ORGANIZATION OF SURGICAL SERVICE

The course of normal surgical procedure begins with the examine of the surgical departments work group and care of sufferers. Why are the first 12 months college students concerned in sufferers commentary at present and is sanitary observe launched after the tip of the ІІ 12 months of examine?

Sanitary observe and care of sufferers are included into the academic technique of medical colleges with a view to assist college students mastering all information essential for hospital attendants and nurses. The vast majority of college students contemplate that they enter the institute to be a health care provider, however a health care provider ought to know the entire work habits of hospital attendants and nurses and be capable to carry them out higher than his subordinates, and doing like this he shall be a great physician.

The fashionable thought of surgical procedure significantly differs from the previous one. If surgical procedure was thought of to be a medical specialty earlier than, for the final 100 years it had such radical modifications, so at present it’s attainable to reckon it as one of many youngest and quickest creating a part of medication. If earlier than solely folks with varied pathological processes, which had exterior indicators of sickness, went to surgeons, at present the idea of “normal surgical procedure” is getting narrower.

Because of the improvement of anatomy and physiology, the introduction of anaesthesia and preventive measures of surgical an infection, haemotransfusion, surgical procedure obtained fast improvement, which led to showing impartial disciplines: traumatology and orthopaedics, obstetrics and gynaecology, oncology and urology, pores and skin and eye illnesses, otorhinolaringology, and so forth. The specialization is on even these days. The departments of cardiovascular surgical procedure, toracic division, esophagus division, microsurgery, proctology, and so forth. are open. Specialization, actually, is a constructive factor. It provides a chance for extremely expert therapy, however it has its disadvantages. The truth is, earlier than the start of therapy in such a division, one of many medical doctors ought to first make a analysis. So, medical doctors, particularly part medical doctors, ought to have full information of all illnesses. Due to this fact the college learning is carried out in such nice quantity for college students of all schools.

The group of surgical care in the course of the interval of existence of surgical procedure as specialty, had important modifications: from barber, chiropodist, and medical hospitals — to trendy construction. The fashionable surgical service is a part of the medical community. It incorporates medical and preventive institutions, polyclinics — state, jointstock and personal.

Establishments of motherhood and childhood care (maternity hospitals and feminine consultations, youngsters’s homes, boarding colleges, and so forth.) are considerably separated in our nation.

All medical establishments work in keeping with a territorial precept — they serve the inhabitants of a sure space. In massive factories there are polyclinics, medical-sanitary elements, which serve the workers of this manufacturing unit.

The fundamental medical establishment is an ambulance station (from the phrase ambular — stroll slowly on foot). 80% of the inhabitants start and end therapy in out-patient institutions and solely 20% are hospitalized.

The best significance in organisation of medical take care of the agricultural inhabitants, which lives in rural medical territory, have the medical assistant-obstetrics stations (MAOS). They’re essential for a small inhabitants within the nation; the settlements are 3–5 km from native hospitals. There there needs to be two medical staff: the medical assistant and midwife. The first purpose of MAOS is rendering pressing assist in an ambulance station or home, and revealing infectious illnesses. The medical assistant retains in shut contact with the native hospital, refers sufferers who demand medical help and session to it, seek the advice of them with the physician throughout session on the MAOS.

MAOS takes half in prophylactic medical examination of the inhabitants and divulges early types of illnesses and carries out sanitary-educational work.

The agricultural medical ambulance station settles within the nation, its activity — to render the primary medical assist to the agricultural inhabitants, handle the MAOS, and finishing up preventive means.

The polyclinic is a many-profile out-patient medical establishment, which is part of the integrated hospital. Its workers consists of: therapeutists, surgeons, traumatologists, stomatologists, ophthalmologists, otorhinolaringologists and medical doctors of different specialties. Relying on the quantity of attendance they’re divided into 3 classes. In case of greater than 1,000 attendances the polyclinic belongs to the first class. The native physician carries out reception in flip: both within the morning, or within the night. Just lately, the household physician, who carries out therapy of sufferers of a sure area and includes in consultations completely different consultants, was launched into observe.

