What is included in the screening. Medical examination. Medical examination of employees: why is it so necessary

Every time, having learned about an examination organized at work by doctors, many are indignant: why is this necessary? Obviously, this is a fundamentally wrong approach. The employer who organizes the physical examination shows his best side. However, one should not assume that he does this solely from altruistic motives. The fact is that, in fact, it is the boss who pays for each hospital employee - he deducts interest to the Social Insurance Fund, from which money is then given to you. In addition, the time of a skilled worker can cost a company infinitely, making it much cheaper to protect yourself from downtime through preventive maintenance.

Employer and employees

Many, having gone to work or re-employed, probably faced the fact that they were sent for a physical examination to the clinic. What for? Because I feel healthy or healthy!!! On the one hand, employers are now obligated to send subordinates to this event, and on the other hand, it is important for each person to identify the initial stages of various diseases in time and begin appropriate treatment. What are medical examinations of persons working in contact with harmful and (or) dangerous factors? Currently, the priority national project "Health" is being implemented in the Russian Federation, aimed at preserving the health of citizens and the labor potential of the working population. One of the important measures to preserve people's health is preliminary (when applying for a job) and periodic medical examinations (examinations).

The main goals of medical examination

Among the main tasks that the medical examination is designed to solve, seven main ones can be distinguished. It:

• determining the conformity (suitability) of workers and employees with the work assigned to them, ensuring labor safety;
• identification of persons with occupational diseases or suspicion of such diseases, prevention and timely identification of the initial signs of occupational diseases;
• identification of common (non-occupational) diseases in which further work in contact with factors of occupational hazard may worsen their course;
• assessment of working conditions and development of sanitary and hygienic measures aimed at eliminating the causes of occupational disease;
• dynamic monitoring of the health status of workers under the influence of occupational hazards;
• timely implementation of preventive and rehabilitation measures aimed at maintaining the health and restoring the working capacity of employees;
• accident prevention.

The medical examination includes a very important examination - fluorography. This is an X-ray examination of the lungs for the presence of tuberculosis. Tuberculosis is a very common disease in our time. People with high blood pressure should have regular check-ups, as this problem can lead to a heart attack or stroke. Vascular thrombosis occurs. People need to carefully look at their state of health, as now

arterial hypertension affects quite young people who may not be aware of the disease. In this case, a physical examination will help identify violations and specialists will advise what lifestyle is needed in order to prevent the occurrence of high blood pressure. Especially important is the annual medical examination for people who are employed in work with harmful or dangerous working conditions (for example, underground work, etc.).

It is necessary?

Yes, if you:

• work in a dangerous enterprise;
• connected with children (teacher, educator);
• work in a medical facility.

In all other cases, a person has the right to refuse to visit a doctor.

What kind of doctors do you need to go through?

You will have to visit:

• therapist;
• psychiatrist;
• narcologist;
• dentist
• dermatovenereologist;
• otorhinolaryngologist.

This is the basic program. For people working in hazardous enterprises, it can be expanded in accordance with the specifics of the activity.

Also, most often, the main tests are included in the physical examination:

• blood (common);
• swabs for gonorrhea and pathogenic staphylococcus aureus;
• biochemistry of urine and blood.

All of them will help to make sure that the state of the body does not pose any threat to either you or others. Typically, such an inspection is carried out once a year to keep information about the health of employees up to date.

How often do you need to undergo a medical examination?

The frequency of periodic medical examinations is determined by appendices 1 and 2 to the order of the Ministry of Health of Russia No. 90, but should be at least once every two years. Persons under the age of 21 undergo periodic medical examinations annually (Labor Code of the Russian Federation, Art. 213).

Periodic medical examinations of employees may be carried out ahead of schedule in accordance with a medical report or at the conclusion of the Rospotrebnadzor authorities with justification of the reason for the extraordinary examination. Unscheduled medical examinations are carried out at the request of the employees themselves or in accordance with the recommendations of one of the specialists involved in the examinations, as well as according to epidemiological indications.

Employees engaged in hazardous work and work with harmful and (or) dangerous production factors for five years or more, periodic medical examinations are held in occupational pathology centers and other medical organizations once every five years. Of course, such centers must have licenses for examination of professional suitability and examination of the connection of the disease with the profession.

