Medical examination of working capacity. Academy Department of Public Health and Health

The patient's working capacity is determined by two groups of factors: medical and social.

Medical factors include correctly and timely diagnosis, which is based on a comprehensive examination of the patient.

The need for a thorough comprehensive examination may also arise in cases where there is no correspondence between the subjective sensations of the patient and the data of an objective examination. Various expert situations are possible, for example, there is a lot of subjective, but little objective (such an expert situation occurs quite often). But a situation may arise when the patient (for various reasons) wants to hide the existing disease. In such cases, no complaints are made, and objective studies reveal significant changes.

Clinical expert diagnosis should reflect the following components:

- nosological form of the disease;

- its etiology;

- prevailing syndromes;

- the nature of the course of the pathological process;

- stage (if the disease has a staged course, the frequency and duration of exacerbations, if the disease has a relapsing course);

- the presence and severity of functional disorders;

- the presence and nature of complications;

- accompanying illnesses.

In determining the state of working capacity, along with medical, social factors: profession and specialty of the patient, skill level, nature and conditions of the work performed, the presence of harmful production factors, work experience, age, gender, education, place of residence, marital status, intention to continue working, etc.

However, when conducting an examination of temporary disability, the attending physician, when assessing social factors, first of all, finds out the nature and conditions of the work performed, determining the predominant factor (hard or hard work or hard and hard work), then establishes the severity of the prevailing factor. In this case, the Guidelines for the hygienic assessment of factors of the working environment and the labor process, criteria and classification of working conditions R 2.2.2006-05, approved by Rospotrebnadzor on 29.07.05 and put into effect on 01.11.05, are used.

Thus, a reasonable expert opinion on the state of working capacity and a correct assessment of the clinical and labor prognosis are possible only taking into account medical and social factors, the combination of which determines the practice of two main components of medical expertise: examination of temporary disability and medical and social.

In the majority of patients seeking medical care, medical factors predominate in assessing the prognosis. Social factors prevail much less often, as a rule, with mild functional disorders. Therefore, the concepts of temporary and persistent (permanent) disability are medical and social.

Related questions

1. The history of the development of social insurance in Russian Federation. Social insurance fund, its functions.

2. The concept of working capacity, disability, classification.

3. Clinical and labor prognosis.

4. Factors affecting the ability to work. The main causes of temporary disability.

5. Statistical form 16-VN, methods of analysis

6. Solving problems 114–117, preparing an abstract and making a presentation.

Essay topics

1. Social protection and social security of the population.

2. State character of social insurance and social protection of the population.

3. Legislation on social insurance and social protection of the population.

4. Interaction of health authorities and institutions with institutions of social insurance and social protection.

Basic

1. Lisitsyn, Yu. P. Public health and healthcare [Text]: textbook / Yu. P. Lisitsyn. - M.: Medicine, 2007. - S. 402-442.

2. E. V. Zakharova, Collection of Problems and independent work[Text] / E. V. Zakharova, I. L. Sizikova. - Abakan: FGBOU VPO "Khakassky State University them. N. F. Katanov”, 2014. – S. 61, 62.

Electronic media

1. Educational portal of KSU N. F. Katanov. – URL: http://edu.khsu.ru

2. EBS "Student Consultant" / GEOTAR-Media Publishing House. – URL: http://studmedlib.ru/

Practice 19.
Organization and procedure for conducting an examination of a temporary
disability. Documents certifying VN,
the order in which they are

Relevance of the topic

Issues of medical expertise are encountered daily in the practice of the attending physician. Expertise is the study of special issues, the solution of which requires special knowledge, with the issuance of a certain judgment. A medical examination is understood as a study conducted in the established manner, aimed at establishing the state of health of a citizen, in order to determine his ability to carry out labor or other activities, as well as to establish a causal relationship between the impact of any events, factors and the state of health of a citizen. Thus, to solve the issues of medical expertise, a fairly extensive amount of knowledge is needed.

Lesson objectives:

- to study the procedure for organizing EVN in a medical institution;

- to master the basic concepts and terms of the examination of temporary disability;

- apply the acquired knowledge in practice and perform independent individual tasks.

The initial level of knowledge and skills necessary to achieve the goals: fundamentals of healthcare organization, medical statistics and informatics, computer skills at the user level

When conducting an examination of working capacity, the attending physician is guided by medical and social criteria.

