American pediatrician about medicine in America and Russia
Source: Israeli Medicine
Oleg Devityarov, Russian, Odessa, having arrived in the US ten years ago, became Oleg Devi. A doctor by training, works by specialty. Oleg told the publication Israeli Medicine about american medicine.
I'm a renegade
- Oleg, the first question may seem trivial to you, and yet: why did you leave the Union?
- For me, concepts such as autonomy and independence have always been very important. I was terribly nervous when some kind of Komsomol stupid dictated to me what I should do, or the head doctor, a worthless and completely ignorant person, stated that instead of treating children and lecturing to students, I had to go and dig potatoes. I never sought political freedom, never was a dissident.
On a national basis, nobody harassed me either: my mom is a 100-percent Ukrainian, a dad is Russian, a communist, a colonel, a brother is a communist, a major of the State Security Committee, an uncle is an academician of the Ukrainian Mednauk Academy. And in everyday terms, I was not offended by the country: I did not beg, my family lived in a beautiful three-room apartment, there was a car. That is, I am a renegade. But I repeat once again: the only thing I lacked there was the ability to work normally. I was fed up with paradise and oblast health departments, where people were sitting who understood nothing in medicine and for this reason became superiors.
Who you were there, nobody cares
- What is the difference between the American School of Medicine and the one that existed in the former Soviet Union?
- First of all, in the training system itself. In fact, American medicine is the most professional medicine in the world. Any doctor from any country in the world who wants to practice in America must travel a very difficult and difficult path, absolutely the same for everyone. No one here sets the task for all doctors to become geniuses, professors and academicians who have unprecedented knowledge and an unheard of approach to the sick. The main thing - a patient in America must be sure that the doctor to whom he turned will not make a blunder. The doctor here is a very long study. The doctor begins to work independently, as a rule, only by the age of forty. In 18 years a person finishes school. 4 of the year goes to college, then 4 of the year goes to medical school. After this 3 residency. And if you dream of becoming a cardiologist, add another 7 years, a neurosurgeon - 8 years. I graduated from college in 1984, became a pediatrician in 23.
I can say with full responsibility: the bulk of the doctors in the Union, especially those who have just graduated from the institute, could not be allowed on the cannon shot to the sick. We poured some liquid to the children, not knowing what we poured and why, we determined whether it was better for the child after the infusion or not at all, according to whether he has a skin fold or she fell, we prescribed drugs for children that are not a normal doctor will not prescribe. All American medicine is evidence based.
In the Soviet Union, we injected children with an enormous amount of immune drugs, various gamma globulins, and an enormous amount of plasma. In America, no one transfuses plasma. Blood plasma as a drug does not exist here. Albumin, which we poured in tons to children, is extremely rare here. Why? Because it is proved that it is ineffective. Those who have suffered jaundice, infectious hepatitis, perfectly remember that they were prescribed Essentiale, Essentiale Forte — these drugs do not exist here. Because it is proven - they are ineffective.
- Do you think that there are no good doctors left in Russia, in the republics of the former Soviet Union?
I think this is far from true. Their only drawback is that they do not have excellent medical equipment, which is here. By the way, if the American doctors of their cutting-edge equipment lost their hands, would they not be completely at a loss, could they make a diagnosis, prescribe a treatment, as our best clinicians do?
- The doctor in Russia has to spend a tremendous amount of time with the patient, he must examine and examine everything, even the nails, down to the smallest spot on the body in order to come to some conclusion. However, the examination of the patient, which the doctor conducts, relying only on his hands, eyes, ears, is quite subjective. One doctor sees better, the other worse. In the presence of modern technology to work by touch, intuitively absurd. Why extra risk? One of the American channels recently showed absolutely fantastic guys, in my opinion, from Novosibirsk, who did a heart transplant. Their professional level is simply beyond description. As well as the antediluvian apparatus, which they used. The USA today is probably the only country where such a huge amount of equipment is used. The equipment allows you to reduce the risk of error in diagnosis, during surgery to a minimum. In addition, the responsibility of the American doctor to the patient is much higher than the Russian one. In Russia, the responsibility is exclusively moral, based on the Hippocratic Oath. And here, among other things, for any mistake doctors have huge insurance sums.
- Diplomas of doctors of the former Soviet Union in America are recognized?
- Yes, our diplomas are recognized. But in order to work as a doctor in America, you must pass four exams. The first exam is basic sciences: anatomy, physiology, histology, pathology, pharmacology. The second is clinical science: surgery, pediatrics, therapy, obstetrics and gynecology. The third is a license exam. And finally - English. One exam lasts a whole day - a test is offered, the order of 550-800 questions, and from several options you need to choose the right one. Successfully passed all exams are allowed to residency. And here, I will tell you, many of our former compatriots drop out of the race. Residency is hard labor, where the strongest survive. I used to wash my feet in blood, my wife poured blood clots out of her shoes every night, my lunacy was running, the beeper was bursting incessantly, my sisters tore apart. I went through it, being more or less young. And what about those who are older? There he was a professor, an assistant professor, and here he was told by a black nurse what he should do and how. Because she has this right, she has more experience and because no one here is interested in who you were there.