There are several types of medical examinations for employees:

1. Preliminary. Their goal is to find out whether the candidate’s health condition allows him to perform this or that job. For some categories of workers, such examinations are mandatory.

For example, a preliminary medical examination upon admission to work must pass:

• people whose professional activities are related to the management of complex mechanisms and devices (crane operators, electricians);
• people who work in dangerous conditions (industrial climbers, sailors, oil and gas industry workers working in the Far North);
• people driving vehicles (drivers, pilots);
• food industry workers;
• employees of children's and medical institutions and others.

2. Periodic. They are carried out in order to identify diseases at an early stage that can be dangerous to others or make a person unsuitable for performing a certain type of work, to track the dynamics of changes in health, as well as to identify possible occupational diseases and minimize harm caused to health and employee well-being. Employees under the age of 21 must undergo a medical examination annually.

3. Carried out in special cases - at the request of the employees themselves, when occupational diseases are detected during the last scheduled medical examination, in cases where someone in the team has a dangerous infectious disease, and also at the request of Rospotrebnadzor. Requirements for the frequency and procedure for conducting medical examinations are prescribed in the Labor Code of the Russian Federation (Articles 212, 213 and 266). And article 5.27.1 of the Code of Administrative Offenses of the Russian Federation establishes that admission to work without undergoing a mandatory periodic medical examination entails a fine on officials and individual entrepreneurs in the amount of 15,000–25,000 rubles, on legal entities - 110,000–130,000 rubles .

The procedure for conducting medical examinations of employees of enterprises

The organization of a medical examination is the responsibility of the management of the enterprise, it also pays for this event.

Briefly, the scheme for organizing a medical examination for employees of the enterprise looks like this:

Step 1. Formation of a list of the contingent of workers who should be sent for a medical examination. The list within 10 days must be sent to the territorial department of Rospotrebnadzor of your administrative district.

Step 2. Conclusion of an agreement for the examination of employees with a medical center. Coordination of the timing of the medical examination.

Step 3. Signing an order on the frequency of the medical examination and the order of its passage. Employees must be familiarized with this document at least 10 days before the start of the medical examination.

Step 4. Issuance of referrals for a medical examination. Directions are drawn up in the organization in any form.

Step 5. Collection of signed and sealed conclusions with the results of a medical examination. The conclusion is signed in two copies - one of them is given to the employee, the other remains in the institution that conducted the medical examination.

Step 6. The medical center draws up the final act. This may take time, usually up to 30 days. A certified act signed by a medical institution and organization is sent to the territorial department of Rospotrebnadzor in its administrative district for approval.

Employees are obliged to appear at the medical center with which the contract was concluded, exactly at the time indicated in the direction. You need to have your passport and referral with you. If the employee does not show up, the employer must suspend him from work without pay until the inspection is completed. If the inspection was missed due to the fault of the employer or for reasons that do not depend on either the employee or the employer, the exclusion from the performance of duties is regarded as simple and is paid in the amount of 2/3 of the average salary of the employee. As a rule, during a periodic medical examination, employees visit several specialists and undergo various instrumental and laboratory tests. The specific list depends on the types of work and harmful production factors. The commission is formed by the medical center with which the contract for the medical examination was concluded. It necessarily includes an occupational pathologist, as well as other specialists.

If the responsibility of approaches to assessing professional suitability increases, then the quality of work in certain areas should indirectly improve, which, in the end, will positively affect the well-being of the population as a whole.

Since 2012, a narcologist and a psychiatrist have been added to the list of doctors who must be taken in the process of medical examination to extend the medical book. This caused numerous discussions, arguments, indignations and protests. In fact, these specialists, especially the psychiatrist, are traditionally classified as doctors of a special, specialized direction. They were not previously associated with a general medical examination. However, since 2012, these doctors have been included in the list of mandatory visits when applying for a medical book and have become the only doctors (besides the therapist) who evaluate the professional suitability of civil servants.

Let's try to figure out why in our country more attention has been paid to mental health and emotional state, as well as the degree of adequacy of workers in responsible areas. The bottom line is that medical assessments are indeed incomplete if they are focused only on the analysis of morphological, physiological indicators of health and at the same time completely lose sight of the psycho-emotional component. Meanwhile, it has long been proven and everyone is well aware that sometimes mental health and mood, as well as emotions themselves, can determine the physical state, influence the processes occurring in the body, etc.