Medical criterion (clinical)- this is a timely and clearly formulated diagnosis of the disease in accordance with the existing classification.

The diagnosis should reflect the stage of the disease, the severity, the nature of the course, as well as the degree of functional disorders of the body, which led to the temporary disability of the patient.

Social or labor criterion, takes into account the professional activity of the patient, the working conditions in which he works, the degree of physical or neuropsychic stress experienced, the presence of adverse production factors.

A well-founded expert opinion is possible only if medical and social criteria are taken into account, the combination of which determines the practice of disability examination.

When making a decision about the state of working capacity of patients, either a medical or a social criterion may be of particular importance. Yes, at acute diseases or exacerbation of chronic processes occurring with severe functional disorders, when the patient needs a regimen and any work is contraindicated for him, the social criterion is practically irrelevant. The doctor, having made a diagnosis, prescribes the appropriate treatment and releases the patient from work, giving him a certificate of incapacity for work. In this case, the patient's ability to work is determined only by medical criteria.

social criterion becomes important in establishing temporary disability in persons whose work is associated with overstrain of certain organs and body systems (singer, announcer, musician, diver, etc.). So, for example, with the same disease, but a different profession, a person in one case can be recognized as able-bodied, but not in another: a singer, an announcer with residual effects laryngitis will be recognized as disabled, and an accountant, computer operator with a similar diagnosis can perform professional activities.

The terms of temporary incapacity for work are different for the same disease in people of intellectual labor and those working with significant physical stress, in unfavorable working conditions.

Determining the duration of temporary disability without taking into account one of the criteria often leads to expert errors.

The issuance and extension of a certificate of incapacity for work is carried out by a doctor after examining the patient and recording data on his state of health in an outpatient card, justifying the need for temporary release from work. The certificate of incapacity for work is registered in the outpatient card indicating its number, dates of issue and extension, and the patient's discharge to work. A sick leave certificate is issued to a patient by a medical organization on the day it is closed.

In the event of illness of a citizen of the Russian Federation during a stay abroad, documents confirming temporary disability, by decision of the medical commission of a medical institution, can be replaced with a certificate of incapacity for work established in the Russian Federation.

GENERAL PROVISIONS

A disability examination is a type of examination that consists in determining the causes, duration, degree of temporary or permanent disability of a person due to a disease, injury or other reason, as well as determining the patient's need for types medical care and measures of social protection.

Naturally, the question arises, what should be understood by the working capacity of a person?

Ability to work is a state of the human body in which the totality of physical and spiritual capabilities allows you to perform work of a certain volume and quality. Based on the data of a comprehensive medical examination, a medical worker must establish the presence or absence of a disease in a particular person. Employability has medical and social criteria.

Medical criteria for working capacity include a timely clinical diagnosis, taking into account the severity of morphological changes, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications, the determination of the immediate and long-term prognosis of the development of the disease.

However, a sick person is not always disabled. For example, two people suffer from the same disease - panaritium. One of them is a teacher, the other is a cook. A teacher with a panaritium can perform his professional duties - he is able-bodied, but a cook is not, that is, he is disabled. In addition, the cause of disability is not always the disease of the patient himself. For example, the same cook himself may be healthy, but someone in his family has contracted viral hepatitis, as a result of which the cook cannot perform his professional duties, that is, prepare food, since he has contact with a patient with viral hepatitis. Therefore, illness and incapacity for work are not identical concepts. In the presence of an illness, a person can be able to work, if the disease does not interfere with the performance of professional duties, and disabled, if their performance is difficult or impossible.

Social criteria for working capacity determine the labor prognosis for a specific disease and working conditions, reflect everything related to the patient's professional activity: a characteristic of the prevailing stress (physical or neuropsychic), the frequency and rhythm of work, the load on individual systems and organs, the presence of adverse conditions labor and occupational hazards.

Using medical and social criteria for working capacity, medical worker an examination is carried out, during which the fact of the patient's incapacity for work can be established. Disability should be understood as a condition caused by illness, injury, its consequences or other reasons, when the performance of professional work is impossible in whole or in part for a limited time or permanently. Disability can be temporary or permanent.

EXPERTISE OF THE TEMPORARYINABILITY

If changes in the patient's state of health are temporary, reversible, and recovery or improvement is expected in the near future, as well as restoration of working capacity, then this type of disability is considered temporary. Temporary incapacity for work (TI) is a state of the human body caused by illness, injury and other reasons, in which functional disorders are accompanied by the inability to perform professional work in normal working conditions for a certain period of time, that is, they are reversible.

