Professor M. M. Bikbov: "We managed to create a team of like-minded people"

By the decree of the President of the Russian Federation Vladimir Putin the title of "Honored doctor of the Russian Federation" has Bikbova the month of Muharram Muharemovic.

The newspaper "sight" and publishing house "April" congratulations to Professor M. M. Bikbov: on this momentous occasion.

"Your high competence and responsibility has earned You deserved authority and respect of colleagues. You are appreciated as a respected mentor of young, talented surgeons. We wish you success in Your noble work for the benefit of domestic ophthalmology!"

— Muharram, Muharemovic! Exactly a year ago we met You in the hospitable land of the Ufa, at the conference "East-West 2012". You told the readers of the "Field of view" about the Ufa research Institute of eye diseases: successes and challenges. For reviews of readers, the interview was a success. Before You ask the first question, may I thank you for your hospitality. I am very pleased that You be respectful of the press. Let's start with the outcome of the conference. In Your opinion, what has been done, what went wrong?

Conference, in my opinion, should be primarily to perform educational functions, its audience ophthalmologists working in the field. Not all doctors have the opportunity to travel to Moscow or St. Petersburg for a "big" conference, and our event counted on the participation of ophthalmologists of the Republic of Bashkortostan and neighboring regions: Chelyabinsk, Orenburg, Sverdlovsk, Tyumen, Tatarstan. In this respect, we have achieved our goal: registered more than 700 participants from many regions of Russia and near and far abroad. We were able to show doctors the latest advances in medicine, and You know that last year our Institute was equipped with equipment of last generation — for example, femtosecond laser for cataract surgery, and other equipment. The great achievement of this conference lies also in the fact that it was supported by many of the leading ophthalmologists of the country, and local physicians had the opportunity to listen to eminent scientists, ask them questions, chat with them on the sidelines. As for the shortcomings, they were, I saw them...

— ...no, they were, therefore, in the future we will strive "to hone skills". We already went to the annual format, the conference was attended by prominent domestic and foreign scientists. Want to see the organization more clearly, but as they say, the sky's the limit.

— Most recently, the company "Bausch+Lomb" has invited the newspaper "sight" of the fgbi "IRTC "eye microsurgery" them. Acad. S. N. Fedorova" a demonstration on the use of femtolazer Victus. Some media, particularly the Federal television channels, introduced the event as "the first surgery for removal of cataracts with the femtosecond laser, conducted at the state medical institution". I know in the clinic "Vostok-Prozrenie" Professor S. Y. Anisimova has this laser already and 300 operated eyes. For this reason Svetlana did a presentation in St. Petersburg. But with what surprise I learned that in Russia, another government institution, in Your Institute, is already working femtolazer Victus and that have been operated on more than 100 eyes.

The Department of surgery of the cornea and lens

— You are absolutely right, at the moment when the IRTC was conducted this surgery in our Institute had already conducted more than 100 femtofarads.

— Muharram, Muharemovic, let me ask you, why don't You invite TV channels for presentation of the latest equipment? Thinking out loud: what, in essence, a difference of — state or non-state medical institution has acquired ultra-modern equipment? The main question — and if there's some benefit to the patient? What are the benefits in using the machine Victus? Please tellreaders of this new technology.

— Victus is the first Combi-system. We bought the full version of the machine: combination laser platform which includes an excimer laser system Technolas 217 P and the Victus femtosecond system. To date, Victus is the only system that allows you to do and femtotech, and work on the cornea, do Femto. As I said, we have done more than 100 operations for cataracts, a few dozen operations on cornea. Operations practiced on the diagnostic system, supplied with laser equipment. These operations we were set on stream, plus they are free as we — clinic state. What are the advantages of the new system? Victus, of course, designed for a large number of interventions. If in a hospital bill in the thousands of phacoemulsification in a year, you have such a machine profitable. The advantage of the new laser lies in the fact that the "human factor", the mood of the surgeon, will not affect the outcome of the operation capsulorhexis is done with micron precision. However, contrary to popular belief, this machine can work the surgeon of the highest caliber, I have to say that implantation of a premium IOL at the hands of a surgeon, and his precision (especially if we are talking about a multifocal lens), and, accordingly, the qualification needs to be perfect. That is, robotic technology, and in the case of laser Victus we are talking about it, assumes the highest qualification of the surgeon.