Enlargement of polyclinics grew to become the essential step, which provides the chance to equip them by diagnostic services and make extra handy for inhabitants.

The principle activity of a polyclinic is diagnostic, therapy, preventive measures of illnesses and experience work capability. For experience of labor capability in a polyclinic medical management commition (MCC) and medical professional fee (MEC) exist. If the affected person isn’t capable of work greater than 4 months, he’s appointed a bodily lack of ability group. The polyclinic and native medical doctors present medical service not solely within the polyclinic however at homes, such a polyclinic physician is named a household physician. The household physician involves the affected person on a name or visits him with out invitation.

The medical middle of well being care is treatment-prophylactic institution on the enterprise or collective farms. Relying on the quantity of staff or collective farmers, they are often medical doctors’ or medical assistants’. At massive factories the middle of public well being providers have been changed into medical and sanitary posts (MSP). The open MSP carried out treatment-prophylactic measures in close by territory, i.e. among the many inhabitants of a given space, the closed ones serve solely the employees of the enterprises. The duty of the MSP is much like the middle of public well being providers’. The MSP physician is the fundamental workshop therapeutist. He carries out dispanserization and preventive surveys, early revealing illnesses, preventive measures {of professional} illnesses.

Because the 40s, prophylactic facilities have appeared in our nation. Preventive measures of illnesses and sanitary-educational work with wholesome individuals are primarily carried out in clinics. There are such clinics: narcological; tuberculosis prophylactic centre; oncological; dermatovenerological; psychiatrical, and so forth. Youngsters’s polyclinics and feminine consultations belong to scientific strategies of service. Employees of the clinics participate in finishing up prophylactic medical examination. In clinics, actually, there’s a hospital, the place sufferers are handled. After restoration, sufferers are on the books for a very long time.

Thus, it’s attainable to attract a conclusion that rendering medical surgical assist within the nation facet and within the metropolis isn’t equivalent. Within the nation facet the primary medical service takes place on the MAOS, then on the rural medical ambulance station, native hospital, and district and regional hospitals. Within the metropolis first assist, as often medical doctors’, is emergency care, then directly the affected person is delivered to a specialised hospital.

Right this moment the medical stations and hospitals of pressing assist are created in all massive cities and settlements of our nation. The Odessa firstaid station was one of many first in Europe. It was initiated beneath direct participation and the technique of a depend N. N. Tolstoi. It was created due to an accident occurred to his daughter, who swallowed a fish bone within the night. The depend Tolstoi despatched for a lot of medical doctors, however no one got here; the physician arrived solely within the morning and eliminated the bone from her throat. After that Tolstoi despatched a messenger into many nations of Europe to seek out out whether or not there have been any medical institutions there offering emergency assist. Such medical institutions in Europe weren’t discovered. Then the station, which had some carriages and medium-level medical personnel, was created.

Now in Odessa, substations of emergency assist and specialised brigades have been organised. If earlier the emergency assist served for fast ship of the affected person to a medical hospital, at present its medical doctors can render extremely expert medical assist.

The surgical assist is given within the district, metropolis and regional hospitals. On this degree relying on the tools and qualification the specialised assist is offered. The administration of the hospitals is carried out by republican scientific institutes and facilities. So, in Kiev, there’s the Scientific Institute of Scientific and Experimental Surgical procedure, and in Kharkov — the Institute of Pressing Surgical procedure. The premise of them is made by the surgical division (hospital).

