{"id":61849,"date":"2025-11-13T13:37:27","date_gmt":"2025-11-13T12:37:27","guid":{"rendered":"https:\/\/www.invarena.cz\/?p=61849"},"modified":"2025-11-13T13:37:27","modified_gmt":"2025-11-13T12:37:27","slug":"interniste-hledaji-cestu-z-pretizeneho-systemu","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=61849","title":{"rendered":"Internist\u00e9 hledaj\u00ed cestu z p\u0159et\u00ed\u017een\u00e9ho syst\u00e9mu"},"content":{"rendered":"\n<p><strong>Praha, 13. 11. 2025 \u2013 Nav\u0161t\u00edvit pohotovost sedmkr\u00e1t do t\u00fddne nebo nechat se v pr\u016fb\u011bhu jednoho m\u011bs\u00edce vy\u0161et\u0159it \u0161esti r\u016fzn\u00fdmi l\u00e9ka\u0159i stejn\u00e9 odbornosti \u2013 to v\u0161e je v&nbsp;\u010desk\u00e9m zdravotn\u00edm syst\u00e9mu mo\u017en\u00e9. Pacient v&nbsp;mo\u017enostech objedn\u00e1v\u00e1n\u00ed nem\u00e1 prakticky \u017e\u00e1dn\u00e9 limity. Podle \u00dastavu zdravotnick\u00fdch informac\u00ed (\u00daZIS) p\u0159ipad\u00e1 na ka\u017ed\u00e9ho obyvatele \u010ceska celkem 16 konzultac\u00ed v ambulantn\u00edch ordinac\u00edch za rok. V&nbsp;Evrop\u011b se tak \u010cesk\u00e1 republika \u0159ad\u00ed mezi zem\u011b s&nbsp;nejv\u011bt\u0161\u00edm po\u010dtem kontakt\u016f se zdravotn\u00edm syst\u00e9mem. Pokud jde o&nbsp;specializovan\u00e1 pracovi\u0161t\u011b, mezi jedny z&nbsp;nejvyt\u00ed\u017een\u011bj\u0161\u00edch pat\u0159\u00ed intern\u00ed ambulance. O&nbsp;aktu\u00e1ln\u00edm stavu budou mimo jin\u00e9 diskutovat l\u00e9ka\u0159i na XXXII. kongresu \u010cesk\u00e9 internistick\u00e9 spole\u010dnosti (\u010cIS). Ten startuje 19. listopadu.<\/strong><\/p>\n\n\n\n<p><a><\/a> L\u00e9ka\u0159i intern\u00edch ambulanc\u00ed provedou ro\u010dn\u011b p\u0159ibli\u017en\u011b 2 500 000 vy\u0161et\u0159en\u00ed. O dal\u0161\u00edch 340&nbsp;000&nbsp;pacient\u016f se staraj\u00ed na l\u016f\u017ekov\u00fdch odd\u011blen\u00edch. Ka\u017ed\u00fd z&nbsp;nich se na intern\u00edm odd\u011blen\u00ed zdr\u017e\u00ed pr\u016fm\u011brn\u011b 6,2 dne. Ze dvou t\u0159etin jde o pacienty star\u0161\u00ed 65 let. <em>\u201eP\u0159ib\u00fdv\u00e1 pacient\u016f se srde\u010dn\u00edmi i&nbsp;metabolick\u00fdmi onemocn\u011bn\u00edmi, jako je nap\u0159\u00edklad vysok\u00fd tlak, srde\u010dn\u00ed arytmie, cukrovka a podobn\u011b. Lid\u00e9 se do\u017e\u00edvaj\u00ed vy\u0161\u0161\u00edho v\u011bku, ale ne ve zdrav\u00ed. My v&nbsp;sou\u010dasnosti \u017eijeme v&nbsp;m\u00edst\u011b a dob\u011b, kdy se m\u00e1me velice dob\u0159e, nic n\u00e1s nenut\u00ed k&nbsp;pohybu a netrp\u00edme hlady. Sp\u00ed\u0161e naopak. To se bohu\u017eel podepisuje i na mlad\u0161\u00edch ro\u010dn\u00edc\u00edch. Nikdy&nbsp;d\u0159\u00edve jsme nem\u011bli tolik ob\u00e9zn\u00edch d\u011bt\u00ed,\u201c <\/em>vysv\u011btluje prim\u00e1\u0159 Intern\u00edho odd\u011blen\u00ed Nemocnice Znojmo MUDr. Zden\u011bk Monhart, Ph.D., FEFIM. Typick\u00fdm pacientem internisty je senior se \u010dty\u0159mi a v\u00edce diagn\u00f3zami, kter\u00e9 v\u00fdznamn\u011b