Alexey Viktorovich Svet– cardiologist of the highest category, expert in the field of secondary prevention and cardiac rehabilitation, healthcare organization, member of the Russian and European Societies of Cardiology, the European Society of Secondary Prevention and Cardiac Rehabilitation, the American College of Cardiology, Associate Professor of the Department of Preventive and Emergency Cardiology of the First Moscow State Medical University named after. Sechenov

Sometimes you change your destiny with one movement of the pen

– You told how once on your birthday you saved your full namesake, who also had an anniversary.

- Well, yes, I was on duty, and the dark-haired Alexey Viktorovich, my year of birth, was admitted to our intensive care unit with a terrible circular infarction.

– Then you also said that to some extent you were saving yourself...

- Well, that’s just me... I was 30 years old then, now I’m 49, I’m less romantic. But we save ourselves all the time when we do good deeds. Who else will we save? Only yourself. Someone forgets a little that in fact - by being an agnostic, an unbeliever, or whatever - he is actually saving himself. When he's working hard in the operating room or doing something else. He won't feel bad about himself.

1996 MMA im. Sechenov. Photo: Facebook

– And after what incident were you glad that you were a doctor?

– When on the plane they shouted “Doctor, doctor!” ( smiling). I had a case - I was returning from somewhere, and suddenly the flight attendant started asking: “Is there a doctor?” And I was about to get up, when suddenly about fifteen healthy men ran past me. These were anesthesiologists who were flying from the congress, and therefore they grabbed the resuscitated man.

When did I become glad that I was a doctor? I am always glad that I am a doctor. Do you want to ask me when I saved someone and said that he would live? But this is completely uninteresting. Because today you saved someone, but tomorrow you didn’t save someone.

I remember there was a grandfather who forced me to drink a glass of vodka at a conference... He came to Moscow and had a heart attack. They brought him to Pirogovka, and we worked with him night and day. Then he began to recover.

And now the morning conference is going on, and suddenly the door opens, and this grandfather comes out, holding a glass and a red cucumber on a tray. He doesn’t pay attention to anyone, comes up to me, bows and says: “Drink, doctor, to my health!”

– And how did you feel at that moment?

- Nothing! You see, it is impossible to describe it. Do you know why skiers really love their skis so much? Because when you rush around screaming “Ah-ah-ah!” from the mountain, you get such an amount of oxygen in your head that you enter some kind of state of euphoria.

And now, probably, when you succeed, and it could be anything - you could correctly prescribe the drug, and the patient went from one fork in the road to another, you can have time to see something and sometimes change your fate with one movement of the pen. And for this you just have to know a lot.

There are people who don't like me, but they are professionals

– Was it easy for you to make the transition from practical work to managerial work?

– I’m still a quasi-practicing doctor, I haven’t left my practice, I do it at least every day. So that the doctors do not get irritated by some of my remarks during the rounds, I must speak the language of the subject. In this regard, it is easier for a therapist; it is much more difficult for doctors of instrumental specialties.

I go on rounds every day to stay in shape myself, so it was very easy. And there is no feat in this. Colleagues start at seven in the morning - this is how the whole world works.

– What is your typical working day like?

– By seven I arrive at the hospital, reset the clock that had fallen behind during the night - it’s very old, I manage to make myself a cup of coffee, and then I walk 1 km 200 m to the intensive care unit entrance. If I arrive at 7:10, it means I’ve already had coffee at home.

At 7:30 I look at the entrance intensive care unit - this is the intensive care unit where the most serious patients are brought, for example, with injuries after an accident, and I take part in this more as a therapist, rather than as the head physician. And many of my colleagues - Denis Protsenko, Seryozha Petrikov - work as doctors without fail in the morning.

I don’t teach surgeons to operate or obstetricians to deliver babies. But we understand what we are talking about - we are talking about the patient. Which needs to be operated on, nursed, treated.

We have conferences with the head physician several times a week; we resolve some issues on a routine basis, via WhatsApp. I have a number of tasks that need to be completed per day: monitoring a number of things and doing strategic things.

– How were you accepted here as the head physician?

“I remember when I first came here, one doctor said: “Alexey Viktorovich, how good it is that you are here!” I ask: “What am I like for you?” - “Seventh.”

I am part of the interior to some extent. Chief doctors change often. We need to perceive not you, but what you do.

I think that I am perceived well, no worse than everyone else.

– Did you have to fire people?

- It happened like that. I fired more people here than my two predecessors, for sure, because I was not satisfied with their professional level. But all the decisions that were related to firing people were quite difficult for me.

– When do you realize that the person is yours?

– How can I tell you... Yes, I can make a mistake about a person, but I rarely make a mistake about a professional, let’s put it this way. And if his human nuances do not interfere with professionalism, a person can be anything he wants.

There are people here who don't like me, but they are professionals. And I never touch them. But if he doesn’t love me and he’s not a professional, then it will be difficult for us to get along together.

The duty of the chief physician is to know what they feed in the hospital

– They say that for a whole year you forced the head of the food block to eat food that was prepared for the sick. How was it?

- How? Here is the food. I understand that in my right mind and good memory I would not put this food in my mouth. It is the responsibility of the chief physician to know what they are fed in the hospital. I say: “Please call the boss to me.” Comes. I ask: “Do you want some tea?” And I bring it to him: “Try it.”

- And so the whole year?

- Well, not like every day...

– What’s the result?

“Then they appointed another person.” But he’s probably already heard a lot... Well, how? Listen, I say again: “Do as I do, don’t do as I say.” I do not know how to explain it. They won't believe you. And if they don’t believe you, it will affect the patients. And so at least there will be some crumbs...

– What else can piss you off?

“Everything pisses me off all the time, I’m the chief doctor.” Besides, I have an explosive temperament. But I'm learning, learning. There were, are and will be difficulties - this is an integral part of the work.

– Your office is just a museum of rare things. Are you comfortable being here?

- Yes, it’s cozy. Although from time to time I feel like a minister of the tsarist government, creaking the parquet floor, I approach the window, around the panel, there is a portrait of Golitsyn. And outside the window is the 21st century, a completely different story...

– Don’t you want to modernize it?

– It’s quite modern. Right now, right here, you and I can look into any operating room, I can find out how much money is in which accounts. And this doesn’t require high-tech, it requires brains.

