Denis Protsenko - RBC: "We are not isolated in the professional world"

The HEAD physician of Kommunarka Denis Protsenko in an interview with RBC spoke about how covid was replaced by post-covid, the frequency of epidemics and new threats due to anti-vaxxers Denis Protsenko

- Your name is often associated with the treatment of COVID . How many people are now hospitalized with this diagnosis? How has COVID treatment changed?

– I’ll surprise you now, but it’s been exactly a year since June 1, 2022, since Kommunarka got out of COVID and returned to the work that was planned. We are now called the Moscow Multidisciplinary Clinical Center Kommunarka, which consists of more than 1,000 beds - this is oncology, chemotherapy, hematology, and a vascular center. During the covid period, a perinatal center, a department of an outpatient oncological care center, an endoscopic center were opened, 100 beds for childhood infection were opened, we have a hemodialysis center, a clinical center with a large number of researchers, mainly from the second medical center (Russian National Research Medical University named after N.I. Pirogov ). The construction of the building for radiation therapy continues.

We have a small number of patients with COVID, but there is no such severe course as in a pandemic. If we talk about this topic, which everyone is tired of, now post-COVID is of great interest to the medical community. Its manifestations are really very, very diverse, from skin rashes to rare cases when people’s sense of smell has not been restored or the symptoms of the covid debut have persisted - fatigue, memory loss. Covid dealt a very big blow to the cardiovascular system of those who had been ill.

We collected data from patients, and they absolutely correlate with foreign ones - the number of people with diabetes has increased, the numbers of arterial hypertension have become younger. Therefore, to say that we survived covid and forgot about it would be unfair.

How long is the tail? How often do you meet in work with post-COVID-19?

— After the publication of the latest studies (including the “Active” register, which I am a member of), the question “have you had covid” was included in the preoperative checklist of the anesthesiologist-resuscitator. Because we understand that if so, then you need to be more careful about pressure and biochemical analyzes for blood SUGAR or glycated hemoglobin.

- What examinations should be done if you have been ill with COVID?

— The Ministry of HEALTH has developed a program of expanded medical examinations, including for patients who have had COVID, there are guidelines for outpatient doctors. For example, this program in Moscow can be completed in our Healthy Moscow summer pavilions, which are open in parks throughout the city.

Realizing that Russian medicine is very different, the country is large, our team developed the Post-Discharge.rf application. We gathered the best practitioners, professors, doctors and candidates of medical sciences, received the support of the Internet Development Institute and released a free application for users - a program of physical rehabilitation and psychological support for those who have recovered from COVID.

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It works like this: a person who has had a CORONAVIRUS , having passed a questionnaire at the entrance, depending on a number of parameters and complaints, receives a specially selected modular rehabilitation video course, consisting of practical lectures by a neuropsychologist, pulmonologist, neurologist, dermatologist, gastroenterologist, psychologist, cardiologist, somnologist and others specialists. Our platform gives everyone a chance to restore health, and I believe that they should definitely take advantage of it.

In which case should I refer to these recommendations? Do I need your application if I had a mild illness, for example, a year ago?

“I think it won't be useless anyway. As an anesthesiologist-resuscitator, as a rule, I meet with a patient in a critical situation, we overcome this situation, the patient is discharged, and there is no catamnesis. The Active register made it possible to observe patients after the disease, and it made us look at COVID and its consequences in a different way.

Denis Protsenko (Photo: Mikhail Grebenshchikov / RBC)

— You mentioned that one of the reasons for the development of this application was the different level of development of medicine — it’s one thing, you end up in Kommunarka, where the whole medical city is new, and another thing — you go to a hospital in some regions.

— Accessibility of primary care is one of the key tasks. And the Ministry of Health is doing a lot, including investing in the construction of feldsher-obstetric stations in small villages.

But the geography and population density in RUSSIA is so heterogeneous that the idea came up to create this tool with the help of a team of specialists who survived the situation with covid. Using modern technologies, a web platform or a mobile application, they will allow you to convey information to anyone about what to do, what to pay attention to.