zat\u011b\u017euj\u00ed zdravotn\u00ed stav pacienta. V\u00fdjimkou v\u0161ak nejsou ani lid\u00e9 trp\u00edc\u00ed vy\u0161\u0161\u00edm po\u010dtem nemoc\u00ed. \u010casto jde o komplikovan\u00e9 a \u010dasov\u011b n\u00e1ro\u010dn\u00e9 p\u0159\u00edpady. V&nbsp;okrajov\u00fdch \u010d\u00e1stech republiky, kde chyb\u00ed nap\u0159\u00edklad diabetologov\u00e9 nebo kardiologov\u00e9, nahrazuj\u00ed internist\u00e9 sv\u00e9 \u00fazce specializovan\u00e9 kolegy. A l\u016f\u017ekov\u00e1 interna pat\u0159\u00ed vedle chirurgie mezi z\u00e1kladn\u00ed obory, kter\u00e9 jsou sou\u010d\u00e1st\u00ed ka\u017ed\u00e9 v\u0161eobecn\u00e9 nemocnice. <em>\u201eChyb\u00ed n\u00e1m tu syst\u00e9m, kter\u00fd by motivoval pacienty, aby o sv\u00e9 zdrav\u00ed aktivn\u011b pe\u010dovali. Nezaznamenal jsem, \u017ee by se za posledn\u00ed l\u00e9ta zm\u011bnilo chov\u00e1n\u00ed na\u0161ich pacient\u016f, pokud jde o informovanost nebo zdrav\u011bj\u0161\u00ed \u017eivotn\u00ed styl. Vn\u00edm\u00e1m to jako velk\u00fd probl\u00e9m, proto\u017ee v sou\u010dasnosti se na n\u00e1s hrne masa polymorbidn\u00edch pacient\u016f, na kter\u00e9 \u010dasto nem\u00e1me person\u00e1ln\u00ed ani instrument\u00e1ln\u00ed vybaven\u00ed,\u201c <\/em>varuje z\u00e1stupce ambulantn\u00edch internist\u016f \u010cesk\u00e9 internistick\u00e9 spole\u010dnosti \u010cLS JEP MUDr. Tom\u00e1\u0161 Hauer. Internist\u00e9 upozor\u0148uj\u00ed, \u017ee jejich kapacity brzy naraz\u00ed na strop. Krom\u011b populace toti\u017e st\u00e1rnou tak\u00e9 zdravotn\u00edci. Pr\u016fm\u011brn\u00fd v\u011bk intern\u00edch l\u00e9ka\u0159\u016f se podle dat \u00daZIS z&nbsp;roku 2023 pohybuje kolem 57,2 roku, t\u0159etina z nich je dokonce star\u0161\u00ed 65 let. Vedle d\u011btsk\u00fdch l\u00e9ka\u0159\u016f tak jde o jedny z&nbsp;nejstar\u0161\u00edch specialist\u016f. Mezi lety 2022 a 2023 se jejich v\u011bkov\u00fd pr\u016fm\u011br nav\u00edc o 0,8 roku zv\u00fd\u0161il, co\u017e zna\u010d\u00ed, \u017ee do oboru nep\u0159ich\u00e1z\u00ed ani mnoho absolvent\u016f. Posledn\u00ed data o nov\u011b atestovan\u00fdch l\u00e9ka\u0159\u00edch poch\u00e1zej\u00ed z&nbsp;roku 2021. Podle nich z\u00edskalo v&nbsp;tomto roce atestaci v&nbsp;oboru vnit\u0159n\u00edho l\u00e9ka\u0159stv\u00ed celkem 57 mlad\u00fdch l\u00e9ka\u0159\u016f. Mezi po\u010detnou skupinou 4 400 internist\u016f tak \u201emlad\u00e1 krev\u201c tvo\u0159\u00ed p\u0159ibli\u017en\u011b 1,3 %. <em>\u201eNa rozd\u00edl od jin\u00fdch specializac\u00ed je vnit\u0159n\u00ed l\u00e9ka\u0159stv\u00ed nesm\u00edrn\u011b \u0161irok\u00fd obor. Prakticky jej zvl\u00e1dnout vy\u017eaduje v\u00edce \u010dasu a rozs\u00e1hlej\u0161\u00ed objem znalost\u00ed, ne\u017e je pot\u0159eba u&nbsp;n\u011bkter\u00fdch jin\u00fdch odbornost\u00ed. P\u0159itom finan\u010dn\u00ed ohodnocen\u00ed vy\u0161\u0161\u00ed n\u00e1ro\u010dnost nezohled\u0148uje, naopak je zpravidla men\u0161\u00ed ne\u017e u \u00fazce zam\u011b\u0159en\u00fdch obor\u016f. Z\u00e1rove\u0148 jde o specializaci, kter\u00e1 zvl\u00e1dne zdravotn\u00ed syst\u00e9m podr\u017eet. To dok\u00e1zala nap\u0159\u00edklad p\u0159i pandemii covidu,\u201c<\/em> dod\u00e1v\u00e1 p\u0159edseda \u010cesk\u00e9 internistick\u00e9 spole\u010dnosti \u010cLS JEP prof. MUDr. Richard \u010ce\u0161ka, CSc., FACP, FEFIM.