For profitable therapy of surgical sufferers it’s essential to develop and equip the surgical division. The division ought to reply the quantity of the carried out work in keeping with its objective and specialization. Peculiarity of surgical sufferers therapy consists in creation of particular circumstances which offer, to start with, preventive upkeep of wound infections. The next one belongs to the surgical division: acceptance chamber, wound space (clear and purulent), operation, dressing, manipulation, and likewise loos, bathing, eating room, buffet, chief of the division workplace and medical doctors’ workplace, X-ray cupboard, laboratory and different rooms. The chambers ought to have 1–2 beds. The world — 7.5–9 m2 for every mattress. If there is a chance, clear and purulent departments needs to be allotted. If it isn’t attainable, clear and purulent chambers.

Medical Employees

The top nurse and the pinnacle scrub nurse are by one in every division. For every operational desk there are 2 scrub nurses. One dressing nurse for the dressing room. For each 10 beds there might be one ward nurse within the postoperative wards and one — for 15 beds in preoperative wards.

Junior Medical Employees

The quantity of ward aid-women are in keeping with the quantity of medical nurses. Two aid-women needs to be on the operational room. One aid-woman is within the acceptance chamber, barmaid, door-keeper — 1 put up for the division.

Wards and their Gear

The ward needs to be for 1–2 sufferers. Furnishings needs to be handy and clean, easy-to-wash. There needs to be nothing superfluous. The beds shoud be specialised, purposeful, bedside-table, chair-stool, above-the-bed demountable desk for feeding the severely unwell sufferers (one for each 5 individuals); helps for haemotransfusion and options (one for each 10 beds), stretcher-wheelchair or a wheelchair (one for each 10 beds), a vessel and urine dispenser in a ample quantity. Buffet and eating room needs to be supplied with sufficient utensils.

Working Block

It needs to be remoted from different wards. Home windows needs to be reverse to the north for discount of photo voltaic beam reflection from nickelized instruments on the working area. In the summertime, via fallacious orientation of home windows, the temperature of the air within the working room will increase, which complicates the surgeons work. The working block consists of a variety of rooms related to themselves: working, preoperating, autoclave (working, instrumental), and so forth.

Within the instrumental room the instruments are saved. The surgeon earlier than an operation selects the mandatory instruments, that are sterilized by the scrub nurse. Generally, there are particular units of devices, that are sterilized throughout an operation by the scrub nurse, in keeping with the operation checklist, which is shipped to the working room upfront.

Within the autoclave, as a rule, are dry-heat case and autoclaves.

Preoperative room is the room the place the surgeon washes his arms and places on sterile garments. The preoperative room might be adjoined with a altering room the place the surgeon modifications garments. In some surgical departments surgeons costume in sterile linen, however these days the single-use surgical garb has been utilized. Gear on the preoperative room: sand-glass, three washstands, disinfectant options, steam sterilizer with sterile lab coats, masks and different linen.

The working room is the fundamental room of the operational block. Gear: working tables (minimal two, however no extra), shadowless lamp, little tables for the scrub nurse, a desk for devices, help for basins, fitted with oilcloth, in order that to not create noise from the devices, which helps the haemotransfusions, narcotic resolution units of various marks, a little bit desk for the anesthetist, machine for mechanical air flow of the lungs, defibrillator, diathermocoagulator, electrical pump and different tools relying on the form of operation.

Practical Duties of the Surgeon

Examination, making the analysis, surgical interventions performing, postoperative care of the affected person and medicaments prescription and purposeful therapy, meals, routine of motion.

Performing morning and night rounds; supervising bandages,dressings, haemotransfusion.

Speak and assembly with the affected person’s kin (for this purposespecial time needs to be decided in surgical departments).

Steering and management of the work of the medical nurse, hospital attendant.

Practical Duties of the Medical Nurse on the Surgical Division

Medical nurses of the surgical division are on obligation with out the suitable to sleep. Care throughout an operation (bandage, drainage) enters the duties of medical nurses of the surgical division. The nurse additionally watches over urination, intestinal evacuations and reviews to the physician on obligation or treating physician. Till the affected person lastly wakes up after narcosis, a nurse-anesthesist ought to continually be close to him after that she cross the affected person to the nurse on obligation. Through the obligation the nurse follows the physician’s indications, takes physique temperature, gathers affected person’s excretions for analyses (urine evaluation, faeces, phlegm and so forth.). The nurse prepares the affected person for operation. Over the night time and within the night she provides clyster, processes the pores and skin, carries out preventive measures in opposition to bedsore, fills within the medical documentation, pastes analyses within the case report at night time, writes down passport information. The nurse is the primary assistant to the physician, significantly the scrub nurse.

