Proofs of the necessity of medical informatics for the physicians in Bulgaria.

It is obvious that medical practice needs to sustain a radical quality change due the fast penetration of information technologies in medicine and healthcare. One of the major problems of this change is the adequate education of the medical specialists to use these information and communication technologies, including Hospital information systems and electronic medical records. A study has been carried out among the physicians in Bulgaria. The aim of the study was to check weather the Bulgarian physicians are ready to face the challenges of modern information technologies in their daily medical practice. The results show that although 97.5% of the Bulgarian physicians have a positive attitude to information technologies and 86.7% recognise the need of using computers in medicine, 84.1% of them do not have the necessary skills and knowledge to use computers in their daily medical practice. They are absolutely unaware what the electronic medical record might contribute to their practice. Their knowledge of the subject, principles and methods of medical informatics tends to nil. The study was the first of the kind carried out in Bulgaria. It proved our initial hypothesis that Bulgarian physicians need to be educated not only how to use computers, they are in badly need of education in medical informatics. The study proved that the adequate education in medical informatics is one of the most important parameters for the implementation of information technologies, especially electronic medical records in medical practice. Its result may form the background for the preparation of the strategy of teaching medical informatics in Bulgaria. The first step of the implementation of this strategy is to include medical informatics in the regular curriculum of students of medicine.

The state of primary medical care in Bulgaria.

This paper describes the state of primary medical care in Bulgaria and related issues. This component of the state health system is based on the so-called principle of the 'district physician'. It is built on the idea of establishing long-lasting contact between the physician and the patients. Primary care is provided by a district therapist (for populations of up to 3000 inhabitants), a paediatrician (for 800-1200 children aged up to 14 years) and an obstetrician-gynaecologist (for 16,000-18,000 female inhabitants), as well as by numerous freely accessible narrow-profile specialists. The main disadvantages of the existing system of primary medical care are the lack of opportunity for personal choice of physician, division of responsibilities among numerous physicians and other medical staff, expensive medical care owing to abundant polyclinical specialists, reduced physician's motivation and hampered users' influence on the quality of medical care. Questions about the future status of polyclinics and both children's and female health centres, as well as about the optimal ratio between family physicians and specialists, remain unresolved.

[Male infertility as a cause of familial sterility (based on data from the Office of Sterility Prevention--the District Hospital Polyclinic and Higher Medical Institute--in the city of Varna)]. / Muzhkiiat infertilitet kato prichina za bezplodie v semeistvoto (po danni na Kabineta za borba s bezplodieto--POKB i VMI--gr. Varna).

The fight against sterility in the family is of great psychosocial significance. Male infertility has not a small part of the causes for sterile marriage. 1470 sterile married couples were recorded in the dispensary system of the consulting room for the fight against sterility in the family at the district hospital in the town of Varna during the period of 1975-1986. Seminological examinations of the husband were performed three times and the final seminological diagnosis was established. The performed examinations showed clearly that almost 1/3 of men had seminological disturbances. The male infertility in sterile married couples increased on the average with 10.28% per year during the investigated period as for men with oligospermia this increase was higher (12.08%) in comparison with azoospermia (6.56%). Prognosis for advancement of disturbances in spermatogenesis was made on the basis of the collected information. The results showed a tendency to a general increase of the frequency of male infertility during the following years. An inference is made that it is necessary to improve work connected with prophylaxis, early discovery and treatment of diseases, which cause male infertility.