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English Language Page In light of the above it is clear that “the right to choose one’s doctor” is not a luxury, not some secondary superfluity, but what in a psychiatric institution constitutes the fundamental right closely connected with the right to adequate therapy. The psychiatrist who has failed to win the trust or sympathy of a patient or has caused them to feel repugnant may no longer participate in the therapy process. In such cases the doctor must be replaced and everything possible should be done to satisfy this right of the patient. But in the conditions of a serious lack of specialists in most of the psychiatric institutions, when a 100-patient department disposes of only one doctor and one department head, a comprehensive realization of the right of patient to choose their doctor is not possible. However, most of the patients are not aware of their right to choose their doctor and their right to demand under special circumstances that their doctor be replaced. Note that just like in cases when patients are transferred to different wards when they seriously conflict with one another, patients must also be transferred to different departments if they do not get along with their doctor and there is no other doctor in their current department. One should not forget however that when a patient chooses their doctor the consent of the latter must also be taken into account (Article 30, paragraph 2 of the Foundations of legislation of the Russian Federation on health care of citizens). To ensure adequate treatment the patient must have a possibility to access their doctor whenever needed and discuss current therapy whenever it is convenient for the patient and not only when they are summoned by the doctor to “collect anamnesis” or modify therapy. In 70% of all of the surveyed psychiatric departments doctors’ offices were located within departmental limits and patients could speak with the doctor if needed. In some departments (for example, in the Bobrovo-Dvorskaya psychiatric clinic of the Belgorod region) doors of doctors’ offices were always kept open. Offices of department heads were more often found outside their departments but patients could approach the department head during their round. Heads of departments make their rounds regularly, in many departments — daily, but not less than two-three times a week on a regular basis. In addition, heads of departments noted that patients can communicate their wish to speak with a doctor to personnel that is always in the department and their request will be immediately forwarded and satisfied. Perhaps doctors believe indeed that they are quite accessible to patients. In the meantime according to results of a survey conducted by Kazan psychiatrists, as well as data provided by the Independent psychiatric association of Russia, more than 50% of patients of psychiatric institutions complain about not having enough of doctors’ attention, as well as enough possibilities to discuss at length their problems and emotions with them. |
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