American doctor - a man respected
- Now you have your own private practice in America. Tell us how a simple American doctor works and lives here?
- An American doctor is at work 24 hours a day, seven days a week. Suppose my patient was in the hospital. By the way, the rules of hospitalization are fundamentally different from those adopted in the Union. To get to the hospital, you must have very good reasons. You won't find patients walking in lab coats around the kindergarten or smoking every 15 minutes in the toilet. If you walk on your own legs, you have nothing to do at the hospital. So, my patient was in the hospital. Whether night, day — it does not matter, they immediately inform me of this, and I am going to him. No other doctor can guide my patient. In America, the holy is your doctor, your lawyer. After examining the patient, I make a decision: if it is within my competence, I prescribe treatment, if not, I invite specialists. The rest of the time I take patients in the office. In the Union, how was it? A man came to the clinic and started walking around the cabinets: from a therapist to a cardiologist, from a cardiologist to get tested. Here the doctor is universal. I am able to do a cardiogram or a test for the lungs myself, check the bone density, take all the tests, make any injection. The doctor in American society is a very respected person. The average therapist earns today 130 thousands of dollars a year.
- By American standards, is it good?
- Let's just say it's not really bad. After paying taxes, it really stays in the pocket about nine thousand dollars a month. This makes it possible to have an excellent apartment or house, several cars, to teach a child in a prestigious school, that is, to live very, very comfortably. What is good in this country: a person who has received an education with intellectual potential cannot live here badly. Education is valued and paid very highly. Lawyer, doctor, engineer do not have the right to beg.
- It would probably be crazy for an American doctor to find out that many of his colleagues in Russia receive about 20 dollars a month. However, the best Russian doctors have always been famous for their willingness to sacrifice themselves.
- Yes, you are right, in Russia there really are unique doctors who, with their hands, feet, teeth, somehow, do not allow patients to die. As many enthusiasts as there are probably nowhere else. However, self-sacrifice, enthusiasm in America also exist, but they are at least justified here, because they are well paid. If you are a good doctor, you earn well, very good - you earn very well. In Odessa, my parents often asked me to look at the child in private. Who paid 10 rubles for the visit, who 25, who 50, and I was very happy - it was perk. Good doctors are always given something.
- Even here?
- I will give a case when thanks to me the patient survived. I was in the hospital exactly 15 minutes after she was brought with a rather rare diagnosis in America: pneumococcal meningitis. When I arrived, I immediately made a spinal puncture, prescribed the necessary treatment and then did not leave her until 4 in the morning. Having recovered, this patient presented me with a very beautiful, rather expensive crystal vase. This is accepted. This is completely normal.
- Money, too, can thank?
- No, nobody gives money. Except when the patient has no health insurance and pays cash.
On the street will not give to die
- How is the insurance system implemented in America?
- There are a great many insurance companies and various types of insurance. Some companies profess the principle: saved on the treatment of the patient - earned more. The doctor is encouraged to use expensive equipment as little as possible, not to refer patients to specialists, and not to do tests. Madame Clinton generally wanted to fit the whole country under this system. Thank God, nothing came of it. Good insurance for a family of three is quite expensive, about 8 thousands of dollars a year. Large enterprises, such as Ford, for example, pay their employees the basic amount of insurance, 95-97%. Small companies make it harder, so people often have to buy insurance themselves. Here the person chooses what he needs. Suppose your wife is not going to give birth anymore, it means that you do not buy insurance that covers childbirth and child care. That is, from the colossal number of medical services, you can choose what you need. However, a sufficiently large number of people prefer not to buy insurance, and if necessary, consult a doctor and just pay in cash.
- If a person did not buy insurance covering the birth of his wife, but it turned out that the woman still became pregnant, that she will not accept the hospital?
- Will accept. You just have to pay for it.
- And if a person has no money at the moment?
- It means that they will pay him to pay some minimum amount per month, for example, for 20 dollars.
- And did the people who had neither insurance nor money turn to you for help? In general, what can the poor have in America in terms of medical care?
- I can not answer for other doctors, but as for me, any person who will need my help will receive it, regardless of whether he has money or not. And not only help, but also attention and care, he will receive exactly as much as the one who has money. I want to be known in Russia: in America nobody will ever leave a person in need of medical care in the street.
- And put in the hospital? And the operation will do?
- If it is necessary to save his life - they will. And the operation will be done for free. Each hospital receives a certain amount from the state just for such cases when it is necessary to treat people who are not able to pay for themselves.
- Then we formulate the question a little differently: does a person have money, but for some reason he does not want to pay the doctor or the hospital?
- Every American has a credit history. When a person buys a house or a car and wants to take a loan, the bank checks his credit history, and if it turns out that once he did not pay off the hospital, he will not be allowed to buy even a pack of cigarettes on credit.
- With whom is it easier for you to work, with Americans or people from the former Soviet Union?