And pay attention: all the portraits are copies, but the portrait of Fyodor Rein is the original. And his eyes are completely alive. And every evening Professor Rein looks at me, who in 1915, being a German, on a wave of leavened patriotism, became an honorary citizen of Moscow. And in 1923 he became an honorary citizen of red Moscow. He was an honorary doctor and knew his business. And he looks at me like that every evening.

- And how do you feel?

– I feel responsibility and some kind of connection.

It doesn't matter how many tomographs you have, what matters is what you do with them

– What are you proud of as the head physician?

- People. I am proud that I managed to accumulate around me a very large number of people who are smarter than me, and that these people go to work not just to receive a salary, but to perform this service.

In fact, by and large, it doesn’t matter to me whether they are good or bad people.

But a good doctor cannot be a completely bad person. This still contradicts his mission.

I treat very many people sincerely and humanly well. I have a friendly relationship with many in this hospital. But it’s not like they hit me on the shoulder and say: “Hello, Lekha,” but I shake hands with everyone. And people do not lower their eyes and smile.

– First Gradskaya is one of the few Moscow hospitals where access to intensive care is open...

– If your relative is in intensive care, please come. They will tell you everything, show you around, you sit with him, hold his hand. I welcome this. We don’t do this around the clock - we have an emergency hospital, but during the day and in the evening - for God’s sake.

It's just that sometimes doctors may ask you to wait if they need to revive someone. But I don’t have a single complaint about resuscitation at all. From my point of view, all these closed doors are needed only so that the staff can hide something and gain cheap popularity somewhere, and that’s all!

On the other hand, I don't invite everyone. My beloved Yuz Aleshkovsky had an imaginary art gallery, and one of the paintings was called “Misha Botvinnikov’s mother at a gala reception at the gynecologist.” Well, you see, you can’t turn prayer into a farce. We have screens for patients, but not all patients want their relatives to see them. But, as a rule, there are much more of those who want to. Screens may not be enough sometimes, but I try to make sure there are enough.

– What have they done better in the hospital in terms of treatment?

– As one of my colleagues says, we began to do things that we would never even touch in our lives. A patient arrives with pulmonary embolism - this is a difficult story - and needs to be administered a drug that thins the blood, but she is bleeding from a disintegrating uterine tumor. And you must understand what you will do.

But modern technologies are such that it is possible to close the uterine vessels, turn off the uterus and then still perform thrombolysis so that the patient can breathe, and then take her on the table and operate. And sick at home. Previously, she would 100% die. So you ask about the feeling. Can you compare it to something?

- Miracle?

- No, what miracle? Half an hour later you went out into the street, and you were scolded at the health department because you didn’t do something, and they are right, because you shouldn’t forget about it either.

Your task is not to treat just one patient with thromboembolism, but to ensure that all doctors treat patients with thromboembolism well. This term “multidisciplinary team” has become firmly established, but the patient is treated by several doctors at once. Never in our life is only an anesthesiologist-resuscitator caring for a patient in the intensive care unit. It is led by a surgeon, cardiologist, clinical pharmacologist, and psychologist.

– And a psychologist?

– Of course, I have a clinical psychology department. I don’t know, however, with whom psychologists work more – with doctors or with patients, but they are needed, they are in demand. When I did this, so to speak, I realized that someone had to treat the doctor.

The hospital began to treat better and teach better, and this is not said by me, but by me, and not by the same people whom I can suspect of some kind of sycophantic feelings. But I am a supporter of the theory of small everyday things. Every day you have to do something.

– These things are hardly possible without funding...

“We already have a lot of it, but funding will not solve the problem. It doesn’t matter how many tomographs you have, what matters is what you do with them.

But the fact that we began to do things that we had not done before, and began to pull out patients who had not been pulled out before - wow. But this is the merit of the people. You see, I am not downplaying the role of the individual in history, but history itself flows so quickly that... I began to treat everyone.

Doctors should be interested, patients should not be in pain

– What, in your opinion, should be the ideal hospital that you strive for?

– I am not striving for an ideal hospital. I strive for the perfect construction of medical history. Perhaps for me it is the Mayo Clinic, Heidelberg Medical University.

– What is the main criterion of ideality, so to speak?

– Doctors should be interested, patients should not be in pain.

– Some patients say that the hospital is about pain.

– The hospital is about life. While we live, everything is about life. Mayo's coat of arms has three shields, one large and the other two smaller. The biggest shield is the patient. The patient is at the forefront. Shields are slightly smaller - scientific research and education of doctors. All. This is the ideal hospital.

– That is, that same “patient-centeredness” that everyone is talking about now. Do you like this word?

- No I do not like. Because it's kind of a clumsy word. There are words “complicity”, “involvement”, “compassion”.

– How do you feel about the phrase “medical service”?

– I think it’s very wrong that they began to treat us as a service industry.

I never treat medical services at all. I relate to doctors.

There are a lot of unresolved issues - I will never solve them, but all my life I will

- How did you become one?

– I have such a very motley family – there were artists, lawyers, chemists, physicists, psychologists – mostly people of intellectual work. Dad is a physicist, mom is a doctor. But, firstly, you don’t become a doctor at the age of 17 when you go to medical school. Although someone can. Some twenty years later, while others never do.

In my situation, everything was decided by the people I met. In my second year I liked the physiology teacher. He read well and taught seminars. And I began to study physiology to be on the same wavelength with him. Then there was a microbiology teacher. And in the third year, my mother, a doctor, said: “Lesha, go to Abram Lvovich Syrkin.” I went and am still with him. He was a strapping 63-year-old then, but now he is 87.

True, I must say that in the first year I did not go to college and worked as an orderly in the 4th city hospital. At eight in the morning I arrived at work, washed my hands according to the Spasokukotsky-Kochergin method. These are all such greetings from history. It is very important for me to understand continuity, a certain theory of handshakes. My boss shook hands with Vinogradov, and he shook hands with Zakharyin, and he shook hands with someone else.

And I worked in this hospital, so to speak, not out of fear, but out of conscience. And then I realized that, of course, I would go to medical school. First, you probably need to go through such a physical initiation, let's call it that. You can be a very good doctor, but if you can’t immerse yourself in all this without giving up...

