Medical units, telemedicine and preparation for epidemics: expert from St Petersburg University on the methods that can help Public Healthcare Service withstand epidemics in the future

He is a professor, Head of Health Management and Medical Law Department at St Petersburg University, and Chairman of the Board of the St Petersburg Association of Medical Law. His suggestions include: restoring first aid medical units; development of telemedicine; lifting of red tape for young doctors; and increased epidemiological training for physicians of all specialties.

COVID-19 has exacerbated an already significant staff shortage in the sphere of medicine. And although insufficient staffing in in-patient care was serious but not critical, the shortage of paramedical personnel has run into thousands. The need for specialists was particularly acute in primary care. ‘To put it simply, the system was crying out for general practitioners in state polyclinics. Primary care was the most problematic, because about 80% of the population start and finish their treatment in state polyclinics. The whole Russian Public Healthcare Service relies on them,’ Igor Akulin explained. In spring 2020, it was general practitioners who were the first to face patients with Coronavirus infection and who were the first to face the exponential growth of requests for medical help.

Doctors’ work has always been tough and intense. They have to see no less than five patients per hour. Most doctors combine work in several branches of the polyclinic not to mention the home calls. These are not only time-consuming but also physically draining given the multistorey apartment houses and distance the doctors have to walk from one place to another. Much time is taken up by ‘paper work’. During the pandemic the workload escalated and GPs worked at the end of their tether.

Also, according to the expert, there were problems with protective equipment for physicians.

In the beginning there was an acute shortage of personal protective equipment. And we must admit that we still have not worked out occupational risks insurance for medical workers during the COVID-19 pandemic.

Igor Akulin, Professor, Head of Health Management and Medical Law Department at St Petersburg University, and Chairman of the Board of the St Petersburg Association of Medical Law

There were problems with material incentives especially in the organisations that treated coronavirus patients without switching specialty. Physicians counted on a pay raise but they did not get it in the beginning. These problems were not solved immediately. There were difficulties with additional payments to paramedics as well. ‘There is an allegation that their contacts with patients are less intense, but it is not true. Their role is often crucial in patients’ recovery,’ Igor Akulin said.

According to the expert, the situation will reoccur. This is not the last pandemic in the history of humankind. Some of the reasons behind it may be: increased migration; climate change; and the possibility of outbreaks of infectious diseases that we have long forgotten about, like plague or splenic fever. Such diseases may be dormant for a period of time and then reappear unexpectedly.

‘It is necessary to reconsider organisational approaches to rapid-deployment beds, respecialising general hospitals into infectious. It is important to pay attention to the changes in personnel: we need to expand the number of infection specialists, immunologists, epidemiologists as well as modify training of all other medical specialists, including paramedics.’ According to the expert, it is necessary that doctors of all specialities study: the problems of treating infectious diseases from the group of highly infectious diseases; epidemiological preparation; and organisational algorithms for correct personnel distribution in case of a sudden illness or an emergency situation.

We need to lift the red tape limitations to allow all doctors to work with patients in such difficult situations. Medical residents and senior students, who already have some work experience cannot work with patients according to the current legislation. ‘We need to reconsider this law and remove unnecessary bureaucracy. Before Perestroika we all worked with patients during the flu epidemic when we were students or medical residents, and it did not raise any questions. It only helped us get more experience and qualifications,’ the expert pointed out.

Unnecessary and extraneous bureaucracy in admittance to the occupation needs reconsidering and probably simplifying. The unite system of professional training of senior staff for medicine definitely need simplifying. Coronavirus showed how cumbersome it is.

Igor Akulin, Professor, Head of Health Management and Medical Law Department at St Petersburg University, and Chairman of the Board of the St Petersburg Association of Medical Law

Professor Akulin reminded about so called ‘civil defence’ training in the Soviet Union. He thinks it is important to teach people the basics of self-help and mutual help. ‘It is especially relevant for policemen, airline companies’ crews, and railway transport personnel. We need to restore voluntary first aid detachments. It was a unique and very useful experience.’

It is important to accelerate the development of telemedicine. It will enable contacts between patients to be minimised, between those who have already been diagnosed and those who have not. Therefore, telemedicine will slow down the spread of diseases and can even reduce the workload of doctors. Today, around 30% of patients’ visits are unnecessary and only take place because patients need advice on their treatment or daily regime.

The expert points out that despite the shortage of personnel, the pandemic showed that during such a stressful situation doctors and paramedics worked with exceptional dedication and determination being driven by humane principles of medicine, integrity and mercifulness.

Igor Akulin underlines that such difficult work as the work of a doctor or a nurse requires enhancing its prestige not only through pay raises: ‘We need to implement changes: we must give medical workers more autonomy and make a shift towards family practice when one physician treats patents throughout their lives and knows them well.’

Participants of the 5th St Petersburg International Labour Forum will discuss how Public Healthcare Service and its staff resources will change after the global pandemic. The event will be held in both Russian capitals in a mixed format from 19 to 23 April 2021. The organisers of the Forum are the government of St Petersburg, St Petersburg University, and the Interparliamentary Assembly of the CIS Member Nations with the support of the Ministry of Labour and Social Protection and the Federal Service for Labour and Employment of the Russian Federation.