ABOUT THE NATURE OF FORCED MEDICAL EXAMINATIONS
(According to the Federal law of 21.11.2011 № 323-FZ (ed. from 29.12.2015)
“About bases of health protection of citizens in the Russian Federation” and the order of the health Ministry of Russia dated 12.04.2011 № 302n (ed. by 05.12.2014) “About the approval of lists harmful and (or) dangerous production factors and works, under which compulsory preliminary and periodic medical examinations (surveys), and the Order of carrying out obligatory preliminary and periodic medical examinations (surveys) workers on heavy works and on works with harmful and (or) hazardous working conditions”)
Many believe that these medical examinations put the good purpose of health care workers. But this is not true. Despite the fact that Order No. 302n describes the set goals of dynamic monitoring of workers ‘ health, timely detection of diseases, early forms of occupational diseases, early signs of impact of harmful and (or) dangerous production factors and so on, but they are in violation of the rights of the patient and the person with the use of totalitarian methods of coercion and threats, capitalizing on the concepts of “health” and “health,” going beyond professional examinations, invading privacy, dividing people into “Fit” and “Unfit”.
It should be clarified that we are talking about professions that are not associated with risk or dangerous consequences, such as aviation pilots, doctors, firefighters and the like, for which the medical examinations required because of the specific activities and are carried out by separate provisions. “Our” occupations include accountants, watchmen, janitors, mechanics, programmers and other, quite ordinary and common profession for which the examinations are trying to impose by all means.
If preliminary medical examinations (at receipt for work) and even reveal any violations that impede the work in the chosen specialty, the person has the choice of another speciality, with fewer requirements. Periodic well check-UPS can easily and permanently to deprive the employee of existing works irrespective of length of service, experience, personal qualities. The author knows of similar cases. The list of required examinations by specialists, analyses, functional studies and contraindications is not always correlated with the actual ability to work. Some of them from the point of view of biology, or evidence-based medicine is not needed at all, and demeaning controversy with doctors, often hamyang even in private organizations, the complaint attempts to assert their rights at a higher level only worsen the situation. With a constant shortage of specialists aged 45 years, when it reaches the desired experience and, as a rule, make themselves known disease, not all and not always lead to incapacitation, such an approach easily can deprive a person of a livelihood.
According to the Order № 302n, conducting preliminary and periodic examinations of all surveyed mandatory (despite the indications and the degree of dependence of working capacity) are:
• CBC (hemoglobin, color index, erythrocytes, platelets, leukocytes, leukocyte formula, erythrocyte sedimentation rate);
• clinical urine analysis (specific gravity, protein, sugar, microscopy of sediment);
• electrocardiography;
• digital fluorography or radiography of organs of a thorax in 2 projections (straight and right side), in the center of occupational pathology or medical institution, having the right for examination of competency and the Association of the disease with the profession in accordance with applicable law, conducted x-rays of the chest in 2 projections (straight and right side);
• biochemical screening: serum blood glucose, cholesterol.
• for “decreed”) is added to the list of studies to a number of infections.
Followed by a mandatory medical examination. Although the Order and stipulates that the passage of doctors-experts, laboratory and functional studies marked with an asterisk (*) shall be made on the recommendation of the doctors involved in preliminary and periodic examinations, but in reality this usually does not occur for commercial reasons. The list of mandatory medical specialists, functional studies and analyses can be expanded according to the testimony, or at the request of a number of organizations. World experience shows that the medical examination of workers is advantageously carried out by one specialist alone. Such a specialist is a therapist, which in foreign countries are called General practitioner (GP). General practitioner, GP). Almost 100 countries it is the GP examines employees of the companies, and having identified certain violations – refers to the doctor of more narrow specialization, which will clarify a diagnosis and prescribe treatment. In our country, is still used in an extensive practice of a large number of specialists stubbornly pursuing commercial objectives with totalitarian principles.
As is mandatory for all categories surveyed, the participation of the therapist, psychiatrist and narcologist. All women were seen by a obstetrician with a bacteriological (for flora) and a cytological (for atypical cells) studies at least 1 time per year; women over the age of 40 are 1 every 2 years mammography or breast ultrasound.