Scrub Nurse

Her purposeful duties differ from the duties of an on-duty nurse. To start with, it’s preparation of the devices, suturing and dressing materials for the operation. It’s essential to strictly adhere to sterility in the course of the operation. A scrub nurse is personally chargeable for asepsis violations in the course of the operation and for the completely different problems within the postoperative interval, resembling suppuration of operational wounds, and so forth. The scrub nurse organizes over the work of the working room and supervises their present, scheduled and normal cleansing, clothes the surgeon sterile garments, provides the devices in the course of the operation. She is the primary assistant of the working surgeon, and a great nurse ought to know the course of a majority of operations and perceive the surgeon with out phrases. Sending operational materials for histological examination is the scrub nurse’s obligation.

Practical Duties of Assist Lady

An working assist lady conducts a humid cleansing of the working room in the course of the operation and on the finish of the operation checklist, takes half at normal cleanings of the working room at least as soon as every week, brings sufferers to the working room and transports again to his ward, brings dressings, linen and medicines from autoclave and drugstores, washes used surgical devices.

Practical duties of a ward assist lady: alternative of mattress linens and underwear, washing and cleansing the sufferers on the ward, feeding the sufferers on the ward (basically the nurse can perform the identical work), cleansing the wards and manipulation rooms, halls, corridors and locations of normal objective, giving urinals, urine and faeces analyses transport to the laboratory, the lifeless — to the mortuary.

Admission Workplace

The admission workplace of the hospital is meant for reception, registration, examination and sanitary-hygienic processing of sufferers, who’re dropped at the hospital. Sufferers can enter the hospital by polyclinics referral. Sufferers might be dropped at the hospital by an ambulance automobile. In some circumstances sufferers can flip to the hospital with out an appointment card. Sufferers (as much as 15%) might be directed by the professor managing the division (thematic sufferers) to the division on the idea of which clinics (departments) are.

The admission workplace might be centralized and decentralized, as a result of there is a chance of examination with consultants of various profiles (surgeon, urologist, traumatologist, gynaecologist, and so forth.). The reception division consists of a foyer, registry, examination rooms and sanitary controls. In some reception departments, there are beds for short-term affected person supervision and isolators for infectious sufferers. In these hospitals and departments which perform emergency take care of the surgical and traumatologic sufferers, there’s a X-ray cupboard, laboratory, working, dressing room (clear and purulent), reanimation. Every affected person on the admission workplace ought to really feel the delicate perspective of the medical workers.

MEDICAL DOCUMENTATION

Medical surgical documentation has massive organizational, sensible, authorized and analysis values. An inventory of paperwork, which needs to be made, is exactly decided in particular circumstances. Official paperwork, that are ready in the course of the main and following examinations, needs to be full and written on-time by the doctor-surgeon or nurse.

Medical work on the metropolis polyclinic division is recorded within the medical card of the outpatient. Passport information are crammed in on the title web page of this card. On the primary web page of an outpatient’s card there are last diagnoses with an indicated quantity, date of definition. On the next web page the anamnesis, the target information and the meant therapy are described. Decrease marks are made in regards to the sick-lists and vaccinations. The outcomes of extra investigations (gastrofibroscopy, X-ray, ultrasound, and so forth.), medical report after therapy on the hospital are pasted in to the outpatient’s card. At a polyclinic there’s a e-book of sick-lists giving. Whether it is essential to direct a affected person to the medical professional comission (MEC), separate coupon of reference to the sheet of MEC will increase, which comes again from MEC to the medical consulting fee (MCC). For registration of scholars, pupils of technical colleges, colleges incapacity the particular type is accepted: certificates of short-term incapacity of scholars, pupils of technical and secondary colleges.