Before you put the new lazer for us, I was in the Czech Republic in the clinic Gemini Dr. Paul Stodolka. He has the most experience in conducting femtofarad. He uses almost no ultrasound even with a fairly dense cataract, it only makes aspiration. Our surgeons are still afraid to completely move away from the ultrasound, but we should strive to do. In other words, femtocharge, on the one hand, considerably facilitates work of the doctor, on the other — implies his great skill. With the advanced technology skills of the surgeon will be critical.

— What's new for the year happened in the Institute?

Aftercomplete reconstruction and re-equipment of introduced operating 1-th microsurgical Department. I want to note that serious help with this we had a charity Fund "Ural". In may this year opened again operating on the 2nd floor. Conducted full re-operating: installed combination laser platform includes excimer laser system Technolas217 P and Victus femtosecond system, as well as one of the most modern operating microscopes OPMI Lumera 700. Doctors and researchers of the Department of surgery of the cornea and lens were trained on femtosecond laser cataract surgery and vision correction under the guidance of engineers from Germany.

Literally 2 weeks after the opening operating on the 2nd floor and started operating on the 3rd floor. After 1 month completed the repair in two operating street Aurora, 14. All operating reconstructed by counterparts overseas clinics with the use of modern technology, one of the obvious and basic benefits which are climate control, air sterilization, ventilation, etc. by the Way, You can take a 3D tour of operating on the website of our Institute http://www.ufaeyeinstitute.ru//. Operating provided 2 workstations equipped with a modern microscope OPMI Lumera T, and the ultrasonic surgical system Infiniti Vision System Ozil. Surgical microscopes OPMI Lumera T manufactured by Carl Zeiss, Germany (and we we got them in the amount of 7 pieces) is an excellent device for various sections of ophthalmic surgery. Microscopes equipped with innovative lighting technology Red reflex, which significantly reduces phototoxic effect on the retina of the patient. The function of the Deep View system control depth of sharpness of the image significantly improves visualization of microstructures.

— I would like to talk to You about the problems of the patient and other issues. In our country there is a system of compulsory health insurance, which ensures its citizens receive quality and timely medical care. At this stage, the MHI system has many flaws that prevent it from developing further. First and foremost, it is a gapbetween state guarantees and reality. As for LCA, there is a conflict of interest with medical institutions. Insurers seeking to improve the profitability of their activities, trying to reduce the volume of payments. And medical establishments, seeking to increase their income, focused on providing as many services in which the patient sometimes does not need. How do You assess the effectiveness of OMS and DMS today?

— In our experience of interaction with regional Fund of compulsory medical insurance, the biggest problems in this matter, I do not see. Indeed, the Fund allows you to Fund almost everything that we need for our requests. As well as the financing we receive on completed cases, all other issues are resolved itself. The only difficulty that we face is the purchase of medical equipment worth over 100 thousand rubles. The problem is quite acute, and it would be highly desirable that the medical establishment (of course, if it earns enough money) had the opportunity, after completing all obligations under the mandatory medical insurance Fund, the savings to be used for purchasing necessary medical equipment. We can purchase any most modern equipment, but do not have the right to purchase ultrasonic handle for facoemulsificator. I'm not talking about facoemulsificator. If to increase the allowable amounts to at least 500 thousand rubles, it would be much easier. In my opinion, the purchase of large equipment is not really the objective of the Fund. It is the task of the budget, sponsorship, etc. However, the Fund comes to meet us, but not always, the problem is solved quickly.