Here it is impossible not to recall the common expression in everyday life "all diseases are from the nerves." Moreover, you can safely rephrase it, pointing out that many aspects of the treatment of diseases are also determined, in turn, by the state of the psyche and emotional background.

Recently, the passage of an examination by a psychiatrist and a narcologist has ceased to be something suspicious and frightening. It has become a preventive measure. At the same time, the doctors of these specializations themselves have somewhat increased work. Obtaining the conclusion of any of them traditionally requires only a simple standard check whether the person is registered with the relevant institutions. This refers to narcological, psychiatric registration or registration as a person prone to antisocial behavior.

When it comes to checks of civil servants and checks that accompany the issuance of a medical book, then just checking the records is not enough. You need either a medical certificate from a narcologist and a psychiatrist as a separate document, or the conclusion of these doctors, which, accordingly, is reflected in the medical certificate for the civil service and the form of the medical book.

In turn, the issuance of a medical book and a medical certificate for the civil service invariably involves a medical examination. It turns out that doctors work not only with documents, but also directly with patients in the form of, at least, verbal detailed conversations. If we take into account, therefore, the total number of people undergoing medical examinations, one can imagine how much work there is for narcologists and psychiatrists.

For patients who, in the process of applying for a job, must receive designated conclusions, all these activities are undoubtedly burdensome. Additional medical examinations cannot please when it comes to a purely mechanical necessity - to undergo certain procedures and receive a final health document.

In fact, emotional and mental adequacy are important just to maintain these forms of security. If a person is unstable in these respects, then one should not expect from him a serious approach to anything, in particular, to the proper passage of medical examinations and ensuring sanitary and anti-epidemiological safety.

In addition, additional control is also necessary to exclude poor-quality performance by people of their professional duties, which are officially recognized as socially significant and socially oriented. It's really wild to imagine a drug addict or a mentally ill person as an employee of, say, a kindergarten or a medical practitioner.

Actually, all the difficulties here are associated with elementary additional actions. In fact, there is nothing wrong with an additional medical examination and an additional medical check. Accordingly, there is nothing to be upset about. If the responsibility of approaches to assessing professional suitability increases, then it should be assumed that, in a sense, the quality of work in certain areas should indirectly improve, which, in the end, will positively affect the well-being of the population as a whole.

According to the Order of the Ministry of Health and Social Development of the Russian Federation No. 302n, employees of enterprises and institutions must undergo regular medical examinations. Such a requirement helps to identify and eliminate diseases in time, which has a positive effect not only on the well-being of the employee, but also on the workflow of the entire team. It also makes it possible to protect other people in contact with the worker. Below we will consider the rules for preparing for a physical examination, and also tell you which doctors you will need to visit.

Which doctors are being examined?

Every person planning to make a physical examination should know which specialists need to be visited. The list of doctors may vary depending on the specifics of work, working conditions, sex and age of the employee. Most often, a physical examination includes an appointment with:

• therapist;
• neuropathologist;
• otolaryngologist (ENT);
• ophthalmologist;
• gynecologist (for women);
• urologist or proctologist (for men);
• surgeon
• narcologist;
• dentist.

Preparing for a physical examination with a therapist

The medical examination begins with a visit to the therapist. This multidisciplinary specialist conducts a general examination of the patient, his skin and mucous membranes, palpates some organs and lymph nodes, assesses the condition of the musculoskeletal system, listens to the lungs with a phonendoscope, measures pressure and body temperature. The results of the anamnesis are recorded in your medical book.

An examination by a therapist does not require any special preparation. All you need to do is wear comfortable clothing that won't interfere with the examination, and be prepared to talk to your doctor about your health.

Rules for preparing for a professional examination by a neurologist

If you experience recurrent or frequent headaches, migraine attacks and dizziness, trembling hands, sleep problems, seizures, you need to make an appointment with a neurologist without waiting for the scheduled physical examination. If you do not observe any malfunctions in the functioning of the nervous system, a visit to a neurologist should take place as a preventive measure once a year (during a physical examination).

An examination by a neurologist consists in taking an anamnesis, measuring blood pressure, lightly tapping the patella with a special hammer, pricking the patient's skin with special needles to determine the threshold of sensitivity, assessing coordination of movements and balance.