But even this is not the most important thing, perhaps. Again, I shamelessly quote my teacher, whom one very famous person asked: “Abram Lvovich, how do you love your patients so much?” And Abram Lvovich said: “I don’t love anyone, but I have compassion for everyone.” Do you understand?

– What is the difference for you between “love” and “compassion”?

- It's a difficult question. Compassion does not affect the entire spectrum of emotions; compassion is pity, participation, understanding. Love is a feeling that defies description. It simply is. Compassion can be more or less, love cannot be more or less. It either exists or it doesn't.

There are things, so to speak, completely unconscious - love for children, parents. And you can't explain why it is there. I love my parents, children, my wife. And perhaps what makes medicine so interesting is that it raises many more questions than it gives answers.

– Do you have any unresolved issue?

– Yes, I still have a lot of unresolved questions. After all, a person spends his whole life solving some global issues, but I haven’t solved these. And we solve tactical issues every day.

– Which ones are global?

- This is to change the world, so that all sick people do not suffer, so that everyone gets better. I will never solve them, but I will throughout my life.

Understand, this is not pathos, but I don’t even put them in front of myself. I have so many things to do, starting from “fixing the visor in traumatology so that it doesn’t fall and hit anyone in the head” - I also have to keep an eye on this - to understanding when my new arrhythmology will start working and they will start to come out of building computed tomographs, but how will I teach residents, and what will I do with neurosurgeons? Do you understand? Therefore, it is not always fun and joyful, but it is always very interesting.

There is nothing to be ashamed of, but praise is still far away

– You once said that “it’s a shame not to study.”

- Well, of course. But this is absolutely not my prerogative, but the prerogative of any person, because a fool is dangerous.

Imagine if I don’t know something and don’t understand how to use my knowledge. Knowledge is a kind of mosaic that you have to put together. And some people have 60 cubes of this mosaic, and others, like me, have 16. But I will combine my 16 and slowly add them.

I have no illusions about my great intellectual superiority. But it is important not only to know, but also to use this knowledge, and this requires practice. You should see the sick every day, but you also need to read.

When I became the chief physician, I found myself reading or watching something for 30-40 minutes, because now the speed is such that you fall behind instantly.

You’re not even a squirrel in a wheel, you’re a squirrel on two legs in a wheel, you can’t keep up, because the amount of information, knowledge, and their application is absolutely colossal. If we talk about anesthesiology, then this is just a symphony orchestra.

– Do you have any way to quickly relax in this mode?

– I love good books. I carry a PocketBook with me all the time, and I can open and read any page, “Dead Souls,” for example. Gogol is one of my favorite writers. You get physical pleasure from the text.

I like Dickens, Hoffman, especially Bulgakov. True, it is useless to read it as a child. Although I read “The Master and Margarita” at the age of 13 and re-read it constantly.

– In one interview, you said that there are moments that bring such self-satisfaction that you feel like a titan. What are these moments?

- They probably were. I do not remember. You know, there are soldier medals and there are cardboard medals. I don’t like cardboard medals, and I don’t have many real soldiers’ medals yet, but I do have some.

– Don’t you want to talk about them?

– I think this is immodest. And while we are at the point of development that we are at, I believe that there is still nothing special to boast about. We have nothing to be ashamed of, but we are still far from praise.

– How did you answer the question of who should run the hospital – a manager or a doctor?

– There is a giant American study where 400 hospitals were studied. And hospitals run by doctors were 30-40% more efficient than those run by managers. Of course, it would be better if there was a director, and I would deal only with strategy and medical management. But you see what the matter is... We are always in a transition period.

But I graduated from the Moscow State University of Education of the Moscow Government, under the “Master of public administration” program, and the RANEPA program in healthcare management. You get a certain base, you know how to read the law, what you are not allowed to do - and this is much more than what you are allowed to do.

You get used to living under fairly strict regulations for all your actions. And if you follow it, it will save you from many tragic mistakes.

– Do you feel like you are in the right place?

– I feel in my place when my expectations correspond to the result. My expectations are strategic things, when it is possible to open a direction, when some project is supported by the department.

Each of your questions is such a big topic that it is difficult to answer simply. I don't know how I can describe my breathing, how I can explain whether I'm happy with my right arm or my left leg?

My mood can change several times a day: in the morning you come home from your rounds inspired and then you realize that something hasn’t been done around the house, or vice versa. I want to read, and I also have children who need to see their dad at least sometimes.

– We ask all the interview subjects about the meaning of life. Please share your insight.

– Do you want a simple answer? People search for the meaning of life all their lives. Some find it, some don't. But if a person stops searching, he ceases to be a person. These are very complex things. The easiest way is to answer you somehow, but I don’t like to lie.

You ask yourself, you are a hero too. I don’t know, the meaning of life is in life itself. This is a little primitive, of course, but you shouldn’t be ashamed of yourself, because you can’t lie to yourself. That's all.

Interviewed by Nadezhda Prokhorova

Photos: Efim Erichman

Remember those classic scenes in foreign films about doctors? The ambulance is transporting a “seriously” patient, at the entrance he is already met by a team of specialists who immediately put him on the operating table and pull him out of the “clutches of death”. Is it the directors' imagination? But no. Reality! And ours, Moscow.

In record time, a “heart attack network” was deployed in the capital. These are 24 vascular centers operating in the structures of urban multidisciplinary hospitals, which are dispersed throughout the metropolis. Thanks to a clearly structured emergency response system and rapid delivery of the patient to the clinic, hospital mortality from acute myocardial infarction has decreased by 3 times since 2011. Now, by analogy with the “heart attack network,” a “stroke network” is being formed in Moscow.

One of the clinics in which the vascular center operates today is the famous First City. About how the “heart attack network” works and how it was possible to achieve truly fantastic results in reducing hospital mortality from acute coronary syndrome in Moscow, the Our Version correspondent talks with the chief physician of City Clinical Hospital No. 1 named after. N.I. Pirogova Ph.D. Alexey Svet.

– Alexey Viktorovich, why exactly is the “infarction network” needed? Can't people with heart attacks simply be treated in the cardiology departments of city hospitals?

