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How to change the attending physician in the clinic?


The document is small, but important, because for the first time it clearly defines the mechanism for choosing a doctor. In itself, this right has existed in Russian health care for a long time, but it was always difficult to use it - the final decision depended largely on the location of the chief physician of the medical institution, and sometimes, to be honest, and on his character.

So, in order to change the attending physician for general care (in a clinic, outpatient clinic, dispensary, hospital, etc.), you need to write a statement addressed to the head doctor indicating the reasons why you require it. Their document does not regulate in any way, therefore, there can be any reasons - from dissatisfaction with the style of communication to distrust of a doctor and his competence, from an uncomfortable schedule of his work to a specific conflict. The supervisor must inform the patient in writing or orally about what other doctors are in the institution and what their work schedule is. Based on such information, he makes his choice.

It is important that the transition to the doctor of your choice is subject to his consent. It is understood that he may refuse if, for example, he is overloaded with work.

In principle, the right to choose a doctor naturally arises from civil rights and individual freedoms. However, like all our other rights, it also has limitations. This should not be forgotten, demanding your own.

Vladimir Porkhanov,Chief physician of the Krasnodar Regional Clinical Hospital, corresponding member of RAMS:

- If the patient expresses such a wish, we, of course, try to satisfy him when there is an opportunity. But if one doctor does 8 operations a day, he physically cannot do 9 or 10. There is only one way out, I think: all hospitals need to be good, and all doctors are highly qualified and have a normal attitude towards patients. Then there will be no need to choose. And we strive for this.

Oksana Denisenko,Deputy Chief Physician of the Moscow City Polyclinic N34:

- For us, the patient’s desire to change the local doctor is not a problem. There are very few such statements, not more than 1-2 per year. The reason, as a rule, is that relations with the doctor did not work out. We decide the question right away, the patient can go to any other doctor. The only restriction is that his local therapist will come to the house when he calls, because the territorial principle of service is maintained.

The procedure for replacing a doctor in a medical facility

The law provides for the replacement of a doctor no more than once a year, except in situations where the patient moves to another region. The insured citizen has the right to demand the replacement of a local therapist or pediatrician, family doctor, paramedic, gynecologist and other doctors of the clinic or hospital. If there is only one specialist in this profile, then the patient can change the medical facility. When replacing a doctor, you can immediately indicate the specialist whose insured person wants to be observed. In this case, the selected doctor has the right to refuse to take an additional patient due to the heavy load or remoteness of the site.

A prerequisite for changing the attending physician is a written statement addressed to the head of the medical institution or branch of the clinic. The document must explain why the patient refuses the services of a previously selected specialist. The regulatory acts do not establish specific reasons, therefore the applicant has the right to limit himself to any formulations: inconvenient work schedule, conflict, lack of competence, etc. After 3 working days (no later), the patient should be provided with information about other clinic specialists with an indication of their appointment schedule. Based on these data, a citizen can decide on a doctor, who will be observed in the future. It is worth remembering that a local therapist (pediatrician) will come to call at home, since the principle of territorial home care remains.

What should I do if the head of the clinic ignores the doctor’s replacement statement?

For complaints to higher authorities, a written refusal of the head to replace the doctor is required. To do this, you need to write a request to change the specialist in 2 copies, which must be endorsed in the registry of the clinic. The documents must indicate the filing date, incoming number and visa “for management consideration”. Within 3 working days the patient will receive a written response from the administration. If it is negative, then you can file a complaint with the Ministry of Health using the right confirmed by the above law No. 323.


The possibility of replacing a doctor is regulated by law, but you can change a specialist no more than once a year. When moving to another region after attaching to a medical facility, you can replace it again. The replacement procedure consists in submitting an application to the head of the medical institution, which should provide the patient with a list of similar doctors. The doctor has the right to refuse additional patients if he is working with a heavy load.

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The patient had the right to refuse a doctor and ask for a replacement earlier. But this possibility remained rather theoretical, but in practice could meet many obstacles. Now, the Ministry of Health ordered the heads of medical institutions to respond to such requests within three days and for the first time clearly prescribed the procedure for changing the attending physician.

To change the attending physician, you need to write a statement in the name of the head physician, and if it comes to the provision of specialized medical care - in the name of the head of the unit. The statement must indicate the reason for your dissatisfaction. It can be anything: an uncomfortable schedule of the doctor’s work, an unkind look, and loss of confidence - this order does not regulate the moment.

