Medical Practice

Medical Practice, the regulated practical activity of medical workers, carried out by them in the course of performing their professional work. It is very common to understand medical practice as private medical practice. In pre-revolutionary Russian medical-sanitary legislation, which bore the stamp of bourgeois-serfdom state order, the rights and interests of medical workers found reflection only in the plane of their private relationships with patients, that is, medical practice was understood as private medical practice. There was naturally not even a mention in pre-revolutionary legislation of medical activity as socially useful work aimed at improving the health of the broad working masses. Even regarding physicians serving in state service, the regulations on state medical service spoke only of 'medical ranks' from the point of view of promotion, ensuring career advancement, and service privileges. The law was concerned primarily with these physicians as the highest corporate group, which was to be used to serve the administrative-sanitary, mainly medical-police needs of the bureaucratic state apparatus. The characteristic features of the pre-revolutionary order were manifested in the negative attitude toward the employment of women physicians, who according to note 2 to article 44 of the 'Charter of Medical Practice' 'were not permitted to manage general hospitals and similar medical institutions and their male departments in cities, nor to perform the duties of a physician in military service examinations, or to independently conduct forensic chemical examinations at the request of judicial institutions.' In accordance with the understanding of medical practice as private practice adopted in pre-revolutionary legislation, it contained many articles regulating private practice regarding the size of fees, relationships with patients, etc. Medical seals, medical congresses, especially the Pirogov congresses and congresses of medical assistants, dentists, before the revolution repeatedly dealt with the issue of private medical practice, and only a very small, most advanced part of the medical personnel, mainly workers of zemstvo medicine, were negative toward the institution of private medical practice, considering it incompatible with the calling of a medical worker. D. N. Zhbankov in his work 'Reviews on the Question of Private Medical Practice of Professors and Teachers of Medical Faculties, Military Medical Academy and Women's Medical Courses' (M., 1906) presents reviews of 45 professors and 17 privat-docents, the overwhelming majority of whom spoke in favor of the advisability of private practice. Closely linked to the capitalist system, which gave it a number of privileges, the top layer of the medical mass naturally held especially firmly to private practice. In light of this close connection of the medical mass with the capitalist system, the well-known strike of physicians in a number of cities after the October Revolution becomes understandable. Pre-revolutionary Russian medical-sanitary legislation in its attitude toward medical practice differed little from the legislation of other bourgeois countries. In these capitalist countries and to this day medical practice is also regulated as private medical practice, which enjoys state support. Even in those countries where social insurance has been introduced, for example in Germany, England, Austria, France, the activity of medical personnel, even those serving insurance funds, takes place under conditions little different from those of private practice: insured persons are received by physicians in offices in their homes; a fee is collected from the insurance fund for each insured person accepted, which is connected with the pursuit of as many patients as possible and the restriction of physicians' access to insurance practice through appropriate corporate medical organizations; physicians wage an energetic struggle (for example in Germany and Austria) against insurance funds regarding the organization of their own polyclinics, special outpatient clinics and hospitals, against the expansion of the circle of persons entitled to free medical care from insurance funds, for example against including in this circle family members of insured persons. Medical assistance to the uninsured and in particular to the rural population in the aforementioned countries is also mostly provided in the manner of private practice. It is characteristic that in many countries, for example in Germany and the USA, private practice physicians have the right to treat their patients upon their admission to a hospital, even if they are not on the staff or supernumerary staff of the hospital. In many university clinics, professors have their 'private departments' where they place their patients for special payment. The fact that in some countries, for example in Germany, there is no prohibition on providing medical assistance by persons without medical qualifications is the subject of constant attacks by physicians not only because of the harm associated with charlatanism, but mainly because this circumstance contributes to the reduction of their earnings from private practice due to competition from charlatans. A special form of medical practice abroad is work in private hospitals, clinics, sanatoriums, which play an enormous role in the health care system in capitalist countries; in these institutions, exploitation of hired medical personnel already takes place directly by the owners. The attitude toward private practice is completely different on the part of the Soviet state- USSR. Considering private practice a bourgeois-capitalist relic subject to systematic displacement as socialist construction expands, health authorities through their measures to improve and improve medical-sanitary assistance to the working population (development