In order for a specialist to receive accurate information about the state of health of a person who came to him for an examination, it is necessary to give the neurologist truthful and reliable information when answering his questions. If the doctor suspects any pathologies, he can prescribe an appointment for additional examinations - for example, magnetic resonance imaging, computed tomography, electroencephalography, echoencephalography.

Before undergoing a medical examination by a neurologist, it is advisable to sleep well, stop drinking tonic drinks (coffee, energy drinks, Eleutherococcus or ginseng tinctures) and alcohol. Also, if you are already taking any medications (sedatives, tranquilizers, sleeping pills), be sure to tell your doctor about it.

Otolaryngologist examination: what you need to know and how to prepare?

During a visit to the ENT, an examination of the mucous membranes of the throat and nose, auricles is performed. Preparation for a professional examination at an ENT consists in carrying out hygiene procedures: before visiting a doctor, you need to brush your teeth, clear your nose of natural mucus, and gently clean your ears with a cotton swab. Also, do not gargle and rinse your nose so that the specialist can take samples for analysis.

Rules for preparing for a professional examination by an ophthalmologist

An ophthalmologist (oculist) examines the eyeballs, the mucous membrane of the eyelids and the fundus, measures eye pressure, and checks the patient's visual acuity using special tables. To prepare for the examination, it is advisable to abandon the preliminary instillation of the eyes. You will also need to bring glasses or contact lenses to your appointment if you wear them.

Preparing for a professional examination for women (visiting a gynecologist and a mammologist)

The prospect of an upcoming gynecological examination is the reason for the excitement of every second woman. This can be easily understood from a psychological point of view, because few people feel comfortable during a visit to a gynecologist. However, every woman should understand that such an examination is a guarantee of health, not only for herself, but also for her partner.

A visit to a gynecologist includes a conversation about the nature of sexual activity, the menstrual cycle, the presence or absence of pain, discharge of an unclear nature and discomfort. This is followed by an examination in the gynecological chair using sterile equipment. At the end of the examination, the doctor takes a smear for laboratory testing.

To prepare for a physical examination by a gynecologist, a woman should give up sexual intercourse and vaginal douching 2-3 days before going to the doctor. It is also worth excluding the setting of vaginal suppositories and the use of intimate hygiene products (it is better to replace the use of the latter with washing with a decoction of chamomile or just warm water).

During the physical examination, women also need to undergo a mammologist. During a visit to this doctor, a visual examination and palpation of the mammary glands is performed, the doctor asks questions about possible pain and swelling of the breast during PMS. If the mammologist suspects that the patient has a particular disease, he will advise her to undergo an ultrasound of the mammary glands or mammography.

A visit to a mammologist during a physical examination does not require prior preparation. The only thing that needs to be done is to put on comfortable underwear and refuse the dress, since it will have to be completely removed for the examination (it is better to come to the appointment in a skirt and blouse, jeans and a sweater).

Professional examination by a proctologist or urologist (for men): how to prepare?

A timely visit to the proctologist and urologist for men is as important as an appointment with a gynecologist and mammologist for women.

Examination by a proctologist consists of questioning the patient, visual examination of the anal area, and palpation of the anus. On the evening before the proctologist, it is recommended to do a cleansing enema, as well as refuse dinner. If the appointment is scheduled for the afternoon, you can have breakfast with very light foods in a small amount.

As for a professional examination by a urologist, it includes an examination by a doctor of the scrotum and penis, as well as palpation of the prostate through the anus. In addition, sampling for laboratory testing of prostatic secretion may be required.

The rules for preparing for a professional examination by a urologist are simple: 2-3 days before visiting a doctor, you must give up sexual intercourse, conduct a cleansing enema the day before and refrain from urinating for 1-1.5 hours for examination.

Preparing for a medical examination by a surgeon

A visit to the surgeon is necessary for the timely detection of injuries and pathologies. After collecting an anamnesis, the doctor performs a visual examination and palpation of certain parts of the body, an examination using percussion and a stethoscope. If he has suspicions about the presence of a disease in a patient, the surgeon can refer him to an ultrasound or x-ray.

To prepare for the examination, shower beforehand and wear comfortable clothing that can be quickly removed for the examination.

How to prepare for a dental examination?

