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Amputacja jest tańsza od leczenia PDF Drukuj Email
06.05.2009.
 

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Uwaga cukrzycy! Jeśli słyszycie, że amputacja stopy to dla was jedyny ratunek, skonsultujcie to z innym szpitalem. W środowisku diabetologów wrze od krytyki niektórych placówek. Te w ramach "oszczędności" nie leczą kończyn, które mimo cukrzycy można uratować. Ucinają stopy, choć nie muszą. Tak jest taniej. A wszystko przez skąpy NFZ - ustalił DZIENNIK.

Narodowy Fundusz Zdrowia stawia szpitale przed dramatycznym wyborem: czy leczyć pacjentów z tzw. stopą cukrzycową i zadłużać się, czy raczej amputować chorą kończynę? Na leczenie jednego takiego pacjenta NFZ daje bowiem szpitalom zaledwie 4 tysiące złotych. Tymczasem rzeczywiste koszty leczenia stopy cukrzycowej są trzy razy wyższe. W efekcie szpitale wolą okalecza ludzi niż ich leczyć. "Amputacja jest w Polsce nadużywana, a NFZ wręcz zachęca do tego szpitale" - powiedziała DZIENNIKOWI diabetolog doktor Teresa Koblik.

Statystyki są bardzo niepokojące: w Polsce na 100 tys. mieszkańców wykonuje się rocznie aż 8 amputacji z powodu stopu cukrzycowej, tymczasem w Danii dwie, a w Hiszpanii i Holandii po jednej."Szpitalowi znacznie bardziej opłaca się odciąć chorą kończynę cukrzykowi, niż ją leczyć" - mówi DZIENNIKOWI prof. Krzysztof Strojek, krajowy konsultant ds. diabetologii.

Szef Polskiego Towarzystwa Diabetologicznego prof. Władysław Grzeszczak przyznaje, że słyszał takie opinie. "Nie chcę nikogo oskarżać, a jeśli już, to Narodowy Fundusz Zdrowia. Trzeba koniecznie zmienić wycenę procedur" - apeluje.

Eksperci podają konkretne dane: leczenie pacjenta ze stopą cukrzycową, czyli poważnymi powikłaniami prowadzącymi do uszkodzenia naczyń krwionośnych, niedokrwienia i miażdżycy stopy, trwa średnio 50 dni i kosztuje szpital ok. 12 tys. zł. Tymczasem NFZ daje tylko około 4 tys. zł, a całą resztę placówka musi dołożyć z własnej kieszeni.

Ale już za amputację fundusz płaci o 1 tys. zł więcej, choć hospitalizacja trwa kilka razy krócej. "Jeśli założylibyśmy, że to NFZ wyznacza standardy postępowania, to okazałoby się, że standardem leczenia stopy cukrzycowej jest jej obcięcie" - ironizuje dr Piotr Liszkowski, kierownik Zespołu Stopy Cukrzycowej w szpitalu AM w Poznaniu.

Rzeczywiście statystyki są wymowne - tylko na Mazowszu wykonano w ub.r. 310 amputacji, a w całej Polsce kilka tysięcy. Eksperci nie mają wątpliwości, że w wielu przypadkach operacji można było uniknąć.

"W tym roku przyjęliśmy 107 pacjentów, których inne szpitale zakwalifikowały do cięcia. Uratowaliśmy stopy 103 osobom" - mówi szef Kliniki Gastroenterologii i Chorób Przemiany Materii w warszawskim szpitalu na Banacha prof. Waldemar Karnafel. Poznańska klinika diabetologii wyleczyła w tym roku nogi 27 z 30 osób, które miały skierowanie na operację.

Podobnie było w Klinice Chorób Metabolicznych Collegium Medicum UJ w Krakowie. Do tych poradni trafiają ludzie, którzy nie pogodzili się z wyrokiem.

"Niestety wielu lekarzy, głównie z prowincjonalnych placówek, nie szuka innych możliwości leczenia. Najprościej pacjenta odesłać na chirurgię, no i znacznie taniej" - mówi prof. Wierusz-Wysocka, szefowa poznańskiej kliniki.

Zdaniem dr. Grzegorza Rosińskiego ze szpitala na Banacha, lekarze zbyt szybko rezygnują z walki o uratowanie stopy. "To mit, że chirurg, amputując nogę, ratuje komuś życie. On je de facto skraca. Ludzie po amputacji zachowują się jak po śmierci bliskiej osoby, popadają w depresję, czasem próbują się zabić. Średni czas życia po takiej operacji to tylko kilka lat" - mówi dr Rosiński.

Profesor Waldemar Karnafel przyznaje, że leczenie pacjentów ze stopą cukrzycową nie jest łatwe. Wymaga mnóstwa czasu i pieniędzy. Jego własna poradnia tylko w trzecim kwartale tego roku odnotowała stratę w wysokości pół miliona złotych.

"Co chwilę jestem wzywany na dywanik do dyrektora, boję się, że w końcu zamkną mi klinikę. Ale nigdy nie obciąłbym komuś z tego powodu nogi. To obrzydliwe i nieludzkie, ale wiem, że się w Polsce zdarza. Takiego postępowania nie można tłumaczyć niewiedzą i niedopatrzeniem" - mówi prof. Karnafel.

