Проблема «врачебной инертности» в практике офтальмолога

Abstract

The authors study the problem of inertia in the medical practice of ophthalmology, which implies the absence of any modification of the treatment in the presence of objective necessity or clinical indications. The treatment of multifactorial diseases, including primary glaucoma is particularly critical. An anonymous survey of 147 ophthalmologists from different regions of Western Siberia — Altai Territory, Kemerovo Region and the Republic of Khakassia, has been conducted. Most of the surveyed doctors believed that their treatment was successful in 40‑80 % of patients. According to literature data, ithe target value of IOP level is achieved in practice in under half of the patients receiving regular therapy. Another reason of medical inertia was the fear of polypragmasy. Almost 54 % of doctors said they are afraid to prescribe several medications, which limits their desire to intensify therapy. The results of our study suggest that the cost of glaucoma treatment, i.e. the fear to prescribe an expensive treatment for patients does not significantly determine the doctors’activity. Doctors often exaggerate the fear of patients for the treatment, believing that a particular medical drug will not be taken by the patient, without trying to figure out the patient’s intention. The economic barrier has become an essential factor for our doctors, as 35 % ophthalmologists believe that 300‑500 Rubles for the therapy per month is expencive for a patient. Over 30 % respondents discussed with the patient the prescribed treatment with cost about 700‑900 Rubles. This could potentially lead to the fact, that the second and third medical drugs would be less likely prescribed due to the increased cost of treatment. Thus, we have set up the structure of the causes of medical inertia — a psychological unwillingness to achieve target values of IOP, overestimation of the therapy success. Less important reasons were the lack of doctor’s awareness and the economic barrier forthe decision making.