For route of sufferers to sanatoriums and relaxation houses the sanatorium-resort card is crammed out on the polyclinic.

After visiting sufferers at house by name a e-book of emergency calls is crammed in.

On the hospital, within the reception of the surgical division there have to be a journal of the reception of sufferers and hospitalization refusals, outpatient journal, inpatient journal, journal of people that had traumas, log-book for taking analyses of blood for alcohol check, rabies journal, and so forth. The case historical past is the principle doc on the hospital. This doc has a giant authorized that means. Every physician ought to know this nicely. The passport a part of the case historical past is crammed by the nurse on obligation. Diagnoses on the affected person’s admission and the scientific analysis are written and signed by the physician. All different data within the case historical past are carried out by the ward physician or the physician in cost, the chief of the division certifies it and the pinnacle physician of the hospital checks it.

The registration of labor of the working room of the surgical division is carried out on the operational journal. The next is marked in it: final, first, patronymic title of the affected person, date and time of operation, analysis earlier than the operation and after it, sort of anaesthesia, quantity of anesthetizing substance, title of surgion, course of operation, all problems occurred in the course of the operation, information from the biopsy or histological evaluation of the eliminated materials, finish of the operation, therapeutic of the operation wound, if the affected person died — specify the explanation of dying, with signature of the working surgeon.

On the surgical division blood is transfused regularly. Due to this fact there needs to be a e-book of blood and plasma transfusion, and likewise a e-book of blood substitutes transfusion registration. Accordingly, on the case historical past the report of haemotransfusion is recorded.

College students fill in these paperwork throughout sensible lessons on haemotransfusion. Throughout operation the surgeon removes part of an organ, generally the entire organ, which needs to be despatched for histological evaluation. For this objective, there’s a particular type, which is crammed in by the working surgeon — an appointment card for pathological anatomy analysis of the eliminated tissue.

On the surgical hospitals, the medical dying certificates, which is then mounted in a registry workplace, is given to the kin. On the hospital, there’s a registration journal of preserving and supply of poisoning, robust, and scarce medicines.

The checklist of prescriptions is crammed in daily by the treating physician. The weight loss plan, regime, drug therapy, physiotherapeutic procedures are marked in it. The nurse, after performing these assignments makes a mark in it.

The physician’s on obligation journal is crammed by each physician on obligation. Information about sufferers’ switch, admission, discharge, severely unwell sufferers, all of the operated the day earlier than sufferers and those that have a fever are famous in it.

The analysis, form of operation, diagnostic research (blood and urine analyses, blood group, Rh-factor, X-ray examination, and so forth.), and proposals in regards to the out-patient and sanatorium therapy, sort of sanatorium and its specificity, checklist of medical therapy, which was carried out, have to be written all the way down to the medical report.

The nurse handing over the watching fills within the journal of the watch transmission. The quantity of stock, syringes, hot-water bottles, catheters, probes, thermometers, medication, particularly robust medication, and narcotics is marked there.

In reference to the start of scientific coaching, it’s essential to concentrate to the worth of medical deontology and medical ethics, which college students study throughout all their time period of learning, however components that are essential to know within the 2nd 12 months.

The time period “deontology” (from Greek deon — correct, logos — examine) was launched firstly of the XІX century by an English thinker Bentham because the title of the science about skilled conduct of an individual. Deontology is carefully intewoven with ethics, which is the doctrine of morals, ideas. So, medical ethics and deontology means a set of behavioral norms and morals of medical staff.

Medical deontology isn’t solely guidelines of physician’s conduct, relations of the physician with sufferers, different folks and all medical workers but in addition preparation of medical doctors for the occupation, their aspiration for self-improvement.