Trudno powiedzieć, czego zabrakło w przypadku 59-letniej Barbary Malczewskiej z Płocka, u której cukrzycę II stopnia zdiagnozowano 17 lat temu. We wrześniu zaczęła boleć ją pięta. Próbowała się leczyć sama, ale nie pomagało. Gdy w końcu zgłosiła się do szpitala, usłyszała wyrok: trzeba amputować. "Nawet zaczęłam się godzić z myślą, że zostanę kaleką, ale dowiedziałam się, że nogi ratują na Banacha. Dlatego zadzwoniłam tam, błagając o pomoc" - opowiada. Warszawska klinika dostaje codziennie kilka takich telefonów.

Co na to wszystko NFZ? Gdy zadaliśmy urzędnikom funduszu pytanie, czy planują zmianę wyceny leczenia stopy cukrzycowej, otrzymaliśmy następującą odpowiedź: "Amputacja jest jedną z form leczenia stopy cukrzycowej. (...) Dokonuje się jej w momencie, gdy pacjentowi nie da się już uratować stopy i konieczna jest amputacja, by ratować jego życie, a następnie założenie protezy (która również wchodzi w koszt procedury). Lekarz leczy pacjenta dotąd, dopóki jest szansa na wyleczenie. Jeśli następują zmiany w kościach, można mówić już tylko o amputacji!" - napisał Andrzej Troszyński z biura prasowego NFZ.

"To są kompletne bzdury, amputacja jest w Polsce nadużywana, a NFZ sam do tego zachęca" - komentuje dr Teresa Koblik z Collegium Medicum UJ.

Rozmowa z Antonim Klisowskim z Warszawy - cukrzykiem, 62-latkiem na rencie, którzy wcześniej prowadził własny biznes.

Magdalena Janczewska: Jakie to uczucie, gdy lekarze mówią: trzeba amputować stopę?

Antoni Klisowski: Gdy człowiek po raz pierwszy słyszy, że ktoś chce mu odciąć nogę, to wcale do niego nie dociera. To tak jakbym pani powiedział, że jutro pani umrze. Widzi pani? Zero reakcji. Nie traktuje pani moich słów poważnie. Ale po jakimś czasie człowiek zaczyna o tym myśleć i wtedy jest przerażony. Zwłaszcza że chirurdzy cały czas powtarzają, że trzeba jak najszybciej ciąć. Mówią jasno - albo amputujemy nogę do połowy łydki, albo będzie jeszcze gorzej i potem utniemy za kolano. Poczekamy jeszcze trochę, to może pan umrzeć. Wywierali na mnie dużą presję. Ale ja wiedziałem jedno: nie zgodzę się na amputację.

A nie myślał pan, że lepiej odciąć stopę, aby uratować życie?
Nie. Nie wyobrażam sobie życia bez nogi. Nie chciałbym być uzależniony od innych. Postanowiłem działać. Poprosiłem lekarkę prowadzącą w szpitalu na Wołoskiej o konsultacje ze szpitalem na Banacha, słyszałem, że tam ratują nogi. Wiem, że lekarze tego nie lubią, w końcu to tak jakby przyznawali się, że sobie nie dają rady z pacjentem. Na szczęście była bardzo pomocna. Pojechałem na badania i okazało się, że wcale nie muszę tracić nogi. Przyjęto mnie na oddział. Po 50 dniach mogłem wyjść do domu. Jeżdżę jeszcze na wózku, bo muszę oszczędzać stopę, ale najważniejsze, że ją mam. Boję się pomyśleć, co by było, gdybym się pokornie pogodził z wyrokiem.

Jak długo chorował pan na cukrzycę?
Zdiagnozowano ją u mnie jakieś 10 lat temu, przy okazji kompleksowego przeglądu. Lekarka zalecała insulinę, ale ja zastrzyki uznałem za zbyt uciążliwe. Przecież tak naprawdę nic mi wielkiego nie dolegało. W końcu zdecydowałem się na tabletki, które brałem dość nieregularnie. Otrzeźwienie przyszło rok temu, gdy przeszedłem zawał. Pomyślałem wtedy sobie: oj stary, organizm daje ci żółtą kartkę. Zacząłem brać insulinę. Za późno, zaczęły się powikłania. W maju moja prawa stopa zaczęła puchnąć i robić się czerwona. I trafiłem na tydzień do szpitala na dermatologię.

Nikt nie podejrzewał stopy cukrzycowej?
Wykluczono ją, bo nie miałem żadnego uszkodzenia skóry. Potem leżałem trzy tygodnie w szpitalu zakaźnym z podejrzeniem róży. W końcu kazano mi szukać pomocy gdzie indziej. Machnąłem więc ręką. Później doszły jeszcze typowe objawy: obtarłem sobie tę napuchniętą nogę. Ale już do lekarza nie poszedłem. Może i trwałoby to dłużej, gdybym nie zadzwonił 15 października z życzeniami imieninowymi do mojej lekarki - diabetolog. Opowiedziałem jej o swoich problemach. Wolę nie myśleć, co by było, gdybym wtedy nie zadzwonił.

za:dziennik.pl/Magdalena Janczewska

"Szpitale obcinają cukrzykom nogi dla zysku"

   
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