Dental examination helps to identify and eliminate caries, pulpitis and other dental diseases in the early stages. To prepare for a physical examination, you must thoroughly brush your teeth and rinse your mouth, and then refuse to eat until the appointment with the dentist. If the check-up is scheduled for the afternoon, it is recommended that you bring a toothbrush and toothpaste with you to work to brush your teeth immediately before your appointment.

Examination by a narcologist: what you need to know to properly prepare for it?

A visit to a narcologist is an obligatory part of a medical examination for drivers, medical staff, pharmacists, pharmacists, as well as for all employees whose field of activity is, one way or another, connected with mechanisms and apparatus.

During the examination, the narcologist asks questions in order to obtain general information about the patient's state of health, living and working conditions. Next, the doctor conducts a series of tests to determine the state of the vestibular apparatus and the basic functions of the nervous system. It is also necessary to visually inspect the skin and check the veins for the presence of non-medical injections. In addition, laboratory tests of the blood may be required for the possible detection of drug particles in it.

On the eve of the examination, it is necessary to stop smoking, drinking alcohol, as well as potent medications. If you are forced to take medication to maintain a normal state of health, this must be reported to the narcologist before the examination.

What is included in the physical examination from analyzes and diagnostic procedures?

• Finger blood test.
• Venous blood analysis.
• Analysis of urine.
• Smear collection.
• Electrocardiogram.
• Fluorography.
• Mammography.

Where to pass a medical examination in St. Petersburg?

Medical examinations are carried out both in public clinics and in private clinics and medical centers. Both those and other medical institutions have their advantages. However, when contacting private centers, you can expect a more complete range of services and attention from the staff. In addition, when registering for a medical examination at a private medical institution, the patient does not have to wait long for his turn, modern equipment is used for research, and the medical examination itself takes much less time.

In "GarantMed" you can pass a medical examination in a short time, after consulting with highly qualified specialists, and get the results of a medical examination in your hands. To do this, you need to contact the administrator and choose the most suitable date for the survey.

Yulia Egorova talks about the new rules for medical examinations

The law obliges

Recently, in connection with the active social policy of our state, such a form of health protection as a preventive medical examination is becoming increasingly important.

The Labor Code defines the groups of people for whom examinations are mandatory.

Labor Code of the Russian Federation Art. 213 (extract):

Workers engaged in heavy work and work with harmful working conditions<…>undergo obligatory preliminary (upon employment) and periodic medical examinations to determine the suitability of these workers for the performance of the assigned work and the prevention of occupational diseases.

Employees<…>medical and preventive and children's institutions<…>undergo the specified medical examinations (examinations) in order to protect public health, prevent the occurrence and spread of diseases.

An important point, reflected in Article 213 of the Labor Code, is that the conduct of preventive examinations of these groups of employees is the responsibility of the employer and is carried out at his expense, during working hours and with the preservation of wages. The state supports this with the "carrot and stick" method. Gingerbread is a preferential taxation of the amounts spent by the employer on professional examinations. A whip is an administrative liability under Article 5.27 of the Code of Administrative Offenses of the Russian Federation for officials guilty of violating labor laws.

What to do with the obligatory examination, if, according to the law, medical examinations and interventions cannot be carried out without the consent, and even more so against the will of the patient?

Preventive examination is obligatory only for certain groups of workers in order to protect public health. The arrangement for such responsible work can only be voluntary, and consent to preliminary and periodic professional examinations is assumed to be automatic upon signing an employment contract, which most often includes an item on passing inspections as an essential condition.

What has changed in the examination?

Until 2012, professional examinations were regulated by several orders, some of which were issued back in Soviet times. Since January 2012, the Order of the Ministry of Health and Social Development of Russia No. 302n dated April 12, 2011 "On approval of the lists of harmful and (or) hazardous production factors and works ..." came into force. At the moment, this order and its annexes are the main regulatory framework for preventive examinations, and the previous orders have been canceled since 2012.

Compared with the old procedure for conducting professional examinations several fundamental differences emerged.

1. Now only an occupational pathologist should head a medical commission, and the commission's medical specialists need advanced training in occupational pathology.

2. The principles of formation of lists of employees sent for medical examination have changed. If earlier employees were included in the list depending on the position, now an employee can be included in this list only on the basis of workplace certification, which must be carried out in accordance with another order of the Ministry of Health and Social Development of Russia (No. jobs according to working conditions). That is, even if a person works at a uranium mine, but the job attestation card is not indicated in the employment contract, then he does not need to undergo a medical examination, and he has no medical contraindications to work.