of a network of preventive medical institutions and improvement of the qualification and specialization of medical practice) systematically reduce the need of the working population to seek medical assistance from private medical practice. In 1921, the People's Commissariat of Health of the RSFSR gave the basic correct, under the conditions of that time, principled guidelines regarding private practice: 'Private medical practice as a relic of the capitalist system contradicts the basic principles of the proper organization of medical-sanitary assistance and the general foundations of socialist construction. Accessible only to individual persons who can pay enormous fees, it disrupts medical-sanitary work, brings disorganization and discord among medical personnel, diverts medical forces from Soviet work for the benefit of the working population, leads to speculation, charlatanism, to the 'Medical Sukharevka'.' Here reference was made to the widely developed private practice as a system of medical assistance that opposed Soviet public medicine. In the past years, the proportion of private medical practice has sharply decreased, being increasingly displaced by the significantly grown and strengthened network of medical-sanitary institutions. However, due to the insufficiency of the existing medical-sanitary network to fully cover the entire population with all types of qualified medical assistance, on the one hand, and the existence, on the other hand, of certain, well-off contingents of the population who are able to pay for the medical assistance provided to them, private medical practice continues to be permitted in the USSR as a special type of medical activity of medical personnel, without any restrictions, and health authorities have no right to hinder the development of private medical practice, provided it proceeds in accordance with existing legislation. Private medical practice actually plays a very insignificant role in the entire system of medical-sanitary service to the working population and, as socialist health care grows and strengthens, it is increasingly disappearing. Speaking about medical practice in the USSR, one must primarily have in mind Soviet medical practice, i.e., medical activity in the service of Soviet state authorities and public organizations, imbued with proletarian class content, i.e., directed toward satisfying the needs of the proletarian state (preferential service to the proletariat and collective farm peasantry) and carried out in close connection with the broad proletarian public on the basis of the population's self-activity. Private medical practice in the RSFSR is regulated on the basis of the decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR of 1/XI 1924 (published in S.U. 1924, No. 88, art. 892) on professional work and the rights of medical workers and the decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR of 10/I 1930 (Questions of Health, official section of 15/III 1930, No. 6). According to this decree, every medical worker wishing to engage in private practice must register with the local health department. A medical worker engaged in private practice must keep records of patients in special books, stitched and sealed by the health department, indicating the name and address of the patient, the diagnosis of the disease, and the prescribed treatment, and these books must be submitted upon demand by the health department, judicial or investigative authorities. The amount of remuneration received is entered in a separate book, stitched and sealed by the People's Commissariat of Finance, to be presented upon demand by the relevant authorities. On signs, advertisements, and publications about medical practice, medical workers may indicate only their title, surname, first name and patronymic, specialty, place and hours of reception. Private medical practice is generally not permitted to feldshers and feldsherinas.

In places where there are no medical institutions or medical care, the question of granting the right to private practice to feldshers and feldsherinas is resolved in each individual case by the health department in agreement with the local department of the medical labor union. To provide doctors and dentists with the opportunity to practice at home, they are guaranteed the right to an additional room or additional space of 10 m² beyond the existing general norm in the absence of a separate room (decree of the VTsIK and SNK of the RSFSR of February 28, 1930). See also Medical personnel. The practice of medicine as a profession by persons without appropriate medical education properly certified, as well as the practice of such medical practice by a medical worker who does not have the right to it, is punishable by compulsory labor for a term of up to 6 months or a fine of up to 500 rubles (Art. 180 of the Criminal Code). Every medical worker engaged in practical medical activity is obliged to provide medical assistance in cases requiring emergency medical care; he is also required to report to the nearest health department about every case of acute infectious diseases, poisoning, murder, infliction of serious bodily injuries or suicide in his practice. For professional violations, medical workers are subject to punishment by court, as well as in a disciplinary manner. Failure to provide assistance to a patient without valid reasons by a person obligated to provide it by law or by special rules is punishable by compulsory labor for a term of up to 1 year or a fine of up to 300 rubles (Art. 157 of the Criminal Code). The refusal of a person engaged in medical practice to provide medical practice, if this refusal was obviously likely to have dangerous consequences for the patient, is punishable by imprisonment or compulsory labor for a term of up to 1 year or a fine of up to 1,000 rubles (Art. 157 of the Criminal Code).