- If a person, following the results of this course, understands that something is wrong with him, where should he go?

He must go to his DOCTOR. The application tells you whether you need to go to the doctor or not, what to look for, what you can do at home.

- Did you manage to convey this information to the primary link in the regions?

- We are doing this now. The project was prepared for a very long time and carefully. And I really hope that we will convey it, including, by the way, there is such an idea, using a large network of United Russia party cells that exist in all regions.

- The primary doctor, to whom the user of your application comes, will not say “have seen enough of some nonsense”?

- I think no. Because the leaders with names recognizable by Russian doctors are invited to the team. A cardiologist - Professor Anastasia Lebedeva, a specialist in skin diseases - Professor Nikolai Nikolaevich Potekaev - these are really leaders in their fields.

- The application you are talking about is very close to telemedicine. How do you rate its effectiveness?

— This is a very important tool, we actively use it in the hospital. Telemedicine is a tool to increase accessibility and always a second opinion. For example, a paramedic sits at a point, there is a competence center (central district or city hospital) 150 km away - in many cases, a telemedicine consultation with a doctor on this line can help minimize unnecessary supply chains, the doctor will give recommendations, advise on what to conduct an additional examination, and then can come if necessary.

We in Moscow are actively using telemedicine in the provision of doctor-to-doctor consultations using VR technologies. We have such a thing as a resuscitator helmet, VR glasses that allow you to conduct a consultation remotely. Especially in an emergency, when the road from Kommunarka to Filatov Hospital No. 15 takes 1.5–2 hours, VR glasses on the helmet of the resuscitator create a virtual presence, you see the patient, the condition of the wound, indicators from monitors, from ventilators.

Do you use artificial intelligence in your work? There were many proposals for him to evaluate the results of analyzes, pictures.

- The results of the analyzes are not yet available, but it is developing very actively, at least in Moscow. For example, artificial intelligence is used to evaluate the results of computed tomography. This speeds up work and allows a large number of customized filters to evaluate various aspects of the performed CT scan. This is indeed a tool that greatly helps radiologists, but does not replace them.

- How big is the threat of a recurrence of the pandemic?

- In fact, this was not the first pandemic. They happen once every 50 years, for example, the "Spanish flu" is well known. When discussing a natural virus or a virus created, I still want, based on what we had, to believe that this is a natural process. Humanity lives with pandemics, and such terrible pandemics happen on average once every 50 years. Our generation is not so lucky.

Do I need to get vaccinated against COVID now?

– You should always get vaccinated, I’m sure of it, and not only against covid – there is a vaccine calendar. I am an absolute provaxer. Every September we got vaccinated against the flu; people over 50, in addition to influenza, should also be vaccinated with pneumococcal vaccine to reduce the risk of pneumococcal pneumonia, which is often fatal in older people. Now we have begun to live with COVID. So, in the season it is necessary to add covid vaccinations. Perhaps the vaccine against coronavirus will appear in a variant combined with the flu.

“There is a lot of talk about the return of measles right now. What else to expect?

- All childhood infections - measles, rubella, everything that is included in the childhood vaccination schedule. Therefore, there is this calendar, which determines how much from which infection you need to be revaccinated.

Denis Protsenko (Photo: Mikhail Grebenshchikov / RBC)

— During covid, there was a powerful public clash with anti-vaxxers, which had not manifested itself on such a scale before. To what extent did you manage to convince the population?

- We sometimes really made very harsh statements and said: come to the red zones and see how people breathe heavily. But I see that this should be a deeper methodical work at the level of the state and beliefs.

- Precisely beliefs, not prohibitions?

— No, I'm still a supporter of persuasion. With bans, we can go very far. Persuasion, persuasion and more persuasion. There may be different tools, but I am for persuasion. We have a lot of people who have been affected by covid in a severe form and who have lost their loved ones, especially the elderly. What other argument is needed to be against vaccination? However, such people still exist.

- If the pandemic started now, and not a few years ago, how much more difficult would it be, given the sanctions, the possibility of introducing equipment, etc.?