3. A psychiatrist and a narcologist are included in the medical commission, their examination is now mandatory for everyone undergoing a medical examination, and not just for those who are hired or have a drug permit, as was the case before.

On the whole, these innovations can be considered positive, especially if professional examinations of employees are not reduced to a formality, as, unfortunately, sometimes happens. The emphasis on occupational pathology increases the preventive value of medical examinations, and the exclusion of persons with alcohol or drug addiction from hazardous work will certainly reduce the level of injuries at the workplace.

Health passport

Also, the so-called “health passport” is gradually being introduced into practice - a document of the established form, a sample of which can be found at the link medexx.ru. The passport contains information about the passage of professional examinations of employees, during the examination it is in a medical organization, and after it is issued to the employee.

The introduction of health passports does not cancel personal medical books. The procedure for issuing a medical book is regulated by the order of Rospotrebnadzor No. 402 dated May 20, 2002 “On a personal medical book and a sanitary passport”, which continues to be valid. In addition, the lists of employees who are required to have a health passport and a medical book are somewhat different, and employees of children's health institutions are required to have both. Of course, in this case, you can undergo an annual medical examination, entering the results of the examination in both documents. You can learn more about medical books and who needs them on the website of the Moscow Center for Hygiene and Epidemiology http://www.mossanexpert.ru

Organization of professional examination of employees

According to the order, now only a medical institution that has received the appropriate license can provide medical examination services. At the same time, the staff of the institution should have a permanent medical commission under the leadership of an occupational pathologist. Therefore, the natural desire for every health worker to undergo a medical examination directly at the place of work, unfortunately, is not feasible if the institution does not have the appropriate license.

The same is true with analyses. For an organization performing a medical examination, there is no regulatory document prohibiting the use of the results of analyzes and examinations performed in other medical institutions. But, given that this service is paid, it is unprofitable and quite risky for medical institutions to accept third-party results, since they can be faked. Unfortunately, it is also impossible to pass a medical examination in private - where you like it more, because the employer must organize a centralized examination and provide the medical organization with a list of names of employees, data on attestation of workplaces and harmful factors of production. Moreover, the medical organization must summarize the results no later than one month after the completion of the periodic medical examination. Then, together with the territorial bodies of the federal executive body authorized to exercise state control and supervision in the field of ensuring the sanitary and epidemiological welfare of the population, and representatives of the employer, the medical institution draws up a final act.

Our physical examination or medical examination of doctors

Let's talk about the features of a medical examination for health workers. According to paragraph 17 of Appendix No. 2 to Order No. 302n, medical personnel of all medical institutions must undergo a preventive medical examination annually. The "program" of the medical examination is presented in Table 1.

Consultations and examinations	Who is passing	How often to pass
therapist, psychiatrist, narcologist, dentist, dermatovenereologist*, otorhinolaryngologist*	all	1 time per year
clinical blood test (hemoglobin, color index, erythrocytes, platelets, leukocytes, leukocyte formula, ESR)	all	1 time per year
clinical analysis of urine (specific gravity, protein, sugar, sediment microscopy)	all	1 time per year
biochemical screening (content of blood glucose, cholesterol)	all	1 time per year
blood test for syphilis	all	1 time per year
swabs for gonorrhea	all	1 time per year
neurologist, ophthalmologist, allergist, endocrinologist, oncologist	health workers whose work is associated with exposure to chemical, physical and biological adverse factors	1 time per year or 1 time in 2 years - according to Appendix No. 1 to Order No. 302n **
blood test for hepatitis B and C, as well as for HIV	only workers who have professional contact with infected material or blood products, and only with the consent of the worker	1 time per year
studies on the carriage of pathogens of intestinal infections and serological examination for typhoid fever	all	upon admission to work and in the future - according to epidemiological indications
research on helminthiases	all	upon admission to work and in the future - at least once a year or according to epidemiological indications
a swab from the throat and nose for the presence of pathogenic staphylococcus aureus	all	upon admission to work and in the future - 1 time in 6 months

* The inclusion of a dermatovenereologist and an otorhinolaryngologist in the commission of a professional examination for medical workers is based on frequent professional contact with various kinds of allergens. On the recommendation of these specialists, an additional examination may be prescribed in the form of specific allergodiagnosis, examination of the function of external respiration and consultation with an allergist. ** Appendix No. 1 to Order No. 302n also indicates additional medical contraindications for work associated with adverse factors, such as hypochromic anemia, benign neoplasms, microcirculation disorders of any nature.