The logo of the Worldwide Society of Surgeons declares: “Surgical procedure provides life”.

We should always always remember the traditional precepts: “Don’t hurt to start with”.

Whereas working on the medical establishment the physician, nurse and assist ladies ought to use phrases very cautiously. Japanese knowledge says: “The wound carried out by a knife might be cured, however the wound carried out by the tongue by no means heals”. In reference to this we should always underline the significance of observing medical secrecy. What’s the “medical secrecy”? These are information obtained by the physician from the affected person throughout a dialog or examination and therapy, which shouldn’t be offered in society or amongst relative and shut pals, and information which the physician mustn’t inform the affected person, as it could possibly function a purpose for psychological trauma (dangerous analysis, dangerous prognosis, and so forth.). Nevertheless, you will need to perceive that medical secrecy mustn’t turn out to be a battle to the general public. Medical secrets and techniques ought to all the time exist untill they violate the pursuits of society (hiding a legal, concealing info of infectious illnesses, and so forth.).

Naturally, there are a variety of great questions earlier than younger women and men who determined to dedicate themself to medication, specifically: what ought to a health care provider of our time be like, what qualities ought to he aquire in the course of the years of college learning with a view to carry most profit to folks and society.

Its a great luck if an individual finds his vocation, which is a giant artistic successes. The formation of a health care provider is a troublesome and short-term course of. If we take a look at the previous, it’s essential to find out the decisive motives for the senior technology of the perfect representatives of drugs? Generally, like Mykola Ivanovych Pyrogov’s instance testifies the motives like that happen as if subconsciously, within the early childhood. Meditating on his life means, the ingenious surgeon got here to a conclusion that two insignificant circumstances in his childhood performed a sure position within the formation of his ethical representations and future aspirations. The primary one occurred whereas the small Pyrogov was strolling together with his favourite previous nurse by a financial institution of the small river Jauza. A determined squeal acquired their consideration. It appeared that close to water two boys have been taking part in with a canine, one tried to drown it and one other one tried to intervene. The nurse praised the boy for displaying remorse to the poor animal. These phrases, particularly, by some means have been marked in M. I. Pyrogov’s reminiscence. The second case is related to the well-known professor Ye. O. Mukhin who attended the home; he was invited to a severe affected person with acute articulate rheumatism, who was the elder brother of Nikolai Ivanovich. The environment of respectful expectation of the well-known physician, his solemn arrival in a carriage, imposing look, technique of examination of the affected person, in addition to the truth that Ye. O. Mukhin’s suggestions made a constructive impact (the affected person rapidly recovered), — all of this impressed the boy very a lot. For a very long time his favourite pastime was a house “physician” sport. He admired this sport like a student-physician of the primary 12 months, and honestly, he was not even 15 years previous there.

On the identical age an impressive surgeon, founding father of the primary surgical journal “Bulletin of surgical procedure”, professor of the navy medical faculty, Nikolai Aleksandrovich Velyaminov disregarded his aristocratic household to enter the medical school.

The founding father of antiseptics Joseph Lister, who impressed to “work for the welfare of neighbours”, from the age of 17, started making ready for the physician’s exercise.

The well-known therapeutist Sergei Pavlovich Botkin at younger age dreamed of the mathematic school, however he grew to become a doctor fairly unexpectedly. The primary acquaintance with medication radically modified his intentions.

A professor Theodore Billroth from Vienna, who had a exceptional expertise for music, was going to dedicate his life to artwork and solely after his mom insisting he obtained medical schooling. Not lengthy after he grew to become one of many main feagures of medical science.

What qualities make up a health care provider? I. P. Pavlov considers that a health care provider ought to be capable to analyze the information, however primarily, synthesize them, he ought to be capable to gather the information provided to him by nature. Expertise takes from nature the whole lot he needs, “the information is the air of the scientist”.