– Previously, when a person had a myocardial infarction, the patient was doomed to long-term treatment in the hospital. And only then, somewhere in a federal clinic - in the cardiac center, or the Institute. Bakulev, or at the Institute of Transplantology - he was already undergoing surgery as planned.

There were situations when patients did not live to see surgery. After all, if angioplasty is not done on time, the person dies. There are certain concepts of the effectiveness of the cardiology service that are recognized throughout the world. “Pain-balloon” is the time from the onset of chest pain, the onset of an attack, until the moment when doctors insert a special balloon into the coronary artery, which inflates it, and then a stent is placed. All over the world this figure is somewhere around 60–70 minutes. Until 2011, in Moscow, for 11 million people, there was only one center for interventional cardiology, and several other hospitals where theoretically they could do this. Nobody thought about emergency angioplasty, or, as they are also called, life-saving plastic surgery (when a heart attack-related artery opens. - Ed.), at the city level. Mortality from cardiovascular diseases, according to WHO statistics, is the highest. We repeat this like a mantra. But these are specific living people. And here I say honestly: what the Moscow government and personally Leonid Mikhailovich Pechatnikov (Deputy Mayor for Social Development - Ed.) managed to do is unprecedented. Over the past five years, Moscow has demonstrated absolutely stunning results in creating a “heart attack network.” Previously, this was impossible in principle. Today, patients come to us in a state of cardiogenic shock - previously the mortality rate for this terrible complication of a heart attack was 97% - and they leave alive and healthy.

The main thing is not what we have, but what we do with it

– What was necessary to create the network? New equipment? What else?

–The “infarction network” itself was modeled when the equipment was purchased and when it began to work. I have been working at the hospital since 2013. When I arrived, there were two angiographs. But having equipment is not enough. The angiograph must operate 24 hours a day. And this means that there must be doctors who have more than one and a half hundred coronary angiographies behind them. Doctors must do the plastic surgery themselves and install the stent themselves. But we also need stents, and this should also be included in the insurance standard for compulsory health insurance to pay for it. This is a multi-purpose, multi-factor task. And in principle, European countries have been solving this problem for decades: there the corresponding concept was adopted in the late 1990s - early 2000s, immediately after comprehensive studies showed that stenting is no less effective than coronary artery bypass grafting. In Moscow, this gigantic work was completed in just three years.

A regional vascular center was built in our hospital. Packed, equipped. Imagine: you arrive at the emergency department, two minutes later you are already in the “shock” room, which is fully equipped to solve the most complex problems of intensive care and resuscitation: from a defibrillator to an intra-aortic balloon counterpulsator.

Further along the corridor - here is an MRI, here is a CT scan, and here is a catheterization laboratory, catlab, as we call it for short. All in one place. We have two CT scanners and two MRI scanners - they work 24 hours a day, seven days a week!

We have all. But the most important thing is not what we have, but what we do with it. Do you understand? It’s not how many tomographs we have, but how many studies have been done on them. And so it is in all clinics of the “heart attack network”. That's how everyone works. That is why we have seen such a decrease in mortality in such a short period of time. And Moscow now sounds like something special in the world “cardiology charts”.

All logistics were laid out in the most brutal manner

– Was it necessary to additionally train doctors for this or were there already ready-made specialists?

– This is for me, a doctor who worked all his life at the university clinic of the First Medical Center under the leadership of Professor Abram Lvovich. Syrkina, everything was clear right away. But in the city they trained ambulance doctors, emergency department doctors, and clinic doctors—everyone was trained. They were given lectures on site and given algorithms of action. Training was constant and under the auspices of the chief cardiologist of Moscow.

Doctors completed internships both here and abroad at the simulation center. After all, if you are an interventional cardiologist, you must be able to do plastic surgery. It was also necessary to start identifying coronary disease in clinics. And for this you need to do stress tests, and it was necessary to make sure that doctors at the clinics were not afraid to do them, so that they interpreted them correctly. It's all a giant kitchen.

– What is the role of emergency doctors in this system?

– Emergency doctors must make a diagnosis and, in some cases, give a loading dose of an antithrombotic drug. And the ambulance must deliver the patient to the nearest clinic as quickly as possible. All logistics, all movements of the doctor and the patient were prescribed in the most brutal manner. There are symptoms, the ambulance makes a diagnosis, gives the necessary medications, and the patient arrives prepared for immediate plastic surgery at the clinic. Today, an ambulance arrives in 8–12 minutes! Because she knows how to go, where to go.

Logistics and a unified information system are the most important points that were taken into account and delivered absolutely correctly. And this system, in essence, is unprecedented both for Russia and for such a metropolis as Moscow.

Accent

– Alexey Viktorovich, can we say that the “infarction network” is Moscow’s know-how? Or is there something similar abroad?

– All good clinics are similar. There is a “pain-balloon” time - and it must be strictly observed. How you achieve this is up to you.

There is several know-how in Moscow. This is informatization, a unified information field. This arouses interest among foreign colleagues. Plus perfectly streamlined logistics, and, of course, record-breaking time in which all this was built and debugged.

What is also new for us, doctors, is that from now on these issues are the focus of attention not only of the industry community, but also of the city leadership.

A week later the patient leaves the hospital

– What is the average age of your patients?

– About 78–80 years old. Now we have placed a stent in the trunk of the left coronary artery of a 94-year-old grandmother. And she went home. So our patients are mostly very elderly people, people with pathologies who simply would not have had a chance before. Our mortality rate from heart attack was 20%, that’s every fifth! And this is in the 21st century! And now I’m already getting a scolding if I have 7.8%. What about stents in the trunk of the left coronary artery? Previously, this was only coronary artery bypass surgery. And today almost every doctor on duty does this for me.

And with an uncomplicated heart attack, a person leaves the hospital on the 4th–7th day.

– Who cares for the patient after he is discharged from the hospital?

Our clinics are working, they are trying, and they will definitely succeed. Because they are under constant care of the main specialists. And these are not words. This is business.

– It is known that it is always easier to prevent a disease than to treat it. Are there any general recommendations for those who monitor their health?

– From a certain age, every person should know their blood pressure, their cholesterol and glucose levels. Know your weight and do something about it. If you walk at least 40 minutes a day, this will already reduce the risk of a heart attack. Taking tests once a year and undergoing a medical examination according to your schedule is also a useful thing. Everyone should know that if suddenly, while walking fast or not very fast, you begin to experience some kind of shortness of breath, which goes away when you stop, if suddenly, when exercising, pressing pain in the chest area begins, you should go to the doctor.