Distinguish between full and partial temporary disability.

Complete temporary disability is the impossibility of performing any work for a certain period, accompanied by the need to create a special regime and conduct treatment.

Partial temporary disability occurs in a person in relation to his usual professional activity while maintaining the ability to perform other work with a different light duty or reduced volume.

Establishing the fact of temporary incapacity for work is carried out on the basis of an examination and is of great legal and economic importance, since it guarantees the citizen the release from work and the receipt of benefits at the expense of state social insurance. Timely release of sick people from work is one of the most effective preventive measures to prevent complications of diseases, their chronicity.

Thus, the examination of temporary disability is one of the types of medical examination, the main purpose of which is to assess the patient's state of health, the quality and effectiveness of the treatment, the ability to carry out professional activities, as well as determining the degree and timing of temporary disability.

Examination of temporary disability is carried out in state, municipal and private healthcare organizations.

Morbidity with temporary disability reflects the morbidity of the working population, therefore, in addition to medical and social, it also has great economic significance.

The document certifying the temporary incapacity for work of citizens and confirming their temporary release from work is a certificate of incapacity for work, which is issued:

With diseases;

In case of injuries, poisoning and other conditions associated with temporary disability;

For the period of aftercare in sanatorium-and-spa institutions;

If necessary, care for a sick family member;

For the period of quarantine;

For the period of prosthetics in a hospital;

For the period of maternity leave;

When adopting a child.

RACK EXPERTISEINABILITY

Permanent disability is a long-term or permanent loss of ability to work or its significant limitation caused by chronic disease(trauma, anatomical defect), which led to a pronounced violation of body functions. Depending on the degree of persistent disability, disability is established through a medical and social examination.

Medical and social expertise (MSE) is the determination of the needs of the person being examined for social protection measures based on the assessment of disability caused by a persistent disorder of body function. A three-stage system of ITU federal state institutions has been created in Russia, which includes: the Federal Bureau of Medical and Social Expertise, the main bureaus of medical and social expertise, as well as the bureau of medical and social expertise in municipalities, which are branches of the main bureaus.

Citizens with persistent limitations of life and work ability and in need of social protection are sent to the ITU, according to the conclusion of the medical commission when:

Obvious unfavorable clinical and labor prognosis, regardless of the duration of temporary disability, but no later than 4 months from the date of its onset;

Favorable clinical and labor prognosis with temporary disability lasting more than 10 months (in some cases: conditions after injuries and reconstructive operations, in the treatment of tuberculosis - more than 12 months);

The need to change the vocational rehabilitation program for working disabled people in the event of a deterioration in the clinical and labor prognosis, regardless of the disability group and the duration of temporary disability.

A citizen is sent for a medical and social examination by an organization that provides him with medical and preventive care (a body providing pensions, a body for social protection of the population), after carrying out the necessary diagnostic, therapeutic and rehabilitation measures, if there is data confirming a persistent impairment of body functions due to diseases, consequences of injuries or defects.

At the same time, the “Referral for medical and social examination” (f. 088 / y-06) indicates data on the state of health of a citizen, reflecting the degree of dysfunction of organs and systems, the state of the compensatory capabilities of the body, as well as the results of rehabilitation measures.

If the organization providing medical and preventive care has refused to send a citizen to the ITU, he is issued a certificate, on the basis of which he has the right to apply to the bureau on his own. Bureau specialists conduct an examination of the citizen and, based on its results, draw up a program of additional examination (and rehabilitation measures), after which they consider the issue of whether he has disabilities.

Medical and social examination is carried out in the bureau at the place of residence. In the main bureau, a medical and social examination is carried out in the event that a citizen appeals against the decision of the bureau, as well as in the direction of the bureau in cases requiring special types of examination. In the Federal Bureau, a medical and social examination is carried out in the event that a citizen appeals against the decision of the main bureau, as well as in the direction of the main bureau in cases requiring particularly complex special types of examination.

A medical and social examination can be carried out at home if a citizen cannot come to the bureau for health reasons, which is confirmed by the conclusion of the organization providing medical and preventive care, or in the hospital where the citizen is being treated, or in absentia by decision of the relevant bureau. The examination is carried out at the request of a citizen, which is submitted to the bureau in writing with the attachment “Referral for medical and social examination”, issued by an organization providing medical and preventive care (a body providing pensions, a body of social protection of the population) and medical documents confirming the violation health.