- We have an open market with very large breakthrough technologies - this is CHINA , I will not be engaged in product placement, but we at Kommunarka work on a large number of equipment, both laboratory and anesthesiology and resuscitation, made in China, and have been working for two years, reliably , qualitatively. In addition, any sanctions  always stimulate internal production, internal decisions.

“This is stimulation, but usually it does not work very quickly, it still takes time to replace complex technologies. What are the difficulties now, you have not only Chinese equipment?

“Maybe, the delivery time of materials has slightly increased, but everything is serviced, parts are brought in for replacement. At the moment, I don’t feel any catastrophe as a leader.

What about drug provision?

- The same. Now, we must pay tribute, our pharmaceutical companies are developing very powerfully with internal development, including quite serious antitumor chemotherapeutic drugs. And the supply of foreign medicines also continues.

- Do you feel isolated from world medicine after the start of the military operation?

— To be honest, no, for one simple reason — covid has accustomed us to the mode of video conferencing. In fact, all conferences, webinars have the opportunity to connect and participate. In any case, in our specialty. We also send reports, but the only thing is that all this is now remote. Therefore, it cannot be said that we have isolated ourselves in the professional world - no, absolutely not.

Do you take in the wounded?

“We have a civilian hospital.

— What about people from the new regions?

- Let me remind you that emergency assistance in Russia is provided to everyone, regardless of citizenship, religion, etc. And this level of assistance will not differ from each other.

Denis Protsenko (Photo: Mikhail Grebenshchikov / RBC)

- It has been a long time since all covid allowances were canceled, how did this affect the shortage of medical workers, the situation with salaries?

“Normal people understood perfectly well what these allowances were for then and why they left. You see, I am sitting with you without a mask, we are working in normal dock-like conditions. So we went back to pre-Covid wages.

There is no staff shortage. The staffing of medical personnel in our hospital is under 88%. Why not 100? Because there is always some percentage for internal part-time work. And we do not experience any super shortage of personnel. Over these two years, the backbone of Kommunarka has formed, as we write the hashtag on our Kommunarkateam hoodies. It really was two years when the team rallied. All these “I am a cool surgeon, I am an anesthesiologist, and you are a therapist” are gone, this is absolutely not. In two years, a team with common values ​​has been formed - the patient is in the center of attention, and medical processes are not around the patient, but for the patient. Formed its own corporate culture, which consists of thousands of little things.

- How has this team been affected by the last year and a half? How many people left? Do you have internal political disputes?

- Let's be honest: we have something to do, except to discuss politics. In my office, meetings with deputies start at 7:15. At 7:45 we already have a conference. At 8 o'clock it ends, everyone goes to the operating room. I am sure that in the team there are people with completely different opinions. There are also guys who wrote an application and volunteered. Of course, I know the doctors who left, but the social networks have not gone away, we communicate. This is their choice.

- After the recent opening of the children's building, Kommunarka becomes one of the largest children's hospitals in Moscow?

- Yes, there are 200 beds in the building - this is pediatrics, neonatology, ENT, surgery, including neonatal surgery. The second stage is the nursing of small newborns. A large functional building with seven operating rooms, with an intensive care unit, with two intensive care units, one for newborns, the second for children.

Probably, the uniqueness of our center is that even in Russia there are few such decisions, where in the hands of one team a person’s life from the moment of his birth, not even life, but a person’s health, or rather, from his birth and throughout his life .

- The future is in such city-hospitals or in specialized medical institutions?

- This is the biggest controversy. My colleagues have now returned from an internship from Turkey, they say, a replica of our hospital, only 2 times larger, multidisciplinary. I am definitely a supporter of multidisciplinary hospitals. Because, if we take, for example, a diabetic center, an oncological, an endocrinological center, we understand perfectly well that all these diseases do not occur in isolation, like a childhood intestinal infection. These are always patients of age, with a large number of concomitant diseases. And the help of a multidisciplinary team is required.

- Is it not more difficult to create a team when there are so many people in it?