Other positions I have big problems in the relationship with the Fund do not see, but this applies only to our local Fund. For the whole country, I can't answer.

LCA is a very small percentage of the volume of work in our institution. The Institute has practically no paid services and voluntary medical insurance has not received the big development. So the amount of DMS are not determinative. So I can't say enough good about this issue.

— Your responsibilities the main non-staff ophthalmologist of the Republic of Bashkortostan includes the coordination of industry professionals on the provision of quality health care. Tell us about the methodology of evaluation of quality of care and set of indicators characterizing its force in the Republic and, in particular, in Ufrii GB?

Is there a moral issue if the patient must be prescribed the drug, which is not included in the list of free, moreover, it is expensive, and the patient simply has no funds for it? Patients complain that the doctors they offer the services which they need.

— We did not. The treatment is strictly on the lines of MLA Fund. Therefore, the imposition of additional paid services will give us more headache.

I, as the head of the organization, which employs more than 100 doctors and researchers have never encountered such a problem and in the complaints of patients haven't met such a question. Therefore, most likely, will not be able to objectively answer this question. On the other hand, the problem exists, of course. Went 323-law, came 74 article prohibiting firms to stimulate doctors. As you know, now doctors do not have the right to prescribe drugs under their trade names, they write the so-called "substrate", but then the problem shifted from the doctor to the pharmacy staff, the result of extreme was a patient. The doctor can find the patient needs the drug for a reasonable price, the pharmacist the same goal — to sell more expensive drug. I think that's not quite right.

— The press often write that it is necessary to raise the prestige of the doctor, on the last forum AROF talked about this Professor V. V. Neroev. He urged journalists to write very carefully on cases of medical errors. What do You think, what should pay attention to the press concerning the medicine and how to raise the prestige of the medical profession?

— AbsolutelyI agree with the words of Professor V. V. Neroev and I urge my colleagues always careful with the press. Just recently, our staff was on the radio and in live contact with listeners. We thought that would be a discussion of the problems of medical care, provision of medicines, but it came down to the usual consultations about the fact that someone my eyes itch or red. I think that the main problem of the Russian people, which he got in inheritance from the Soviet Union, it is the belief of our citizens that his health meet the doctors and nurses. It penetrates into the consciousness of the people with mother's milk. While in the West people believe that their health they are responsible. I think that the press all their efforts should be directed at persuading citizens to take care of your health and not to shift the problem to physicians. And I want to appeal to everyone with the words: "Think about your own health, the doctors and nurses only help you to return." You can, unfortunately, lead hundreds, thousands of examples of careless attitude to their health, when the doctors are unable to help them.

But we had the same system of examination that somehow, but worked...

— All right, but it is completely accessible and completely free medicine to some extent, corrupted people, and many began to think that "my health is not my problem." Hence people don't exercise, I don't know what is disease prevention. Man believes that he should be treated, and it should be treated. If a person comes to the clinic, and the doctor finds he has a disease that is not treated, assume that the degeneration of the retina, and does not prescribe medication, the patient will write a complaint to the Ministry of health, and the doctor is waiting for a big hassle. In such cases, does the doctor? Assigns a vasodilator, sosudoukreplyayuschee tools, anti-sclerotic drugs that in this situation no significance. The patient is wasting money but remains happy: with the treatment. This evil practice, we doctors must end, and to help us in this need media.

— A specializedpress, in Your opinion, should raise critical questions?

— Required and that the issues concerning the relationship "doctor-patient". The patient should know that he is skilled, intelligent doctor who prescribes the necessary treatment or do not assign useless. A doctor's responsibility is to the destination was adequate to the occasion. In other words, must be respected, a balance of mutual interests between the patient and the doctor. And the task of the press, including the specialized to pay attention to it, to facilitate the convergence of positions of patients and medical workers.

