and cervical canal for women;
- fluorography;
- mammography;
- Ultrasound of the pelvic organs and abdominal cavity;
- measurement of intraocular pressure.
Often the question arises as to whether an additional visit to a gynecologist is required if a woman has undergone the first stage medical examination? Additional examination will be required only if abnormalities in the scraping results are found.
The second stage of medical examination
If during the initial examination any violations in the patient's state of health were identified, then he is assigned a second additional stage. What is a secondary clinical examination, what is included in it? Such an examination includes the consultation of narrow specialists and the conduct of the necessary tests to confirm the preliminary diagnosis and make a decision on the further treatment of the patient. Namely: the examinee is invited to use the following free medical services (the list is determined according to the indications based on the research results obtained during the initial clinical examination):
- consultation with a neurologist, urologist, gynecologist, otolaryngologist, ophthalmologist or surgeon;
- necessary additional laboratory and instrumental studies.
After the completion of the examination by the general practitioner, the "Health card" is filled in.
Clinical examination of children
Preventive examinations of newborns are carried out by the district pediatrician in the first three days after the baby is discharged from the hospital, on the 14th and 20th days. Then, during the first year of life, parents need to bring the child to a doctor to assess the growth and development of the baby.
Children over one year old should undergo medical examination once a year. It is necessary to get advice from such pediatricians as a neurologist, orthopedist (surgeon), ophthalmologist, otolaryngologist, dentist, speech therapist according to the schedule of preventive examinations depending on the age of the child.
The obtained data of examinations and analyzes are entered into the baby's medical record, if necessary (for example, for admission to a preschool educational institution), a special medical form is filled out.
Thus, we explained what a clinical examination is and why it is carried out. Such preventive measures will help maintain health and increase the life expectancy of the population of our country.
Clinical examination is a method of professional measures carried out for certain groups of persons (citizens), which includes examinations by medical personnel, a series of examinations, interviews (questionnaires), the purpose of which is to maximize coverage of the population to identify the risks of the most significant diseases of non-infectious genesis.
The adult population must undergo clinical examination (on a voluntary basis) on the basis of the order of the Ministry of Health of the Russian Federation of 2015 and is carried out by the primary health care unit. Clinical examination is carried out mainly on a territorial basis.
What are the goals for the clinical examination:
- Identification of the risks of development and the presence of diseases in citizens, leading to the appearance of disabling complications and being the direct cause of premature death.
- Based on the survey results, identification of population groups (health conditions) in respect of which it is necessary to carry out preventive, if necessary, therapeutic or rehabilitation and health-improving measures.
- The result of the medical examination is also professional counseling of citizens (short or in-depth with an individual bias). In some cases, group counseling or special education is provided within the patient's school.
At the conclusion of all stages of clinical examination, when individuals with chronic diseases (or / and complications) are identified, they are taken into account by the appropriate specialists.
The procedure for conducting prophylactic medical examination of the adult population
Dispensary examination implies a two-stage sequential principle. At the first stage, which has a screening nature, symptoms and risk factors for the development of chronic diseases of non-infectious origin, the presence of signs of drug (psychotropic) drug use, alcohol abuse. In addition to research, a questionnaire survey of citizens is used.
Based on the results of this stage, indications are determined for carrying out the necessary additional diagnostic measures to clarify the diagnosis at the next (second) stage of clinical examination. The second stage is called the activities carried out in order to clarify the state of the citizen and the implementation of preventive counseling of an in-depth nature.
One of the fundamental points in conducting clinical examination is the determination of risks - (total relative) for persons from 21 to 39 years old and absolute (total cardiovascular) risk if the age of a citizen is 40-65 years old.
To calculate these risks of death, the so-called SCORE scale is used. This scale takes into account the gradation by age, gender (men and women have different risks), the level of systemic blood pressure, plasma cholesterol figures, the presence of a risk factor - smoking.
The beginning of research in the framework of clinical examination is the year when the subject turns 21 years old. Subsequently, clinical examination is carried out in three years, during the entire subsequent life of a citizen.
After carrying out all the necessary stages within the framework of the clinical examination, groups are allocated (health conditions and dispensary observation), the necessary treatment is prescribed, additional diagnostic steps are taken according to the indications, including those that go beyond the scope of the medical examination. This is done if, according to the results of the clinical examination, the need for specialized (or even high-tech) assistance and sanitary treatment is revealed.
A brief vocational counseling conducted at the initial stage consists of recommendations for a healthy lifestyle, excluding tobacco smoking and reducing the consumption of alcoholic beverages, proper nutrition and optimal physical activity.
Also, if a risk of non-infectious diseases is identified in the patient during the course of clinical examination, especially with the likelihood of severe complications, a conversation is conducted on the rules of behavior in case of their development (principles of first aid, calling an ambulance).
When conducting a clinical examination, a citizen is informed that he can undergo a voluntary, free and, including, anonymous HIV test (indicating the addresses of the laboratories).
It is imperative that before the start of the clinical examination, for its greater efficiency, instructions are given (the order, the sequence of passage, its volume are explained).
Stage 1 of clinical examination: what doctors, tests and examinations?
At the first stage, a special questionnaire is filled out (questionnaire) - the identification of existing complaints, hereditary predisposition, the presence of bad habits, the nature of the subject's motor activity is clarified. Also, during the prophylactic examination, weighing, determination of height, blood pressure, intraocular pressure, diagnostics of glycemia and the content of OH (total cholesterol), fluorographic examination are carried out.