— It depends on management and the ability to trust and delegate. Therefore, I can say that I am very proud of my team. And, probably, I must say that we are constantly updating, because the guys are invited to leadership positions in other hospitals. Perhaps this also confirms a certain level.

- Are they invited to new positions in hospitals around the country?

- In Moscow. Somehow, traditionally, everyone in our country tends to the capital, and not from the capital. Although, there are probably examples when Moscow managers travel to the regions and deal with the healthcare system there.

Denis Protsenko (Photo: Mikhail Grebenshchikov / RBC)

— Do you see prospects for creating large medical centers in the regions?

- In fact, they are being created, there are quite a few examples of such. Another thing is that most often buildings are built in the regions on the operating territories of hospitals.

And in Moscow, by the way, the same thing is happening now. It is necessary to assess the needs of the region. 200 thousand sq. m - will they be filled with patients, is it necessary for this or that region?

— Are there enough hospitals in Moscow?

I don't feel lack. Medical technology has changed a lot. If before, after a myocardial infarction, you lie in the hospital for 24 days, then you are discharged, and you are on rehabilitation treatment for another month, but now, with the advent of new technologies and drugs, everything has changed radically. A patient after a myocardial infarction in five to seven days can be discharged, because in the first 40 minutes from the development of a heart attack he was taken by ambulance, a stent was installed, the myocardium was opened and saved, he was given anticoagulant drugs, and the catastrophe did not happen.

All over the world and in Moscow, technologies replacing hospitals are being developed very actively. Previously, in order to operate on a hernia, you had to go to bed, get ready for a week, then the operation, then another seven to ten days after the operation. All this dragged on for the classic 21 days, now the pre-hospital examination, laparoscopic methods of correction, by the evening you can go home.

- Don't you think that the primary link is not very far gone from the 1980s?

- The most important doctor , from my point of view, is an outpatient doctor. Which accompanies you much longer than hospital doctors who turn on for a certain moment to solve some problem, and then you go back to the primary network. Therefore, I do not see that primary medicine is lagging behind. Examination opportunities, algorithms, clinical recommendations, they do not differ for a polyclinic doctor and for a hospital doctor. Here, for example, are the possibilities of the My Polyclinic standard, which is being implemented in Moscow.

We have a center for outpatient oncological care, where doctors are scheduled every 15–20 minutes. And you can’t get to the doctor at 11 o’clock if you are booked for 11:20 and, in theory, there should be no queues at the clinic. I come to the CAOP - a large number of people. We started doing this. “What, is the doctor detaining you, not accepting you?” - "No, son, I have one in time, I'm here right now." The polyclinic is also a psychological center for the elderly, if you like, its social network, where they can communicate with each other. And we very often face the fact that patients come prematurely. And not in 5-10 minutes, but really in an hour and a half. And there is a cumulative effect. Although there is EMIAS, the ability to sign up through the call center or through the application, through administrators. And, it would seem, there should not be a queue.

But if the patient, the same elderly woman who communicates there, is better off, maybe this is also part of the mission of the polyclinic.

Denis Protsenko is the chief physician of the Kommunarka Clinical Center, Moscow's chief freelance specialist in anesthesiology and resuscitation. Born in 1975 in Ashgabat. In 1999 he graduated from the Moscow Medical Academy. THEM. Sechenov (now - Sechenov University) with a degree in General Medicine, in 2000 he completed an internship in the specialty "Anesthesiology-Resuscitation" at the same university.

In 2003, at the Russian State Medical University (now RNIMU named after N.I. Pirogov) he defended his dissertation for the degree of Candidate of Medical Sciences. From 2008 to 2014, he served as Deputy Chief Physician for Medical Affairs at the City Hospital No. 7 (now - S.S. Yudin City Clinical Hospital), from 2016 to 2019 - Chief Physician of this hospital. Since 2019, he has been the head of the department of anesthesiology and resuscitation at the Russian National Research Medical University. N.I. Pirogov. From the same year to the present, he has been in charge of hospital No. 40.

In June 2020, the head of one of the main coronavirus hospitals was awarded the Hero of Labor star.