The main points that suggest about tyrannical, totalitarian and inhuman entities such compulsory inspections.
1. To refuse medical examination for ethical, scientific (especially from the point of view of evidence-based medicine), religious or other beliefs or reasons, fully or partially, despite the fact that article 41 of the Constitution of the Russian Federation medical care is defined as the right, but not the obligation, under current legislation it is impossible. Itself periodic inspection is completed only in the case of inspection of the employee all medical specialists, as well as perform a full scope of laboratory and functional studies foreseen in the List of factors or List of works of Order № 302n. In the case of full or partial refusal of employee to follow a legitimate negative legal consequences consisting of the suspension/dismissal even healthy able-bodied worker, you have the option of punishment for personal beliefs.
2. The minimum set of patients ‘ rights, the observance of which today make medical care safe, consists of the following three points:
• the right to respectful and humane treatment;
• the right to informed voluntary (conscious) consent to medical intervention;
• the right to choose medical institution and the doctor.
In violation of the Federal law “About bases of health protection of citizens in the Russian Federation” No. 323-FZ, article 19 paragraph 5.1 selection of medical institutions and doctors is the employer that does not control the quality of care at the medical examination.
Be sure to note that Federal law No. 323-FZ in the protection of their rights in this situation should not count. In articles concerning the compulsory medical examinations (which is why it made a three – 24, 27 and 46), it is his own text automatically exclude discreditied the concept of informed voluntary consent to medical intervention and refusal of it. The Law also contains a lot of contradictions to their own articles. For example, article 24 (“Rights of workers employed on specific types of work, to protection of health”) contrary to its title, article 4 paragraph 1 and 2, articles 18, 19, 20, replaces the concept of law concept of duty. Application to healthy employees (unless proven otherwise) coercive medical treatment is contrary to the conditions and to the persons specified in item 9 of article 20. These contradictions (conflicts) for some reason is still not given due attention. In this situation it is logical to protect the interests of the majority, i.e. healthy, to use more higher legal acts. In practice, such very difficult. Attempts to force surveyed a healthy person to comply with their constitutional rights and the rights of the patient that is to refuse from the imposed medical services, including painful, dangerous, or humiliating, lead to suspension and/or dismissal, which is legal and absurd at the same time. Practices evidence-based medicine showing the danger of any intervention in a healthy body and the lack of a statistically significant reduction in mortality from carrying out periodic medical examinations (Feldman, Holland, 2013).
These violations, as well as the discrediting of the concept of informed voluntary consent and the inability of non-interference in the aggregate allow us to speak about insecurity and inhumanity of such medical examinations.
3. According to the results of the medical examination, the employer is given a list of individuals with the established diagnosis of occupational diseases by sex, date of birth and other data, a list first established chronic physical illness, the list for the first time established occupational diseases. Neither of which protect medical confidentiality in accordance with article 13 of the Federal law “About bases of health protection of citizens in the Russian Federation” No. 323-FZ of and compliance with article 23 of the Constitution, is not even a question.
4. During the inspection the doctor-ENT according to the Order №302n is audiometry, which is an expensive and time-consuming instrumental study of hearing in order to identify serious violations and conducted according to the testimony. For the needs of the production of enough physical check on the perception of whispered speech.
5. Absolutely senseless annual (in violation of article 213 of the Labour Code (LC) of the Russian Federation) examination by a psychiatrist (or psychiatrist-narcologist, not provided for in the labour code). It is known that mental patients during remission do not differ much from healthy, there are far more important features of accounting and monitoring. Questions like, “Drink alcohol?” or “Suffer from mental illness?” is meaningless because of the unproven in mass inspection.