No need to run to the doctor like going to work, no. But the patient must know about himself. This increases the patient's personal responsibility.

By the way

This year, the first secondary prevention rooms for heart attacks and strokes opened in Moscow. They are already operating in test mode in several clinics. It is assumed that the secondary prevention office will operate in the central clinic of each district of the capital. The appointment will be conducted by the most qualified cardiologists from 46 metropolitan outpatient centers. The rooms will be equipped with modern diagnostic equipment. The clinic will have equipment for stress tests, ultrasound machines, as well as the ability to determine blood coagulation parameters necessary to select anticoagulation therapy for the patient.

Make it in time for the golden hour

– Our immediate plans include the creation of a “stroke network.” When will it be launched and how many clinics will it include?

– A patient with a stroke is a patient who was poorly treated by cardiologists who did not monitor, for example, his atrial fibrillation.

An ischemic stroke is either a spasm or a blood clot that has settled on a plaque and closes the lumen of the vessel. Hemorrhagic is a hemorrhage, a rupture of a vessel. Unfortunately, little can be done about hemorrhagic. Prevention only.

But for ischemic stroke, for example, in First Gradskaya we have had five successful thrombus extractions in the last three months alone.

Here’s the story, and this is true all over the world – whether you’re in Switzerland or America – the proportion of successful thrombus extractions is somewhere around 5–7%.

You must have time in the “golden hour” - that’s three hours - to carry out thrombolysis and, if possible, perform thrombus extraction or thromboaspiration (when the blood clot is “sucked out” into a special bag through a special device) and remove the blood clot.

We had a case: an ambulance brought a patient from Red Square. He arrived with a severe stroke. Both thrombolysis and thrombus extraction were performed, all symptoms of severe plegia regressed within six hours, and on the fourth day he flew home to Germany.

The “stroke network” will have fewer centers. There are currently eight hospitals where the Department of Health is purchasing equipment to carry out these highly complex procedures. We already have catheterization laboratories, angiographs, and tomographs. I think that there will soon be an order from the Department of Health, and we will begin to work systematically. This is also a very ambitious task, because the thrombus extraction process itself is quite complex. But when you see the first results, you want to do it. This is truly fantastic. This is something that could not even be imagined a few years ago.

And I would like to emphasize once again that if it were not for Moscow Mayor Sergei Sobyanin, who set this task to Leonid Pechatnikov, who then headed the Department of Health (now Deputy Mayor for Social Development - Ed.), none of this would have happened. Do you understand?

Our information

City Clinical Hospital No. 1 named after. N.I. Pirogov, known to all Muscovites as the First City Hospital, is the oldest medical institution in Moscow. The hospital received its first patients in July 1802. The patients of the First City Hospital (at that time Golitsyn Hospital) were people from the poorest, most socially vulnerable sections of society. Every year the number of beds in the hospital grew, and already in 1803, an almshouse for the terminally ill was opened at the hospital. Social receptions with the collection of charitable donations were also held on the premises of the hospital.

This year City Clinical Hospital No. 1 celebrates its 215th anniversary. Today it is a state-of-the-art medical institution that provides diagnostics and treatment using the most modern and state-of-the-art equipment. The bed capacity of all departments is 1381 beds. Every year, the hospital treats more than 40 thousand inpatients, and about 400 thousand more people seek consultations at the clinic.

Why did the plan to reduce hospitals surface after the fact, why did it not appear in the public space earlier?

If it had been a document, then it probably would have surfaced in time. But since this is only one of the proposals of the expert group, it was simply stolen from the computer of the health department.

- Nevertheless, why was there no open discussion about the need to reduce city clinics?

Discussion about what?

The fact that we are switching to single-channel financing, that the city budget will not finance the hospital, and all expenses fall on the shoulders of the compulsory medical insurance fund.

What kind of discussion should we have when laws were adopted in 2010 that declared this?

- You yourself said that Moscow violated this law(“Moscow was not included in insurance medicine for quite a long time. We simply did not comply with federal legislation, we had the opportunity to finance from the budget,” Leonid Pechatnikov told RBC). If Moscow violated the law, it would be logical to explain why the law was violated and why this cannot be done anymore?

I see no reason to hold public hearings on whether it is necessary to continue breaking the law. Agree, the subject of discussion sounds rather stupid: we received an act from the Accounts Chamber, which indicated to us that we are breaking the law, financing from the budget what we should finance under compulsory medical insurance. Until January 1, 2015, this could still be afforded, but after that the law becomes an integral part of any legislation. All medical services, except psychiatry, tuberculosis and infectious diseases, are “omitted” from compulsory medical insurance [the state program of the city of Moscow “Capital Healthcare” for 2012-2020 provides for the volume of budget funds for 2014 - 291.3 billion rubles, in 2015 - 303.4 billion rubles, in 2016 - 311.4 billion rubles. In 2015, expenses will be spent, among other things, on the provision of outpatient care (96.6 billion rubles), including these funds to finance neuropsychiatric and drug treatment dispensaries. Moscow will also allocate 2.5 billion next year for the provision of high-tech types of medical care not included in the compulsory medical insurance program].

- Why did you still break the law?

We needed to prepare the basis for optimization; it’s not easy to transfer the system from the budget to compulsory medical insurance.

Many doctors believe that it would be worthwhile to first build new clinics, and then optimize what is available.

We build everything we can. We are building the Morozov Hospital, a perinatal center in Hospital No. 67, and are doing major renovations of buildings on the territory of the Botkin Hospital. Moscow, like all cities in the world, will focus on multidisciplinary hospitals.

To which doctors tell us: such things are good, for example, in Spain, where there are no traffic jams. And in Moscow, where the journey to the hospital can take several hours, someone is bound to die of bleeding in an ambulance.

I will give another example from life. Here is a gynecological hospital, a woman is being taken for surgery. Anesthesia, opening of the abdominal cavity, instead of gynecology, appendicitis. This hospital doesn't even have a general surgery license. A woman is under anesthesia, and a surgeon is coming to her from a nearby hospital to perform an operation. And this is a real-life case: an ophthalmology hospital, a person comes for cataract surgery. He has a heart attack, an ambulance rushes through traffic jams along Tverskaya to pick up this patient to hospitalize him where there is a cardiologist. Single-profile hospitals do not survive; they are dangerous for patients.