In addition, at the first stage, cardiovascular risks (relative and absolute) are calculated, a study of the work of the heart (ECG) is carried out. Female patients (21-69 years old) take a smear and undergo a gynecological examination. It is mandatory that the UAC is carried out as part of the clinical examination.
Clinical examination (at the first stage) should include such mandatory studies as OAM (urine), feces for occult blood (for early detection of tumor processes in the stomach and intestines). Stool examination should include preliminary preparation (diet).
With a frequency of once every 6 years, the standard includes a detailed and biochemical analysis (after 39 years) of blood. This study during clinical examination includes the determination of the following indicators - total bilirubin, creatinine, liver enzymes.
Also, with a frequency of once every 6 years (after 39 years), an ultrasound scan (ultrasound) is performed. In women, this diagnosis includes examination of the uterus (and appendages), kidneys and pancreas. In male subjects - prostate, pancreas, kidneys. Ultrasound of the aorta (detection of an aneurysm of the abdominal localization) is performed in men (69, 75 years old) with a history of smoking.
At the first stage, for women over 39 years old and up to 69 years old inclusive, clinical examination includes an X-ray examination of the mammary glands (mammography).
To clarify the disease or condition of a citizen, an additional additional examination is carried out, which is not included in stage 1, it is carried out at the second (final) stage of clinical examination. This stage also includes in-depth professional counseling (preventive).
Stage 2 - what is included in it:
At the second stage, if there are indications determined at the previous stage of clinical examination, a duplex examination (scanning) of the brachycephalic vessels (BCA) is carried out. This study is assigned to citizens who have undergone acute stroke or those who indicated symptoms similar to stroke, identified by questioning. Also, an indication for scanning BCA at this stage of clinical examination is the presence of at least 3 factors in a person (obesity or excess weight, hypertension, impaired spectrum of blood fats and cholesterol).
If the respondent at the first stage of clinical examination detects complaints from the gastrointestinal tract, possibly indicating the risk of developing or having an oncological disease of the digestive tract, or in the presence of an unfavorable hereditary history, even in the absence of complaints, EFGDS (endoscopic examination of the stomach, duodenum, esophagus) is mandatory.
Examination by a neurologist at the second stage is prescribed if at the initial stage of clinical examination the patient has anamnestic information about the previous stroke, signs of impaired motor (sensory) activity (in patients who are not registered with a neurologist). Also, an indication for referral to a neurologist at the second stage may be cognitive deficit, suspicion of depressive deviations and dysfunctions (motor and sensory) in citizens over 75 years old.
A urologist or surgeon examines men from 42 to 69 years old as part of a clinical examination at stage 2, as well as in the presence of complaints at any age about urinary disorders and from the genitourinary system, ultrasound of the prostate, suspected cancer in the prostate gland and with an unfavorable family history ( cases of cancer of the genitourinary system in blood relatives).
For men, according to indications and suspicion of a malignant neoplasm of the prostate (data from complaints, questionnaires, examination, ultrasound scanning), as part of the 2nd stage of clinical examination, a PSA analysis is assigned.
A surgeon (coloproctologist) examines citizens sent to the 2nd stage of clinical examination if a patient is found to have a positive test in the study of feces for occult blood, or if, according to the questionnaire data, in persons over 45 years old there was an unfavorable heredity for cancer of the colon or other intestines or familial cases of intestinal polyposis. In the direction of the surgeon (coloproctologist), if necessary, if there is a suspicion of cancer of the colorectal region, as part of the 2nd stage of clinical examination, the patient can be sent for a colonoscopic examination of the intestine or sigmoidoscopy.
Stage 2 of the prophylactic examination of persons who have increased values of total blood cholesterol includes a study of the lipid spectrum of a citizen, which includes the determination of cholesterol fractions (HDL, LDL), triglycerides.
Also, at the second stage, according to the appointment of a therapist, smoking of the patient, suspicion of a disease of the bronchopulmonary system of a chronic nature, as part of the clinical examination, the patient should be sent for a spirometric study.
Women who at the initial stage revealed changes as a result of ultrasound, mammography or cytological diagnostic data (smear), are given a referral to a gynecologist's consultation for further examination and treatment.
If increased glycemia (blood sugar) is detected, to exclude or confirm the diagnosis of diabetes mellitus, the 2nd stage of clinical examination includes a specific study of the level of glycated hemoglobin.
At the second stage, as prescribed by the therapist, the clinical examination may include an examination by an ENT doctor (for persons over 75 years old, according to indications and in accordance with the data obtained during the questionnaire survey).
If at the initial stage of clinical examination in citizens over the age of 39, an increase in intraocular pressure was revealed or there are complaints of decreased vision, patients are referred to an ophthalmologist's consultation.
At the end of the final stage in health centers, in polyclinics, FAP, health centers, clinical examination continues with in-depth professional counseling, individually or in groups in patients' schools. These activities are carried out to citizens who have identified certain risk factors or established diseases.
At the end of stage 2, the therapist examines the patient and summarizes the results of the study, which includes clarifying the diagnoses (diagnosis), one or another group of dispensary observation. At the end of the clinical examination, if necessary, the patient can be referred to other studies (diagnostic interventions), which are necessary to clarify the diagnosis, but are not included in the scope of the medical examination. A citizen can be sent for research, based on the results of which indications for specialized (high-tech) assistance are determined.
Based on the results of the questionnaire, the research of the initial and second stage, the documentation and the card for the registration of medical examination are filled out.