Medico-social examination is carried out by specialists of the bureau by examining a citizen, studying the documents submitted by him, analyzing social, domestic, professional, psychological and other data of a citizen. The decision to recognize a citizen as a disabled person or to refuse to recognize him as a disabled person is made by a simple majority of votes of the specialists who conducted the medical and social examination, based on a discussion of the results of his medical and social examination.

The decision is announced to the citizen who underwent the medical and social examination in the presence of all the specialists who conducted the medical and social examination, who, if necessary, provide explanations on it. Based on the results of the medical and social examination of a citizen, an act is drawn up. In cases requiring special types of examination of a citizen in order to establish the degree of disability (including the degree of limitation of the ability to work), rehabilitation potential, as well as obtaining other additional information, an additional examination program may be drawn up, which is approved by the head of the relevant bureau. The specified program is brought to the attention of a citizen undergoing a medical and social examination in a form accessible to him.

After receiving the data provided for by the additional examination program, the specialists of the relevant bureau make a decision to recognize the citizen as disabled or to refuse to recognize him as disabled. If a citizen refuses an additional examination, such a decision is made by specialists on the basis of the available data, about which a corresponding entry is made in the act of the citizen's medical and social examination.

An extract from the act of medical and social examination of a citizen recognized as disabled is sent to the body providing his pension within 3 days from the date of the decision to recognize him as disabled.

A citizen recognized as disabled is issued a certificate confirming the fact of the establishment of disability, indicating the group of disability and the degree of restriction (or without restriction) of the ability to work, as well as individual program rehabilitation.

A citizen who is not recognized as a disabled person, at his request, is issued a certificate of the results of a medical and social examination.

According to the site vmede.org/

determines the labor prognosis for a specific disease, a specific position of the patient and his working conditions. Social criteria reflect everything related to the patient's professional activity: a characteristic of the prevailing stress (physical or neuropsychic), organization, frequency and rhythm of work, load on individual organs and systems, the presence of adverse working conditions and occupational hazards.

Medical and social criteria should always be clearly defined and reflected in medical records.

Therefore, disability should be understood as a condition caused by illness, injury, its consequences or other reasons, when the performance of professional work in whole or in part, for a limited time or permanently is impossible. Disability can be temporary or permanent.

If changes in the patient's state of health are temporary, reversible, if recovery or significant improvement is expected in the near future, as well as restoration of working capacity, then this type of disability is considered temporary. Temporary incapacity for work (TI) is a state of the human body caused by illness, injury and other reasons, in which functional disorders are accompanied by the inability to perform professional work in normal production conditions for a certain period of time, i.e. are reversible. Distinguish between full and partial temporary disability. Complete disability - the complete impossibility of performing any work for a certain period, accompanied by the need to create a special regime and conduct treatment. Partial incapacity for work - temporary incapacity for work in relation to one's usual professional work while maintaining the ability to perform other work with a different light duty or reduced volume.

Thus, the examination of temporary disability is a type

medical activities, the main purpose of which is to assess the patient's health status, the quality and effectiveness of the examination and treatment, the possibility of carrying out professional activities, as well as determining the degree and timing of temporary disability.

Establishing the fact of temporary disability is of great legal and economic importance, because. it guarantees the citizen the release from work and the receipt of benefits at the expense of the mandatory

state social insurance.

Examination of temporary disability is carried out in state, municipal and private systems healthcare. There are the following levels of examination of temporary disability: the first - the attending physician; the second - the medical commission of the medical institution;

the third - the medical commission of the health management authority of the territory included in the subject of the Federation; the fourth - the medical commission of the health management body of the constituent entity of the Russian Federation;

the fifth is the chief specialist in the examination of temporary disability of the Ministry of Health and Social Development of the Russian Federation.

The organization and procedure for conducting an examination of temporary disability are built on the basis of the functions of each of the listed levels.

Control over compliance with the instruction on the examination of temporary disability in state, municipal and private medical institutions, as well as private practitioners, is carried out by the health management body of the appropriate level, professional medical association, executive body of the Social Insurance Fund of the Russian Federation. Commissions for accreditation and licensing of medical and pharmaceutical activities and subdivisions of territorial compulsory medical insurance funds may participate in the exercise of control.

Medical examination of working capacity. Academy Department of Public Health and Health

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