- When can we expect a specific action plan?

I think for the New Year.

Leonid Mikhailovich Pechatnikov

Born in 1956.

In 1979 he graduated from the 1st Moscow Medical Institute.

Pechatnikov spent most of his career as a practicing physician, but was also a professor at the Department of Fundamentals of Pathology and Mathematical Modeling in Medicine at the Moscow Institute of Physics and Technology (from April to June 2001).

Since December 14, 2010 - Minister of the Moscow Government and Head of the Health Department.

Since May 25, 2012 - Deputy Mayor for Social Development of Moscow. According to him, he did not want to become an official, and Sergei Sobyanin twice offered him to take a position in the government.

Business and government

- You have many times called on businessmen to cooperate with state medicine and treat patients free of charge, using the so-called green compulsory health insurance card. Let's take one example: there is a group of companies "MEDSI" , She signed an agreement with the compulsory health insurance fund and invested money in repurposing a hospital in Otradnoye. As a result, MEDSI was not included in the list of medical institutions that were recommended by the Ministry of Health; they do not provide patients with compulsory medical insurance. It turns out that the city still actively supports only its own institutions; the private sector has no opportunity to compete with them.

If you, besides MEDSI, EMC (European Medical Center) and OJSC Medicina, can name me at least one private clinic that deals with hospital medicine, I will be very grateful. As for private clinics, they are very willing to participate in compulsory medical insurance.

- As far as I know, neither MEDSI nor OJSC Medicine entered the compulsory medical insurance system this year.

The problem is that if [private clinics] are included in the compulsory health insurance system, then they must be included in all tariffs: any person can be brought to them by ambulance, and not just those patients who need well-paid (under some tariffs) compulsory medical insurance . I had a similar situation with the Central Clinical Hospital [Central Clinical Hospital], in which they told me: “Don’t bring homeless people from the Kursk station to us. We have a contingent." And private hospitals want to treat only at high rates.

- Do I understand correctly that while the basic tariffs are so low, we won’t see private owners in the compulsory medical insurance system?

Don't know.

- How are payment rates for doctors working in the compulsory medical insurance system currently calculated? Are they greatly underestimated?

In order to live with these tariffs, you need to carry out the very optimization that we took on. Are you asking me if the tariffs are sufficient? I answer you: no, they are not enough. But each state can afford exactly as much as it can.

- How should the hospital survive then?

Due to the intensification of work.

- What does it mean?

For example, if it is possible to operate using the laparoscopic method, then you need to operate this way and not otherwise. If a surgeon does not master this method, he must either learn it or look for another job.

- Will you give compulsory insurance funds subsidies from the city budget?

If we are able to correctly optimize the system today, we will be able to see how much we need. Until today, we have always subsidized healthcare and provided direct subsidies.

How do you feel about the fact that the threshold for contributions to the Federal Migration Service is being lifted? The employer will now pay into the Compulsory Medical Insurance Fund from all salaries [in September, the government approved a bill providing for the abolition of the threshold for contributions to the Compulsory Medical Insurance Fund. The formula for contributions to the compulsory medical insurance fund is as follows: the employer pays 5.1% of the subordinate’s salary, not exceeding 624 thousand rubles. in year. Salaries above this amount are subject to the same deduction - as if the employee receives 624 thousand. According to the Ministry of Finance, the lifting of the restriction will increase the budget of the compulsory medical insurance fund by 200 billion rubles.].

I will answer this question with a real case. We were once sitting with Veronica Skvortsova [Minister of Health], and I lit a cigarette. She says: “Are you still smoking?” I answer her: “Since you visited the president and asked that all excise taxes on tobacco go to the health care budget, I smoke exactly twice as much.”

"May Decrees"

By 2018, according to Vladimir Putin’s “May decrees,” doctors’ salaries will need to be increased to 200% of the average salary in the region. How will you do this?

This is a difficult task. But if these decrees had not existed, it is possible that we would have suffered with the Soviet healthcare system for quite a long time.

- And anyway, how are you going to increase doctors’ salaries?

By 2018, we need the average salary of doctors to be approximately 140 thousand rubles. If the system works efficiently, we will solve this problem.

- How?

Due to what we do. By intensifying work, by increasing labor productivity. The whole problem of the USSR and present-day Russia lies in only one thing: our wage growth is significantly faster than the growth of labor productivity. If we do not increase labor productivity, we will not only fail to implement Putin’s decrees, we will completely collapse.

- That is, when we increase labor productivity, we cannot escape from laying off doctors?

In all industries, everything is structured the same: both in healthcare and in industry. Today we have equipped Moscow healthcare in a way that it has never been equipped before. If previously, in order to diagnose a disease, a person had to be hospitalized, today this is not necessary at all. Today, clinics are no worse equipped than hospitals. If this is so, another source dries up and beds are freed up. There is no point in keeping empty beds and staff. Therefore, there is a shortage of doctors in clinics; the entire surplus concerns hospitals. Everyone is provided with jobs; another thing is that we cannot guarantee them a job in their specialty. We cannot provide all urologists. Does this mean unemployment? But we give them the opportunity to retrain at our expense.

Conflict of interest

Regarding the provision of medical equipment: as far as I understand, you were twice accused of a conflict of interest. The first time was when tomographs were purchased at your suggestion. Toshibafor city hospitals from your UMC partners. Did you do this intentionally?

Yes. In the first case, I understood what I would be reproached for. But in 2010, when I joined the department, by that time I had never bought anything from technology, I knew nothing.

- Didn’t you buy anything at the UMC?

I was president and chief physician, but never engaged in economic activities. When I came to the health department and saw the recommended prices, including for tomographs, I realized that it was about three times more expensive than what was bought at the EMC. In general, I decided that this was a mistake. I went to the UMC and said: “Listen, if you bought for yourself for 30, and they recommend it for 90 for me, maybe you can buy for the city for 30”? But, realizing that I would be accused of a conflict of interest, I told Sergei Sobyanin about this [with the arrival of Pechatnikov, the health department acquired new suppliers - Farmadis CJSC, Inoprom-Med LLC and GEL En-Invest LLC. Having examined the history of these SPARK companies, Vedomosti discovered that they are associated with Pechatnikov’s former partners - co-owners of the EMC (European Medical Center CJSC)Igor Shilov, Leonid Shaimanand Lajos Baljer Csaba, as well asVladimir Smagin,business partner of the former EMC supplier].