- With the Americans. The Soviet patient was always distinguished by the fact that he loved to read various kinds of medical literature with particular passion, thanks to which he allowed himself to get into an argument with a doctor or simply say: doctor, I myself know what my illness is, so write me this and that something. Here we have to deal with this too. Americans do not allow themselves this. They do not self-medicate, do not play with pills. They come to the doctor for help, for advice. They strictly follow all the recommendations of the doctor. For them, official medicine is quite authoritative.
- On Brighton, you can buy Valocordin, Corvalol, and other medicines that are widely used in Russia, but have not been distributed in America. As a doctor, how do you feel about this?
- The approach of Americans to medical drugs is very conservative. In order for a new drug, even a well-established one in Europe, to enter the American market, it must go through many difficult ways, in particular, receive the go-ahead from the most powerful organization involved in controlling the release of food and drugs. All doctors, people from the Union, are well aware of the excellent Swiss drugs, but not a single American doctor will use them, because they are not allowed in the United States. The story of rezulin is too fresh when several people died as a result of kidney failure. But this is a very effective, good drug, which, before entering the American market, has been used for years in the treatment of diabetes in Europe. Or valokordin. Excellent drug. Of course, I will not recommend it to Americans, but when my grandmother comes to me from Russia and says: I drink it for many years and he helps me, I will not take a bottle from her. Helps - drink to health. I will tell you more, in my opinion, the most effective remedy for colds is to breathe over the steam. But here I do not recommend this to anyone: a person can get burned with boiling water, and I will be guilty. Although I myself and all my relatives use this tool.
- In Russia today there are unique developments in ophthalmology, treatment and prevention of drug addiction. Are the Americans open for cooperation or are they not interested in Russian technologies?
- I have already said that Americans are very conservative. But ... All orthopedics today are based on the fact that Ilizarov once created. And their favorite motorcycle "Harley-Davidson"? Few people remember that his "parents" were Russian émigrés Kharlamov and David.
“Oleg, it’s not a secret to anyone that Americans are obsessed with their health, but the American press anxiously writes that every year more and more people suffer from depression. And why among Americans there are so many not just fat, but painfully fat people?
- Americans are more vulnerable than us. The former sovieticus is more hardened, stronger psychologically, it copes better with any psychological stress. A Russian man has gone through so much that I don’t even know what else he needs to be hit on the head so that he will become depressed. And Americans experience any, even the smallest, nuisance quite hard. In addition, they are more alone than we are. They are not as sociable. Their whole lifestyle, the whole social structure predispose to this. Therefore, psychologists and psychoanalysts are much more popular here than in Russia. As for obesity, there is a food cult in the USA.
The Russians, having met the day after the party, as a rule, talk about who looked like and who said what, the Americans will only talk about what dishes were served and what was tasty and what was very tasty. For them, the biggest enthusiasm is something to eat, and then discuss it. However, for the sake of objectivity, I should note: almost 100 percent of fat people are people belonging to the middle and lower classes. Because it is cheaper to eat a hamburger than to buy a piece of a rather expensive fish. A lot has recently become fat children, teenagers. If earlier they were driving football, today they are tied to a computer.
Parents can not afford
- In Russia, the majority of pensioners barely make ends meet. Their miserable pensions are not enough, not only for insanely expensive medicines, but even for kopek fluid. In a country that was one of the first to show the world the “brutal grin of capitalism”, the old people, too, are probably not sweet?
- Especially "not sweet" to the grandparents who came from the former Soviet Union in refugee status. Without hitting their fingers in this country, they immediately begin to receive a very decent pension, and the state assumes all the costs of their medical support, including free medicines. Moreover, retirees in the United States have the right to a free nurse who is obliged to help them with the housework: clean, wash, go to the store. The state pays for it to the nurse 800 dollars per month. So what did our grandmothers come up with? "You, daughter, do not go to me, I myself still able to serve myself, and the money that you pay for me, we will share." I think the situation in Russia is not much different from the Ukrainian one. Most recently, my mother had surgery in Odessa. If we consider that my mother has a pension of 25 dollars, and the operation was worth 300, then this is practically the same as for me 25 thousands. And what did mom get for this money? When we talked on the phone, she could not hold back the hysterical crying. Not only did she have to bring her food, her bed, her blanket, towel, medicines, syringes (by the way, if in America the patient brings her medicines to the hospital, they will simply arrest him), every day a nurse came to her and said: well what, will you give a dollar or will you piss yourself?
“Why don't you take your parents to you?”
- I can not afford it. I will not be able to pay their medical expenses. One day of staying in the hospital without any special procedures costs 1000 dollars.
- In ten years you have never been to your homeland?
- Nope and I do not want. I am very afraid that when I cross the border, some Komsomol geek approaches me and starts rummaging in my suitcase to earn 5 dollars - I don’t think I can stand it. At the same time, I love my people very much, I am proud of its history and culture. And I would really like to help him with something. Maybe someday I will reach such a financial level that I will have the opportunity from time to time to come and provide free medical care to my compatriots. Anyway, I have it in the plans.