1986. Still to come

I know well how the health system in Japan (where my daughter studies). First of all, the trust of the people to the doctors in this country is limitless. We don't have that, moreover, "yellow journalism" enjoying "fried" the facts contributing to even greater split between doctors and patients. And in Japan and in other Asian countries people would never question the doctor delivered the diagnosis or the correct treatment. Another feature of Japanese physicians (as, indeed, Western) not overdoing it with drugs, as is the case with us (injection parabulbarno injections under the skin of the temple and other "torture"). And we have to be safe, adapting to the psychology of our patient: "if the drops do not "tear to the brain" — the good in them whatsoever".

The recent scandal about remarks of the Minister of education D. V. Livanov against wounds died down, but questions remained. I would like to know Your personal opinion regarding the development of fundamental science in the country.

— I have great respect for scientists, I bow before them. The problem is not that now we do not issue anyrevolutionary scientific ideas. In my opinion, we have no basis on which these ideas, methods could be born. Let's see what kind of equipment is in the offices of ophthalmologists, with the help of some of the devices we examine or operate on patients. We are proud to have the most modern equipment, but the domestic unit among this "wealth" you will not find at all desire. Microscopes, phacoemulsification, lasers, excimer, femtosecond, and so on — all this is made not in our country. Ophthalmology as a science and develop new methods for studies of treatment — not quite the same thing. Scientists developing the science, and scientists developing the latest ophthalmic instruments and equipment — all the different incarnations. For example, femtosecond laser — not the development of scientists-ophthalmologists. Worked on it, first of all, physics. And that femtolazer were not we, in the West, most likely, not the blame of the Russian scientists, and the education system.

I believe that our education system, including in ophthalmology, is of a more applied nature. The result — we have excellent surgeons, diagnosticians. But we hardly touch on deep theoretical issues, while in Western countries, future ophthalmologists, for example, thoroughly studied the fundamental aspects of science. We have a theory — not the strong direction, it does not allow our scientists to "give" the world's medicine the latest treatment technologies to the extent we would like. Perhaps all what I said, more for me, but I am a product of the national system of education.

"Science" — the concept of international. Should in any country be a new idea, as it immediately picked up and developed by scientists of other countries. When they hear that, they say, "we use a technique that no one has never used", I have a question: "the Technique is so new that it still has not managed to learn (a maximum of six months about updates to the entire world will know), or she's just not interesting and science is irrelevant?"

— Muharram, Muharemovic, if I may, a few private questions. What event from your own life did You find most meaningful?
Mosta joyous event in my life was my birth. But this was preceded by an acquaintance of my parents. They grew up in the same village, dad was two years older than my mom, fell in love with her in 1st class. For ten years they spent together, told me that dad often ran barefoot over two kilometres, sometimes after the first snow, to pick up mom from school. Even after graduation (daddy — graduate agricultural, mother — teaching) mother remained inaccessible and did not consent to marry. And only when dad was already 27 years old and the mother 25 that the standards of the village quite a lot, my parents got married. However, they still remember how long dad was courting mom, trying to win her favor.

Mother N. And.Bikbov:	Father M. S. Bikbov

— But it could not emerge...

— Indeed, but for the past 57 years they were together.

— When did You meet your future wife?

— We were first-year students, I studied in medical school, she is Bashkir state University on chemical faculty. Between chemists and physicians had very friendly relations. It is a year before I graduated, left for the distribution to work in the district. A year later I graduated, and we got married. We have two daughters.

— Absolutely charming girls. Tell me, in addition to ophthalmology that still interests You in life?

"I judo loved before"...

— Yes, just like Vishnevsky. On skis I ride almost professionally. Although in the summer I also have something to do: to fly a glider, surf. See, I prefer a risky sports. Honestly, I have no "living" space, knees injured.

— You do not have enough adrenaline at work?

For me extreme sport is a wonderful release.

— You love to read?

