A 19th century Russian poet and a diplomat, Fedor Tyutchev, once scribbled this short poem on a scrap of paper:
Russia cannot be understood with the mind alone,
No ordinary yardstick can span her greatness:
She stands alone, unique -
In Russia, one can only believe.
It has since become his most famous - just about all Russians know these four lines by heart. For some, it's an affirmation of Russia's special role as a holy, chosen place, as Tyutchev himself, a Slavic nationalist, likely had intended. But over time, many came to view it in an ironic light: common sense fails miserably in many everyday occurrences in Russia. Lacking a rational explanation, the best choice may be to brace oneself and hope for the miracle.
Doing things uniquely Russian way takes many forms: from a puzzling installation of twin toilets in an Olympic site to hiring cats as library assistants. But there is another, less benign, side to being unconventional. In matters of life and death, when time is of essence, as is often the case with cancer treatment, following best practices is the optimal approach. To most Russian hospitals, this is a foreign concept: since healthcare in Russia is paid for by government funds, hospital employees are required to follow a multitude of regulations that are concerned more with saving money and compliance than with patient care. There is hospital administration that has to approve doctors' referrals and prescriptions. There are budget funds that tend to run out before year-end. And there are laws that criminalize doctors for helping terminally ill patients get pain medications. So when a cancer patient in Russia attempts to receive care, an attitude of infinite patience is of utmost importance.
Recently, a list of actions required from a female ovarian cancer patient to get accepted for outpatient treatment had been posted in social media. We translated this 20-step process and came up with a graphic to help illustrate patient's movements among the three hospital buildings involved in rotation of paperwork and procurement of approvals. A visit to one building is required to see a specialist; a blood test is done in another, and the third has a pharmacy and it is where a patient is actually treated. A patient is responsible for carrying around their handwritten medical history and making sure it is properly updated and filed. There is a vast potential for improvement of this process - it could be shortened and made easier and faster for everyone involved. For example, a patient management system could keep all patient data in one database, ensure compliance and reduce administrative burden. Why is it not being done? With mind alone, it is impossible to comprehend, indeed.
20 Steps to Secure Outpatient Treatment:
1. Schedule a visit to oncologist two weeks in advance and get electronic confirmation.
2. Oncologist visit: Bring ob/gyn notes and chest x-ray results.
3. Receive a free medicine prescription and a referral for blood test. Also pick up a medical history folder.
4. Admin office: pick up a printout of referral for free medicine.
5. Oncologist office: get his/her signature on a printout.
6. Management office for additional signature on the printout. Leave medical history folder there.
7. Pharmacy: bring printout there and receive medications. Pharmacy marks medicine as dispensed on the printout.
8. Blood test in a municipal hospital.
9. Return to a clinic and sign up for a visit to oncologist.
10. Oncologist office: receive referral for outpatient therapy based on blood test results, ob/gyn note and lung x-ray. Pick up a medical history folder.
11. Management office: sign off on referral for outpatient treatment.
12. Outpatient clinic: bring passport, insurance card, referral for outpatient therapy and pension documents.
13. Receive approval signature on referral from the day patient unit manager.
14. Medical documentation office: bring passport, insurance card, referral for outpatient therapy with approval signature, and pension documents. Previous medical history will be entered into hospital's files.
15. Sign up for the time slot available with an on-call doctor at day patient unit.
16. Medical history will be brought to the day patient unit on the day of hospitalization or issued to the patient for review with the treating doctor.
17. At home the following items need to be gathered and brought to the hospital: medical history file, copies of test results, shoe covers, bedsheet, needles for IV infusions.
18. At hospitalization: the doctor will examine the patient, read medical history, update the medical history file, and refer for procedures.
19. Oncologist office: patient returns medical history folder, once the doctor at the outpatient unit no longer needs it.
20. After outpatient procedures are finished, patient should get an excerpt from the medical file from outpatient unit doctor and bring it to the treating oncologist on the next visit. It will be glued into the medical history file.