6. For some categories of employees, of the Order № 302n introduced compulsory EGD fibrogastroduodenoscopy, which in everyday life is called “swallowing light” or “guts”. This study had previously always used only according to the testimony, and it is not just painful. It is also associated with the risk of infection, including the risk of infection by Helicobacter pylori (H. pylori) is a bacterium that causes stomach ulcers, hepatitis, blood infections. The most dangerous possible complications of EGD can be bleeding, perforation of the esophagus, stomach or duodenum, infection. During EGD can happen even to death statistics show that approximately 1 death per 10 000 examinations, usually in patients with serious cardiovascular diseases. In the mass examination of “gut” by definition cannot be reliably sterilized, because the optics be boiled or autoclaved impossible, it can only be put on a certain period of time in the disinfectant solution, and at a mass inspection time is not always observed. The content of the Order №302n does not grant the person the right to refuse even from procedures, co can harm or even death, ignores the very fundamental concept of medicine “do no harm”.
7. During the inspection of the gynecologist or the doctor-dermatologist are humiliating, touching is very taboo in society topics, invasive, quite painful manipulation the scraping of the urethra, anus and the like, can lead to iatrogenic dangerous consequences – bleeding, infection, and even perforation, and quite suitable on the grounds under the definition of “harsh or degrading treatment” and “medical experience”. To abandon them, in accordance with article 21 of the Constitution of the Russian Federation without any negative legal consequences is impossible. Any measures of reducing pain in violation of article 19 clause 5.4 of the Federal law “About bases of health protection of citizens in the Russian Federation” No. 323-FZ is absent. Such a senseless in healthy women (and from the point of view of competency including) the scraping of the urethra should be performed strictly for medical reasons (patient complaints, leucorrhoea, treatment monitoring, etc.). Especially from such forced painful manipulations, and often from rude, unethical and humiliating, invading personal space issues and advice of a gynecologist suffering virgin. Virginity, as does the fact of working in the company of such indications are not.
Of gynecological (and even painful) inspection against the will – humiliating procedure that cause moral, and sometimes physical harm, causing mental trauma that form iatrophobia (fear of doctors). Any concerns about the health of” such could be justified. He is sex discrimination, contrary to article 19 of the Constitution: “2. The state guarantees equality of rights and freedoms of man and citizen, regardless of sex, race, nationality, language, origin, property and official status, place of residence, attitude to religion, convictions, belonging to public associations and other circumstances. Prohibits any form of restriction of the rights of citizens on social, racial, national, linguistic or religious affiliation”, “3. Man and woman have equal rights and freedoms and equal opportunities for their realization”. As in the case of EGD gynecological or dermatological examinations, despite the existence of the Order No. 390н, Order No. 302n does not include the right to refuse painful and dangerous procedures that also ignores the very fundamental concept of medicine “do no harm”.
8. In addition to p. 7. Since January 2012 there have been changes in the conduct of medical examination of drivers of individual vehicles. New Order №302n, which overturned the action of the Order No. 555, expanded the scope of studies and the number of specialists required to undergo a medical examination, as well as its multiplicity. Now, according to the new normative document, a medical examination should take place once in two years. If citizens first visited the psychiatrist, the psychiatrist, internist, surgeon, ophthalmologist, neurologist, and an otolaryngologist, then 2012 becomes a mandatory visit to the dermatologist, and women, even to the gynecologist. In addition, citizens must undergo a chest x-ray, ECG, take blood and urine tests to examine the blood sugar and cholesterol. Women 40 years and older must undergo a mammography or ultrasound breast. During a medical examination for the right driving individual vehicles inspection specialists specified in the certificate of the traffic police is mandatory, regardless of whether they previously passed. As you can see, there is also imposed a completely unnecessary from the point of view of professional competence the examination of professional and studies, in violation of article 19 of the Constitution of the Russian Federation, other normative acts, the rights of the patient and the person that put totalitarian and commercial principles above humane and scientific.
9. At survey the doctor-dermatologist on the subject of the professional suitability of employees of the so-called “decreed contingent completely ignores the scientific data about the transmission of STIs (sexually transmitted infections). If we can theoretically assume it’s not likely contact (nonsexual) transmission of syphilis, which is possible irrespective of whether work on such “decreed” the enterprise, to gonorrhea or trichomoniasis and sexually transmitted diseases with similar manifestations urogenital) transfer in production and the risk to production does not hold water in the absence of alimentary (food grade) and aerogenic (droplet) transmission, malostonski of the pathogen in the environment. Industries that require sexual functions of man in our country does not exist. Features of the disease are well known for more than 2000 years of history of observation and more than 150-year history of scientific study. In the literature described isolated cases of domestic infection or mythological-curious, or are associated with relatively disadvantaged social and living conditions which by definition do not exist, for example, food production.
