Your Blood Is No Longer Needed

Your blood is no longer needed

The Ministry of Health explained why it is planned to exclude urine and blood tests from the prophylactic medical examination program: these studies "have no scientific evidence of benefit and are not carried out for the purpose of screening the population in any country in the world." Patient organizations are convinced that the main reason for adjusting the volume of professional examinations is economic.

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Excessive analyzes

A reduction in the list of examinations of patients undergoing clinical examination is provided for by a new draft order of the Ministry of Health. "On approval of the procedure for conducting clinical examination of certain groups of the adult population." The authors of the document, which should enter into force in 2018, plan to seriously adjust the list of clinical examinations.

In particular, from the first stage of clinical examination, which identifies the risks of a particular disease, general urine analysis, clinical and biochemical blood tests, ultrasound examination (ultrasound) to exclude neoplasms of the abdominal cavity organs, small pelvis and aneurysm of the abdominal aorta and some other studies. The second stage of medical examination is also "optimized". For example, the determination of the concentration of glycated hemoglobin in the blood or the glucose tolerance test for patients who at the first stage showed an increase in blood glucose levels were deleted from the list of studies.

As explained in the Ministry of Health, blood and urine tests will not be performed on "asymptomatic citizens." “These analyzes do not have scientific evidence of benefit and are not carried out for the purpose of screening the population in any country in the world. They are also absent in the WHO recommendations,”said Sergei Boytsov, chief freelance specialist of the RF Ministry of Health on preventive medicine.

At the same time, the Ministry of Health promises that in case of patient complaints or the doctor's suspicions, the necessary additional examinations and analyzes will be carried out. “In accordance with paragraph 15 of the new order, when a patient is identified in the course of clinical examination of medical indications for examinations by specialist doctors, studies (including blood and urine tests) and activities that are not included in the scope of medical examination, they are prescribed and performed taking into account the provisions procedures for the provision of medical care according to the profile of an identified or suspected disease and standards of medical care, as well as clinical recommendations, "Boytsov specified.

Earlier, the Minister of Health Veronika Skvortsova said that the Ministry of Health plans to make the clinical examination more individualized, and the medical examination program will differ not only depending on the patient's gender and age, but also on the characteristics of his health.

The Ministry of Health is just trying to save money

The idea of the Ministry of Health was criticized by the director of the independent monitoring fund "Health" Eduard Gavrilov. In his opinion, this will further aggravate the problem of late detection of dangerous diseases among Russians. “How can you, by giving up urine and blood tests, detect early signs of impaired kidney, liver, pancreas, and so on? An increase in the level of leukocytes in the urine is often the only sign of tuberculosis of the genitourinary system in the early stages, when there are no other signs. By removing these studies, we exclude the possibility of timely diagnosis of dangerous diseases. Not seeing the results of laboratory tests, a doctor can detect a disease only at a late stage, when it is already difficult or impossible to treat it,”he said.

As the expert recalled, two years ago, the Ministry of Health has already revised the list of examinations during medical examination. But then this list was expanded, and today everything is the other way around. “At the same time, in both cases, the authors refer to international experience. It is possible that now the ministry is simply trying to save budgetary funds on preventive work, "Gavrilov said.

Costly and ineffective technology

Another opponent of the Ministry of Health, who can hardly be suspected of sympathizing with the department, agrees with the reduction of medical examination. Pavel Vorobiev, Department of Hematology and Geriatrics, Institute of Professional Education of the First Moscow State Medical University named after Sechenov. According to him, preventive examinations can be very effective in risk groups, but if they are carried out to everyone in a row, it is a costly and ineffective technology. “And carrying out laboratory and instrumental studies as a screening is a waste of money,” the expert is sure.

“We are discussing leukemia,” Vorobyov gave an example. - Chronic. An acute one cannot be "caught" by examination: from the onset of the disease to death only a month, during this time the patient always goes to the doctor with symptoms. The incidence of each type of chronic leukemia is approximately 1: 100,000 of the population. There are three main ones. The disease before manifestation (there are different periods) can be from many years to several months. Let only six months pass. This means that in each specific month the incidence of the disease will be one per million inhabitants. If a blood test costs 500 rubles, then to identify one case of leukemia you need to spend … 500 million rubles. With a total check. Of course, the numbers may change, there are still diseases manifested by anemia or increased ROE. But they are all extremely rare in the general healthy population without human complaints."

The same is with the analysis of urine: screening to identify kidney pathology is impossible, says Vorobyov. “The problem of hepatitis is similar: there are no symptoms - no pathology can be identified. Believe me, probably hundreds of thousands of patients have passed through my hands: there are no asymptomatic changes in biochemistry. Therefore, the main emphasis should be placed on the work of the doctor with the patient: a thorough collection of anamnesis and complaints. And only when some symptoms appear - to prescribe an examination. That is, the doctor must form the very notorious risk group in which the symptoms and signs of the disease must be looked for,”the expert said.

According to the screening standards, I did not fall into any risk groups

Meanwhile, numerous inspections of Roszdravnadzor and opinion polls of doctors show that in most medical institutions, clinical examination is carried out formally, for the sake of reporting and obtaining funds. And poor test results in such a situation can somehow alert doctors and force them to pay more attention to the patient who has come for a professional examination, insist in patient organizations.

As the chairman of the Association of Oncological Patients "Hello!" Irina Borova, who recently defeated breast cancer, it was a general blood test that helped to detect her disease at the first stage. “Prevention should be made of iron,” Borovova is sure. - According to the screening standards, I did not fall into any risk groups: up to two years old I breastfed five children, did not have a single abortion. Cancer found me at an unexpected moment, I felt completely normal and just donated blood from a finger. The analysis revealed an increased ESR (erythrocyte sedimentation rate), and then they began to unwind this ball. Despite the first stage, it turned out to be a very aggressive type of cancer. I received 29 chemotherapy sessions. And it’s even scary to think what would have happened if not for that blood test”.