- That is, Sobyanin knew about this?

My former partners won all the competitions. They agreed on purchases with Toshiba and came out with record low prices. We bought 64-slice computers for 21 million, 80-slice computers were bought, it seems, for 28. I warned the mayor, Igor Artemyev [head of the Federal Antimonopoly Service], about this. I spoke about this with the presidential control department. I told them: “If the participation of the UMC does not cause any allergies to you, then they are ready to participate.” They said that they didn’t care who would sell us computers and MRIs. There is only one task: to bring down this extremely criminalized market.

When in 2013, the building of the 63rd hospital was transferred for a 49-year concession to the same EMC, some, let’s say, members of the medical community said that no one was included in this tender, because everyone understood: the EMC is Pechatnikov’s clinic, she will have preferences.

I can only say that when the UMC came to me with this idea, I said that if they have extra money, I cannot interfere with them. From a business point of view, I considered this idea a losing proposition for them: they paid a billion for the right to concession, and at the same time took upon themselves the obligation to build a new hospital complex for $12.5 million. To build something that won’t even belong to you, you can’t even borrow against it. I found this idea difficult from a business point of view, but I am not that much of a businessman. If they thought it would be beneficial for them, I wish them success.

Will it happen that after some time they will build a hospital that will not accept patients under compulsory medical insurance?

They will be there. The question is different: will these volumes of compulsory medical insurance give them?

- Then the agreement will be violated...

The agreement stipulates that if the city gives them these volumes, they are obliged to accept at least 40% of the compulsory medical insurance.

- And if the city does not provide these volumes...

This means they will do everything for a fee.

- Then it's a good deal.

About the terrible

- Why did you decide to become an official?

I did not decide to become an official; I had no such plans. I refused twice. Ultimately I had to agree.

-Are you happy with how everything turned out?

Today I would rather treat people. I still do this: I consult patients in Moscow hospitals, this is a relaxation for me. In addition, once every two months I conduct anatomical examinations in city clinics, trying not to lose my qualifications.

Will you go and talk to people at the rally “Stop the collapse of Moscow’s healthcare system,” which is scheduled for November 2 on Suvorov Square?

- Why?

I know these people, we talked to them, I understand them very well: they worked in the same system, and today they are told that this will not happen anymore. I feel incredibly sorry for people who are already aged, it is very difficult for them to relearn, I understand them. But the task is to preserve the system. These are emotionally difficult things, but they are moving forward. And if you think I enjoy being called a “health demon,” you’re wrong. Now I often quote my friend Gennady Khazanov, who called me and said: “Lenya, it’s not scary when you are mixed with shit. It’s scary when people confuse you with him.”

Which hospitals are being liquidated?

Leonid Mikhailovich Pechatnikov— statesman of the Russian Federation, Honored Doctor of Russia, Deputy Mayor of Moscow in the Moscow Government for social development.

Early years and education

Leonid Pechatnikov's childhood years were spent in a troubled area of ​​the capital - the factory district on Sokolinaya Gora. As Leonid Mikhailovich recalled, he started smoking at the age of seven. And by the second grade he already had two appointments with the police. That’s when the parents transferred their son to another school, which was far from home. The school had a French bias. Leonid studied well. His mother was a doctor, and Leonid Pechatnikov himself said that he dreamed of becoming a doctor from the age of three, that is, even before he started smoking.

After school, Pechatnikov entered the First Moscow Medical Institute named after. I.M.Sechenova. In 1979, Leonid Pechatnikov graduated from the institute, and in 1981 completed his residency training in internal medicine.

Work and career of Leonid Pechatnikov

From 1981 to 1987, Leonid Mikhailovich Pechatnikov worked as an assistant professor at the military medical faculty at the Central Institute for Advanced Medical Studies. During this period, Leonid Pechatnikov defended his Ph.D. thesis on the topic “Disturbances of cholinergic regulation in patients with bronchial asthma” (1981).

Until 1994, Leonid Mikhailovich Pechatnikov was the chief therapist at the Central Republican Clinical Hospital of the Ministry of Health of the RSFSR.

In parallel with his medical practice, Leonid Mikhailovich was engaged in teaching activities - he taught a number of courses at the Russian State Medical University, the University named after Leonardo da Vinci(Pôle universitaire Léonard-de-Vinci, founded in 1995, Paris, France), Moscow Institute of Physics and Technology, where he was one of the founders of the Department of Mathematical Modeling in Health Care and Medicine at the Faculty of Applied Mathematics.

Leonid Pechatnikov worked hard and conscientiously, his work was marked by promotion. From 1994 to 2001, Leonid Mikhailovich Pechatnikov held the post of chief therapist of the diagnostic and treatment association of the Ministry of Health of the Russian Federation, from where he moved to City Clinical Hospital No. 67 of Moscow and there until 2004 he was the chief therapist.

And in 2004, Leonid Pechatnikov began working at the European Medical Center as chief physician.

On December 14, 2010, Leonid Pechatnikov was appointed to the position of Minister of the Moscow Government, head of the Moscow Health Department.

On May 25, 2012, Leonid Pechatnikov became Deputy Mayor of Moscow for Social Development.

Leonid Mikhailovich Pechatnikov also headed the department of medical care and doping control of the Organizing Committee of the Olympic and Paralympic Games in Sochi 2014.

Work in the Moscow government

Leonid Pechatnikov claims that life expectancy in the capital has increased to 77 years, and over the past three years - by three years, that is, in a year - a year of increase.

At the same time, the deputy mayor admitted: despite the fact that now the average life expectancy in Moscow is 77 years, the Russian capital has not yet reached the level of Europe in this parameter.

“But, according to the conclusion of the European experts themselves, no country in the world has ever seen such a rate of increase in average life expectancy as it is now in Moscow,” the Interfax agency quoted the official as saying.