It turns out that for a check of professional suitability is cheating patients. Technically and biologically illiterate in several paragraphs of the Order № 302n called all employees “decreed” companies absolutely do not understand the degree of close contact with people (such as doctors or teachers) or risk of infection for production, and forced almost everyone, including 70-year-old working pensioners, who had long forgotten about sexual pleasures, to give blood for syphilis, forced to undergo a painful test for gonorrhea or similar sexually transmitted diseases for admission to work. This approach is pseudoscientific by definition, is not shared and substitute concepts (in particular concepts of infectious diseases, sexually transmitted and infectious diseases that can be transmitted in connection with the peculiarities of production, the concepts of contact and sexual contact), speculates with them has for a long time, almost a century ideological roots, the result of a long isolationist policy of domestic medicine.
10. The order № 302n in fact, entail the absence of harmful and (or) dangerous production factors at the workplace. In addition, it contradicts logically with a clear reference to article 25 of Federal law No. 52-FZ On sanitary and epidemiological welfare of the population” that the conditions of labour, the workplace and the labour process shall not exert harmful effects on humans. In such context, any harmful effect the violation of Federal law, and the Order № 302n in the quest with the help of physical examination to determine the impact of the factors on the organism involves their binding effects on the body. Many of the criteria of the Order or mnohosmyslov, or incomprehensible. Its technical and biological ignorance provokes speculation on the concepts from the specialists for occupational safety, public health physicians, regulatory authorities and other persons and organizations. The result is the inventing of prepositions (op. CIT. – “Harm can not be!”) and the forcing of workers at any cost to undergo a medical examination even in the apparent absence of harmful and (or) dangerous production factors at the workplace. In the end, a good initiative has become a means of intimidation and coercion.
11. The Federal law “About bases of health protection of citizens in the Russian Federation” No. 323-FZ, the Order № 302n and other regulations force the employer to spend money on absolutely do not need a healthy majority of the workers check-UPS and tests. A similar approach can be interpreted as imposed on the service, which cannot be refused without disqualification. Applicable laws the employer is caught in a clever legal trap. Any attempt of the employer to resign from the performance of even unscientific or inhumane laws will result in prosecution to the fullest extent of those laws. Over their observance, regardless of science or of humanity watched by regulatory authorities.
12. As a consequence of clause 11 medical organizations, conducting periodic inspections receive income with absolutely no need a healthy majority of workers of examinations and tests. There is a corruption component as of Order №302n, and other regulations that force employers to spend money under threat of punishment. When the price of the inspection one employee approximately three to five thousand rubles, and the estimated number of able-bodied, under the terms of the Order of the population at least one million people, we can talk about the amount of not less than three billion rubles annually. It is clear that the real figures are much greater. In addition, the number of categories employed is examined twice a year.
Getting real help even the detection of any disease (and especially if deprivation of the cause) is often very difficult, as medical checks does not put such purpose. In just a terrible situation with healthcare, for example, in community clinics or hospitals, the growing imposition of paid medical services, the deplorable situation with high-technology medical care such “health” looks like a mockery.
The list of violations of patient’s rights and human rights, if desired, can be increased, but this makes little sense, as these violations are being actively supported by representatives of the ministries and Federal laws. Such laws are based on the totalitarian and isolationist gerontocratic principles nearly a century ago and have two main purposes – ideological and commercial. At the same time, the work of a doctor, by definition, requires freedom and cannot be described only by orders and instructions. With speculation extremely important for all people the concept of health is speculation another extremely important concept – work. The rejection of a healthy person from a completely unnecessary medical (and often painful carried out according to the instructions, as with things) intervention no offensive punitive consequences puts such medical examinations on a par with such concepts as despotism, terror, and veterinary inspection of animals and subsequent culling of the herd, a collective responsibility, Lagerschperreнацистов from Auschwitz, “care” of the slaves in the Ancient world, fanaticism, pseudo-religious cargo cult and others.
Literature
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