Veresayev in his “Notes of the physician” proves how the analysis is established with the assistance of synthesis and evaluation, amassing information, supervision, revealing positive signs and the proper interpretation. He was impressed by the dialogue of the affected person’s situation made by the professor: “Ultimately the professor began making conclusions. He went to them slowly like a blind alongside a steep mountain path: any smallest signal was not omitted however attentively mentioned with a view to clarify any unuseful symptom on which I didn’t take note of, he turned the other way up a retailer of anatomy, physiology and pathology, he confronted all of the contradictions and ambiguities and left them solely after full rationalization… The sophisticated and unclear image which, for my part, was unimaginable to know, turned out to be completely lucid and comprehensible, and it was thought of on the idea of such insignificant information which have been ridiculous to suppose”.

The issue of the occupation is that sufferers will not be alike and wish a person care.

In one in all his letters A. P. Tchekhov famous: “generally medical doctors have very dangerous days and hours. God forbid”. Such days and hours like which can be inevitable physician’s concomitants. Solely he is aware of sleepless nights “with mounted ideas in regards to the future of severely unwell sufferers”.

A exceptional physician S. S. Yudin after the dying of a 30-year previous woman-agronomist accused himself until the tip of life when he didn’t detected intestinal obstruction and prescribed laxatives. And an impressive diagnostician S. P. Botkin couldn’t forgive himself for the dearth of any goal information, didn’t imagine the complaints of a powerful headache of a younger medical assistant, who arrived on the clinic once more after restoration from belly typhus. The younger man was discharged from the clinic with a mark as a “melingerer”, and the following day he died. Post-mortem confirmed abscess of the mind.

An operation, as V. I. Rozhanovsky marks, is a big accountable act which needs to be taken severely, with duty. There are circumstances within the historical past of nationwide medication when severe emotional experiences brought on by sharp feeling of medical duty for a mistake or failure had tragic penalties. So, prof. S. P. Kolomnin (1866) dedicated suicide after the dying of a affected person operated on by him with the utilization of a brand new technique of anaesthesia (cocaine).

In 1928 a preferred doctor-gynaecologist Z. V. Vasilyeva from Saratov started to make use of morphine, being unable to endure the dying of her buddy, a gifted surgeon N. V. Almazova, whom she operated. These circumstances are unique however they show how troublesome is typically duty of a health care provider and the way a lot energy and self-possession are wanted in order that to not be bent beneath its weight.

Therefore comes conclusion that medical doctors ought to handle each other, defend from worries and emotional anxieties, which our troublesome occupation is wealthy in. The instance of such perspective to occupation on the finish of his life is the lifetime of the Leningrad professor P. A. Kupriyanov, an impressive physician for his scientific deserves and honest nobleness. He was severely unwell, and it was time for severe surgical intervention. When the pinnacle of the division addressed to him with the request to designate the surgeon who would function him, P. A. Kupriyanov checked out him amazed and mentioned: “I perceive my situation and I do know that it’s a punishment to function me. Don’t you suppose that I may severely punish anyone of my pals?” There are a variety of examples like that.

Prof. V. R. Rozhanovsky says that some medical doctors and college students are notable for nice indiscretion. They’re prepared to tell sufferers of the mandatory and pointless. There was such a case: one identified pathologist was operated on on the clinic of a well-known Moscow surgeon regarding polyposis of the abdomen. He instructed that earlier than the operation a younger assistant who carried out curation, wishing to strike with erudition, for a very long time and in particulars instructed him (the affected person) in regards to the outcomes of operation in circumstances of polyposis of the abdomen, the mortality share and malignant transformation of polyps, and so forth. Think about, that the affected person — an impressive pathologist who many instances carried out autopsy examination of people that died after such operations, having quite a lot of works regarding this query, was so traumatized by the dialog together with his “physician” that for a very long time after the operation was considering with concern in regards to the impression made by this dialog.

It’s troublesome to be a health care provider, however to be a great physician is way more troublesome as a result of it wants everlasting expertise coaching.