According to Pechatnikov, women in Moscow, based on the results of 2015, live on average 81 years. “Hospital mortality from myocardial infarction, when comparing 2010 and 2015, decreased by 3.6 times. We have reduced maternal mortality by almost half, and infant mortality by about a third, because we have created many new intensive care beds for children in maternity hospitals and perinatal centers,” summarized Deputy Mayor

In 2014, Leonid Pechatnikov told Novaya Gazeta about the successes of healthcare in Moscow, saying that “this happened due to the modernization that we carried out over three years... We spent 45 billion rubles only on equipping the capital’s medicine with equipment, at those prices it was more than 1 billion euros. Moreover, they bought twice as much equipment as we were ordered to buy—prices collapsed throughout Russia. True, all sorts of absurd accusations arose here: for example, allegedly I take equipment from Japan for free, return half of the allocated money to the budget, and put half in my pocket...” Pechatnikov complained.

Criticism and scandals with Leonid Pechatnikov

The activities of Leonid Pechatnikov in the Moscow government cause a lot of criticism.

In 2012, a revolutionary situation arose in the capital's ambulance service. Tired of enduring “inhuman conditions” at work and “bestial attitude” towards themselves from management, doctors from the 12th substation wrote a letter to the mayor of Moscow Sergei Sobyanin .

The complaint was transferred to the mayor’s reception, but it was not the mayor who responded to the doctors, but the head of the capital’s health department, Leonid Pechatnikov, who rejected all claims, calling them “baseless”

The official admitted that it is not easy to get to a patient quickly in Moscow, and this is fraught with risk, but the leadership does not intend to reduce the standards for reaching patients. Ambulance workers, fire departments and the Ministry of Emergency Situations put their lives at risk. They have to drive in the oncoming lane to get to their destination quickly. However, this risk is paid off, Pechatnikov emphasized. According to him, the average salary of a doctor at this substation is 89 thousand rubles, which is more than the salary of an ambulance worker in Spain and Portugal, wrote"SP".

In December 2016, a scandal broke out in Moscow around the city oncology hospital No. 62. Its chief doctor Anatoly Makhson criticized the decision of the city health department to deprive the medical institution of its autonomous status and thereby the right to independently purchase medications. He stated that the hospital bought drugs at several times cheaper than the department.

“They are trying to present the situation as my personal conflict with Pechatnikov, they say, I raised the topic of government procurement because I didn’t want to lose a warm place, but I would have resigned from the post of chief physician in any case, because it is becoming impossible to work,” Makhson told Vedomosti. . The non-transparent procurement system leads to inflated prices, supply interruptions and shortages of drugs, says the former chief physician. Pechatnikov said that he does not supervise purchases and forwarded all questions to the health department. A department representative did not answer questions about procurement.

As Vedomosti wrote, having studied procurement issues, “competition among suppliers turned out to be surprisingly low and although all the largest federal players are active in the market, most orders go to lesser-known companies founded by the owners of the European Medical Center group of companies , EMC), where Pechatnikov himself once worked, or their partners.”

In 2018, Deputy Mayor Leonid Pechatnikov said that Moscow has not experienced a shortage of doctors for several years, noting that the healthcare system employs more than 121 thousand medical workers. At the same time, the number of health workers in 2016 was 141,401 people.

In March 2018, the news of most media outlets included offer Pechatnikov that patients with advanced cancer should pay for their treatment themselves. The deputy mayor referred to the experience of South Korea. There, all citizens must undergo mandatory medical examination, and if a person is diagnosed with cancer and has not previously been examined, then the entire financial burden of treatment is placed on him.

At the same time, the Interfax news dated March 21, which reported that Moscow Deputy Mayor for Social Development Leonid Pechatnikov approved the practice of paid treatment for late-stage cancer, was subsequently edited. Now it says that Pechatnikov proposed to encourage citizens, including financially, to ensure that they undergo timely examinations for the early detection of cancer. Interfax apologized to readers and Pechatnikov personally for the incorrect quotation.

Leonid Pechatnikov said that the average salary of Moscow doctors in January-February 2018 was 135 thousand rubles. The news caused sincere surprise, the capital doctors noted that their salary figures are exaggerated at least twice.

“It’s already a tradition that the mayor of Moscow and his deputy take turns telling how quickly doctors’ salaries are growing. But for some reason doctors don’t notice this,” said "SP" Semyon Galperin, President of the Doctors' Defense League.

In April 2018, children in a Moscow kindergarten were given White Spirit solvent to drink. Leonid Pechatnikov said that the necessary measures have been taken against the employees of the institution. “We are talking about a preschool unit at institution 630. The school has already been inspected, all measures have already been taken, including administrative and quite strict ones,” - quoted Pechatnikov in the news.

In the biography of Leonid Pechatnikov on Wikipedia, it is noted that although in the news of many media he is called a Doctor of Science (as he was called by RIA Novosti, Rossiyskaya Gazeta, Kommersant, Gazeta.ru, Petersburg. Channel Five), but the doctoral dissertation of the vice-mayor of Moscow could not be found in any of the available sources, including the Russian State Library, the Central Scientific Medical Library and the Higher Attestation Commission (HAC). It is also reported that in RIA Novosti’s biographical information for 2012, the phrase “Doctor of Science” in relation to Leonid Pechatnikov is no longer mentioned.

Income of Leonid Pechatnikov

According to the anti-corruption declaration, in 2017, Leonid Pechatnikov’s income amounted to 6,800,071 rubles. According to the declaration, the real estate of the deputy mayor is small: Apartment 50 sq. m. m (in use) and parking space, 14 sq. m.

In 2015 and 2016, in Pechatnikov’s income statement, everything was approximately the same. In 2014, Leonid Pechatnikov’s income amounted to 7,185,301 rubles; in that successful year for his family, his wife also earned 265,329 rubles.

It was noted that Pechatnikov’s wife had a dacha plot of 2,400 square meters. m and an apartment of 100 sq. m.

In Leonid Pechatnikov’s previous income declarations, Audi A8 and VAZ 2114 passenger cars were noted.

Personal life of Leonid Pechatnikov

Leonid Mikhailovich is married twice. From his first marriage he has a daughter, Natalya. Second wife - Lyudmila Borisovna Pechatnikova(born 1964).