— I like Russian classical literature. About every ten years I return to the Russian classics. Now re-read "Oblomov" and once again get a true pleasure. I do not understand people who do not read books referring to employment and lack of time. Stupid, in the end, one hour a day to detach from the dream... Love Haruki Murakami, get pleasure from Bernard Werber, recently read his "Ants".

Almost all want to turn back time and change something in your life.

I don't want. I believe that for a person best time in which he lives. However, depending on the age a person perceives different life. We become more experienced, minds are changing.

Courses keratotomy in MNTK "eye microsurgery" (Moscow)

small;">After defending his doctoral RMAPO (Russian medical Academy of postgraduate education)

— You always dreamed to be a doctor?

— No, not always. Recently was in Kazan for the first time in many years, stopped in Kazan

Suvorov military school, where I studied after the 8th grade. My father, a former officer, a veteran of special risk units, and since childhood I wanted to be a soldier. But once he told me that the army has no prospects. I then (remember it was 1972) my father's words seemed odd: the USSR had the most powerful army in the world, and then — "no prospects". I still went to Kazan and entered the Suvorov military school, but, after a few months, he returned home, he entered the physico-mathematical school. Military career was not held, and math I love you still, you expect and very much like people with a mathematical turn of mind.

When I was in school, class 9-m, I came across the book of a psychiatrist, writer Vladimir Levi "the Hunt for thought: Notes of a psychiatrist". The book I was literally shocked how many secrets contain the depths of our consciousness! It probably spurred me to do medicine. Almost to graduation, I wanted to become a psychiatrist, I was seriously interested in human thinking. However, the first lesson in ophthalmology when I saw the exact optical instrument when he realized that vision is a product of the activity of consciousness and mind, my physical and mathematical inclination and interest in psychiatry coincided, and I became ophthalmologist.

— And never regretted his choice?

— Never regretted it. I have had some great teachers, first and foremost, Sunyaev thanks ishakovna and Jangirova Marv Zinnurovna — doctors, primarily women, who all his life devoted to the service of ophthalmology. Ophthalmology truly replace family. They were an example for me of dedication to the chosen path, because there is nothing more important than what you see the meaning of his existence.

My teacher I also called Aznabaeva Marat Talgatovich,a great scientist, a great organizer. He always sought out everything new and progressive. Perhaps these qualities I had adopted.

— Do You consider yourself a tough Director?

— Probably, all the same, Yes. Without a certain stiffness is not enough. Despite the fact that before taking a decision, I listen to their colleagues and given their opinion already taking its toll.

— Often, appearances are indeed deceptive. I was under the impression that You — a gentle man. On the other hand, to manage such a large institution and not be able to "show character" is difficult.

— You're absolutely right, people with soft nature, hardly able to cope with the tasks facing the Director of a large scientifically-medical institutions. In that moment, when I became Director, the situation in the Institute was quite difficult. I still have the decree signed by the President of the Republic of Bashkortostan, the elimination of our Institute. And if it had not been taken severe economic and administrative measures, we might not have got out of this situation.

— Was there any resistance in the team, as it often happens in the period of change of leadership?

— I wouldn't call it "confrontation", but different opinions about the situation really was. Just on the podium, we talked with Professor Vladimir Neroev, recalled developed in the Institute in that period the situation, and he said that the debate is possible, but only "from time to time", then it is necessary to put the question squarely: "either-or", otherwise — not. Some of the employees who disagreed with the ideas of change, had to leave. The former economic policy is completely discredited. Now in economic terms, we fully comply with the status of the state budget institutions, where medical care should be free. We are not paid services, assistance became available to all segments of the population, while the financial situation has become more favourable. Private clinics — its contingent, and we should assistordinary people.

— You were in my life for something embarrassing?