Within three days, the head of the medical institution or unit must acquaint you in writing or orally with the list of available doctors, their work schedule and provide the right to choose.

However, the selected specialist may not take you to his place. His right to refuse a patient is also registered in the order of the Ministry of Health No. 407n dated April 26, 2012. Therefore, with the doctor you want to be treated with, it is better to talk in advance.

As the doctors themselves accepted the new order of the ministry, “Doctor Peter” asked the therapist of the 31st city hospital Tatyana Nekrasova:

- I believe that patients are not always able to evaluate the quality and effectiveness of treatment objectively. For them, the personal attitude of a doctor is often more important than professionalism. Grandmother lies in the hospital and laments: “Doctor, give me a dropper. How am I without her? I won’t survive the summer without it. ” And if she really needs a dropper, grandmother is not able to evaluate in principle. For her, who appointed the dropper - and well done. And in the end, in the pursuit of the best doctor, patients can get the worst, ”Nekrasova believes.

28 comments Leave a comment

The doctor should have the same right to refuse some patients.

And if someone doesn’t like your nose, then they will not treat you, but they will send you to look around the world.

And what actions should be taken to change the medical institution?
I, for example, are not at all satisfied with the regional clinic, but in others they send me from the doorway - they say that you are assigned to, go there.

Whim - this is such a thing.
Of course, if relations with patients do not develop, the patient immediately needs to change the doctor at his request. But what about the doctor who will increase the load? It is not rubber. In a hospital, one doctor on duty cannot find a common language with the patient, should the second doctor plow most of the duty for him?), And get the same salary?). In the clinic, the doctor also has limited reception hours. Do not dismiss the doctor if the patient has a whim (I have a wound on my finger, I want to have a CT scan of my brain, but the doctor does not give me a referral, although I explained the reason for the refusal), and not a substantiated complaint, for example, a doctor is rude or a doctor refuses to give me an oral written explanation of why I have not been assigned an ECG.

Addition: the introduction of the Ministry of Health is correct, if only it would not go to the dismissal of the doctor at the slightest whim of the patient, and sometimes some outpatient managers perceive this ("changing the doctor means dismissing."). Therefore, my previous post began with "whim - this is the case." Of course, if there are well-grounded complaints, patients constantly present grounded complaints, then you need to part with the doctor.

I think the adoption of such a law may lead to the fact that the "running" of patients from one doctor to another will begin. The load on some will increase (but will the quality of work decrease at the same time?), While others will idle? How will the salary be calculated? By the number of patients? And for patients - is it good? How long will it take to wait in line for my beloved doctor? After all, they will try to get an appointment by any means, but everyone needs to. And then what? "Candy envelope accelerator"? But will they not envy the team of a more successful colleague? Or vice versa: they will try to “get rid” of hypochondriacs, elderly, irritable, annoying patients, sending them to their colleagues. From the fact that they will be treated by other doctors, the nature of sick people will not change. Perhaps this reform is theoretically applicable to narrow specialists or consultants. Although the problem with queues and numbers will become more acute. But for the local therapist or doctor working in the department - this, in my opinion, is absurd. The load is not only about medical work (look, listen, touch). And how much scribble? What about reporting? What about planning? Has anyone "up there" thought about this? It seems to me that you just need to improve professional skills among doctors. To educate them. Learn by yourself. As for rudeness, this, unfortunately, is already the level of culture, more precisely, lack of culture. And not only among health workers, it concerns all professions. Come anywhere, to any institution where there is a large flow of visitors-petitioners, you will understand. A few boors among patients? Sometimes you feel not a doctor, but a service staff. They can easily use profanity. And there is no doctor’s protection from such an attitude. We can tolerate everything. Keep silent. We are humanists.
No, the introduction of the Ministry of Health is absolutely wrong and unpromising. Although not. It will be much simpler now for the immediate head of the unit: no need to understand each specific situation, "threw" the patient from one doctor to another - and that’s all! And “upstairs” everyone is happy: we have no problems. The problem, as it was, remains: the number of “good” and “bad” doctors has not changed. “Bad” doctors will not become “good” if they do not work with patients. Because apart from their own professional experience, there is nothing more expensive.
So the Ministry of Health thought, as always, about his beloved. And issued an appropriate order.

They would also be allowed to change the heads, and sometimes some have such incompetence. The attending physician is still nothing, but some managers. (Did they take anything from the garbage?)