The result of a medical examination

If the subject does not have any health disorders, the occupational pathologist makes a conclusion about the suitability for the work performed. But what if any diseases are found during the physical examination? A complete list of contraindications is quite extensive and is contained in paragraph 48 of Appendix No. 3 to Order No. 302n.

It must be said that many of the points as applied to medical workers are controversial. For example, how stable angina pectoris, post-infarction cardiosclerosis, drug-compensated epilepsy, widespread ichthyosis, or even cancer in the initial stage can interfere with the performance of the duties of a therapist is not clear to me personally.

Of course, for emergency work in the ambulance, operating room, emergency department and similar areas, good health is necessary, but for scheduled appointments and advisory work, such requirements seem to me excessive. With detailed observance of all the contraindications indicated in this list, medicine risks losing a large number of age-related specialists whose knowledge and experience are of great value, despite their imperfect state of health.

Mandatory participation in the professional examination of an occupational pathologist involves identifying the relationship of detected diseases with professional activities. If an occupational disease is suspected, a medical organization issues a referral to an occupational pathology center or a specialized medical institution that has the right to conduct research on the relationship of the disease with the profession. Such a medical institution also draws up and sends, in accordance with the approved procedure, a notice of the establishment of a preliminary diagnosis of an occupational disease to the territorial body of federal executive bodies authorized to exercise state control and supervision in the field of ensuring sanitary and epidemiological well-being.

The employer, in case of detection of medical contraindications, is obliged to remove the employee from the work he performs or provide him with another one that is not contraindicated for him for health reasons. At the same time, at the first stage, the employer is obliged to offer the employee the vacant positions he has, and then, by the decision of the employee himself, an additional agreement is drawn up to the employment contract on the transfer or, in case of refusal, the procedure for suspension from work is applied, provided for in Article 76 of the Labor Code of the Russian Federation. At the same time, wages for the period of release from performance of labor duties are not accrued, but the place of work and position are preserved. If the period for which the employer is forced to suspend the employee for medical reasons exceeds four months, then the employee is subject to dismissal under Art. 77 of the Labor Code of the Russian Federation.

Individual difficulties in passing a medical examination may arise for employees who, for any reason, have a disability. Together with the referral for a medical examination, it is better for them to provide the conclusion of the next medical and sanitary examination, so that the commission can decide on admission to work.

There is something to strive for

Much attention is paid to the legal regulation of preventive medical examinations: clear rules for their conduct are defined, a list of works is given for which a medical examination is required, obsolete orders are canceled, and centralized control over examinations is introduced. However, perfection has not yet been reached. The most reasonable, probably, would be to issue a separate order on preventive examinations of medical personnel and some softening of the list of contraindications for working in medicine.

Sobesednik.ru found out how often and for what purposes a medical examination should be carried out.

When is it necessary?

The ideal schedule is once a year, although some specialists should be visited more often - every 6 months: for example, this concerns the examination of the dentist and gynecologist. At the moment, there is a legally established procedure for the medical examination of the adult population under the CHI policy. You can get a free medical examination every 3 years - at the age of 21, 24, 27, 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, 60, 63, 66, 69, 72, 75, 78 , 81, 84, 87, 90, 93, 96, 99 years old. In other years (once every 2 years) you can undergo a preventive examination at the clinic.

Who needs?

Actually, everyone. In fact, regular (and conscientious!) physical examinations are the only way to detect some kind of problem in the body before it “shoots” itself and loads you with trouble. In terms of health, the principle “the sooner the better” works, and it is always easier, cheaper and more preferable to prevent a disease than to treat it later. For the purpose of early detection, regular medical examinations, screenings or medical examinations are carried out.

How is it necessary?

Naturally, there will be no point in medical examination if it is done for show, and the dialogue with the doctor will be based on the principle: “Is something bothering you?” - "Not". "Well, that's fine, here's a tip for you." This situation discredits the very idea of ​​a scheduled medical examination, but, unfortunately, it has often met before, and now. The meaning of medical examination is not to miss diseases that at first do not reveal themselves in any way, and when it goes far, unfortunately, they are not completely treated - these are cardiovascular diseases (ischemic heart disease, hypertension, etc.). ), various types of cancer, tuberculosis, diabetes mellitus, pathologies of the spine and joints. So, within the framework of a medical examination, at least there should be an examination itself, as well as a certain set of analyzes and studies, without which the picture will not be complete.