— I am ashamed of the gaps in education. I later began to learn English, he is still my "lame". And in the current situation, when there is wide scientific exchange, foreign ophthalmologists to come to our country, the Russian doctors participate in conferences in many countries, knowledge of foreign languages is very important. It is for this I am ashamed. I read almost all the literature in ophthalmology: domestic and foreign Newspapers, magazines, but constantly I catch myself on thought that is still little known.

— Are you satisfied with them?

— I always think that I have something not completed. All my work is planned to the last detail. Sometimes I have insomnia, and this is good: new ideas, think how to improve the work of the Institute.

— The dream remains little time?

— I sleep a little, but not because give all his time to the work, I just don't have long to sleep to regain strength. Even if I go to bed late, at 7am I was up.

— Never be late for work?

Never. In this respect I am a very meticulous, try not to be late, better come in an hour early than five minutes late.

— Employees of Your so well educated?

— Discipline us severely. If a person starts late, then often the whole day goes awry. Additionally, if you have half a minute late for the morning "the RAM", is possible to lose the quarterly bonus, which is a very decent money. Therefore, staff do not allow myself to be late.

— You trust the heads of departments or trying to solve all issues single-handedly?

Trust, of course. In the solution of issues that fall within the purview of my deputies and heads of departments, I do not interfere and give them the opportunity to take the initiative. They understandthat work only at my direction I do not approve of.

— You have reliable family back?

My family all supports me. My wife, a former Bank employee, now retired, is bringing up her granddaughter. The eldest daughter has reached a great heights in ophthalmology, and the youngest is just starting their way in this specialty, graduation from the internship.

— You and Your daughter PhD Guzel Maharramova Bikbova, June 7, 2013 based on the decision of the Commission of the Academy of Sciences of the Republic of Bashkortostan was awarded the prize named after Gabdulla Kudoyarov of Chabarovice. Congratulations!

Thank you. Immediately after the conference we were invited to the Academy of Sciences of Belarus for awarding the prize named after Gabdulla Kudoyarov of Kabirovich*. This award in the field of medicine, particularly in surgery. The prize is awarded once in two years. We applied for our work "Ectasia of the cornea". The competition was big enough, but the winners were us.

— And, probably, last question: what are You proud of?

— Proud of my family, proud of the work colleagues. Over the years there were different situations that as the sea polishes pebbles, Stoch existed between us corners, priter us to each other and cemented in the close-knit, unified team, a partnership of like-minded people. People work not by compulsion, but from the soul.

Institute: we are one family

— A stranger is clearly visible on the atmosphere that prevails at the time of your conferences. People cannot be forced to be sincere, if they are not.

— You are right. I assure You that we always reigns an atmosphere of sincerity and trust. We often holdtogether free time, organize parties, sing songs. Official subordination leave for work. Trendy word "corporate" in this case sounds like something inappropriate, it's meeting real friends. I am very proud of.

I interviewed Larisa TUMAR
Photos from the personal archive of M. M. Bikbov:
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* Approx. edition. Gabdulla Kudoyarov Kabirovich — doctor of medical Sciences, honored scientist of the RSFSR and BASSR, honoured doctor of the RSFSR and BASSR. Was born in June 1899 in the village of Ablay Belebeevsky district of the Ufa province. In 1926 he graduated from the medical faculty of the Perm University. From 1926 to 1955 he worked at the Ufa research Institute of eye diseases. The participant of the great Patriotic war. Leading the Institute, working with its Director, Gulnara Kudoyarov at the same time headed the Department of eye diseases, Bashkir state medical University. More than two dozen years as a Professor, he was the chief optometrist Min-common BASSR. Developed under the leadership of Gulnara Kudoyarov system of measures for the fight against trachoma was used to eradicate the disease in Bashkortostan, other regions of the USSR, a number of foreign countries. He is the author of over 160 scientific papers. More than two decades headed the Bashkir ophthalmologists. Awarded the order of Lenin and red banner of Labor. Gabdulla Kabirovich honorary citizen of Ufa. Established award in his name.