<\/p>\n\n\n\n<p>Podle l\u00e9ka\u0159\u016f je t\u0159eba hledat cesty, jak zdravotn\u00ed syst\u00e9m zefektivnit. Internist\u00e9 se proto p\u0159ipojili k&nbsp;celosv\u011btov\u00e9mu programu Choosing Wisely, podle kter\u00e9ho by pacienti nem\u011bli b\u00fdt zat\u011b\u017eov\u00e1ni vy\u0161et\u0159en\u00edmi, l\u00e9ky nebo kontrolami, pakli\u017ee to nen\u00ed nezbytn\u011b nutn\u00e9. Ka\u017ed\u00e9 dal\u0161\u00ed vy\u0161et\u0159en\u00ed p\u0159edstavuje finan\u010dn\u00ed n\u00e1klady pro syst\u00e9m, ale tak\u00e9 \u010dasovou nebo zdravotn\u00ed z\u00e1t\u011b\u017e pro pacienta. Proto je t\u0159eba k&nbsp;pacient\u016fm p\u0159istupovat individu\u00e1ln\u011b a nastavit l\u00e9\u010dbu tak, aby byla p\u0159edev\u0161\u00edm bezpe\u010dn\u00e1. Vzorem pro n\u00e1s m\u016f\u017ee b\u00fdt podle l\u00e9ka\u0159\u016f nap\u0159\u00edklad Kanada, Belgie nebo Lucembursko, kde se m\u00edstn\u00ed specialist\u00e9 rozhoduj\u00ed \u010dist\u011b na z\u00e1klad\u011b dat, nikoliv na z\u00e1klad\u011b zvyklost\u00ed. A\u017e 30 % n\u00e1klad\u016f na poskytovan\u00ed p\u00e9\u010de ve zdravotnick\u00fdch za\u0159\u00edzen\u00edch je vynakl\u00e1d\u00e1no na tzv. low value care, tedy p\u00e9\u010di, kter\u00e1 p\u0159in\u00e1\u0161\u00ed pacientovi velmi mal\u00fd nebo \u017e\u00e1dn\u00fd u\u017eitek a m\u016f\u017ee mu potenci\u00e1ln\u011b \u0161kodit. Za deset let, kdy program funguje, proto vytvo\u0159ili odborn\u00edci p\u0159es 600 konkr\u00e9tn\u00edch doporu\u010den\u00ed, kter\u00e1 by m\u011bla pomoci omezit l\u00e9\u010debn\u00e9 \u00fakony, je\u017e nep\u0159in\u00e1\u0161ej\u00ed smyslupln\u00fd prosp\u011bch.<\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>Praha, 13. 11. 2025 \u2013 Nav\u0161t\u00edvit pohotovost sedmkr\u00e1t do t\u00fddne nebo nechat se v pr\u016fb\u011bhu jednoho m\u011bs\u00edce vy\u0161et\u0159it \u0161esti r\u016fzn\u00fdmi l\u00e9ka\u0159i stejn\u00e9 odbornosti \u2013 to <a class=\"mh-excerpt-more\" href=\"https:\/\/www.invarena.cz\/?p=61849\" title=\"Internist\u00e9 hledaj\u00ed cestu z p\u0159et\u00ed\u017een\u00e9ho syst\u00e9mu\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":14888,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-61849","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/61849","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=61849"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/61849\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14888"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=61849"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=61849"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=61849"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}