What do you need?

By law, for most adults, a free medical examination is carried out once every 3 years. Here's what the survey plan looks like now:

Questioning (questionnaire), examination by a therapist

Measurement of height, weight, calculation of body mass index

Pressure measurement

Determination of cholesterol and glucose levels in the blood (express method)

ECG (at the first medical examination, then - for men over 35 and women over 45)

Midwife examination, cervical smear (for women)

Fluorography

Mammography (for women over 39)

Determination of cardiovascular risk

Blood chemistry

Fecal occult blood test (after 45 years)

PSA test (men over 50)

Ultrasound of the abdominal organs (after 39 years once every 6 years)

Measurement of intraocular pressure (after 39 years)

Examination by a neurologist (after 51 years once every 6 years)

Nevertheless, a personal plan may look different - from the timing to the volume of clinical examination. Here, the wishes of the doctors you are seeing can be taken into account (for example, a gynecologist wants to see you at least once every 6 months, a mammologist and a urologist - annually, etc.), and your individual diagnoses and risks. For example, for early detection of bowel cancer after 50 years, it is recommended to do a colonoscopy every 5 years, even without special indications, however, this study is not included in the general medical examination plan and is done only as directed by a doctor. Above is only a general scheme of the survey at the expense of the state.

Blood and urine will not be tested

The simplest analysis, to which a person will be 100% sent for almost any complaint, is UAC, a complete blood count. The same goes for a general urine test. Many generally do them on their own, without waiting for a doctor's referral, and come to the first appointment already with the results. Nevertheless, from 2018, these two studies will no longer be included in the mandatory medical examination plan: the new procedure proposed by the Ministry of Health excluded them from screening as “non-informative”. The agency clarified that neither a blood test nor a urine test will be performed by default on asymptomatic citizens - those who do not have any complaints. Only the level of sugar and cholesterol will be examined using the express method, that is, right at the reception.

point-blank question

Can they be forced to work?

No. In recent years, employers have begun to send employees for screenings, but even in this case, the principle of voluntariness works. By law, if the work does not imply mandatory regular medical examinations, the authorities can only offer to undergo medical examination, providing such an opportunity - for example, by entering into an agreement with a certain medical institution. This case is again purely voluntary, and the results of medical examination, if the employee has passed it, are a medical secret.

The clinic does not have the right specialist. What to do?

If you need advice from a specific specialist, whether as part of a medical examination or not, temporarily or indefinitely, you should be referred to another medical facility where one is available.

I have DMS. Is it possible to pass a full medical examination with such insurance?

If the type of policy does not limit the number of visits to specific doctors (this sometimes happens) - for example, no more than 10 visits to a therapist per year, 5 visits to the ENT, 2 appointments with an ophthalmologist, etc. - it is quite possible to take advantage of this opportunity. The absence of restrictions in this case allows you to make a medical examination more detailed, clarify the nuances and, as a result, possibly get more complete information about what is happening to your health than with a regular scheduled medical examination as part of the CHI.

Is it possible to skip a year or more?

When, to what extent and whether to undergo medical examination at all is your own business. Even if it seems to be necessary by age, it's still up to you to decide. Medical officials are calling for medical examinations to be made mandatory for everyone, and refuseniks to be “turned off” from some free medical services, but so far this is just an idea that is contrary to current legislation.

By the way

What is a medical check?

Check-up is another name for a routine medical examination, which is used in Western healthcare and, more recently, in domestic commercial medical centers. As a rule, a check-up is completed in one day - the program is designed so that the patient does not have to go to the doctors for weeks and months. The intensity of the program can be different - the simplest ones take 3-4 hours and include an examination of 4-5 specialists (gynecologist, ophthalmologist, urologist, therapist, dentist), 1-2 ultrasounds (usually gynecological and abdominal), several tests (for example , CBC, pap test for women, and Pap test to rule out cervical cancer) and a few other tests. A large check-in program can take a couple of days and even include options such as a full-body MRI. The price also depends on saturation.