At the 13th St. Petersburg International Health Forum, experts in the field of healthcare, medical law and IT discussed the transformation of doctor-patient interaction in the era of digitalization. The key themes of the Round Table «Doctor and Patient. The Multidisciplinary Approach» was the search for a balance between introducing innovations and preserving fundamental grounds of medicine, as well as various legal risks.

The first challenge outlined by Igor Akulin, Chairman of the Board of the St. Petersburg Association of Medical Law, Head of St. Petersburg State University’s Department of Healthcare Organization and Medical Law, is the legal uncertainty associated with the use of artificial intelligence. He identified eight key legal risks, starting with the question of whether AI is a medical device, to the problem of allocating responsibility in the case of a medical error committed on the «recommendation» of the algorithm. Following the speaker’s report, any technological innovation may result in the avalanche of lawsuits and undermine confidence in the healthcare system, if legal issued are not addressed. Therefore, doctors and clinics need a clearly defined legal framework for their work associated with digital tools.

«Artificial intelligence will never have the skills that a living person, a doctor, has», stated Professor Igor Akulin, emphasizing the irreplaceability of human intuition and empathy.

Legal issues were also raised by Olga Kotlyar, member of the Association of Medical-Clinics Lawyers, Deputy Director of St. Petersburg State University’s Medical Institute. In her opinion, in the pursuit of technology, one should not forget about basic legal instruments such as informed voluntary consent (IVC). «Everything we say to the patient before a medical procedure is a warning, and everything we say after it is making excuses», summed up Olga Kotlyar. According to her, a high-quality IVC is only a document written in a language understandable to the patient. This is the main way to prevent conflicts and protect medical institutions from court costs.

Services for patients

Speaking about the medicine digitalization, the speakers shared their practical experience, as well. Anastasia Papieva, Head of the Department of Healthcare Information Solutions Implementation and Maintenance, which is related to organizing and providing medical care at Urban Polyclinics LLC (POLIS Medical Centres), told how the company managed to increase the medical check-up by almost half, making the registration process on its website simple, convenient and understandable to people. For example, after introducing a chatbot, a person no longer needs to wait in line. Appointing is made remotely, and the artificial intelligence will send a notice to the chat 30 minutes before the start of the doctor’s appointment. The company has also integrated its website with the Gosuslugi service, and any user can become a customer of the medical centre in a few minutes and within the compulsory medical insurance. Online requests, a personal account with the tests history are tools to have helped change patients’ behavior.

«The patient does not need slogans, but a tool that saves time and nerves», she stated.

Ivan Shafranyuk, Director of «Medicine of the Future» LLC, shared their experience in creating the ecosystem for private clinics. The company’s service allows doctors to prescribe digital treatment courses with video instructions, conduct remote monitoring and consult patients without violating the law.

The experts have demonstrated that modern digital services are not just a «feature», but a powerful tool for improving the quality and efficiency of a doctor’s work.

However, despite the power of modern technology, live communication remains a cornerstone of medicine. Denis Gruzdev, President of the Thread Implantologists Association, Head of the Northwestern Medical Training Centre for Postgraduate Education, Founder and Head of «Dr. Gruzdev Clinic», presented the systematic approach of private clinics to the work with «difficult patients». He called for clearly documenting all stages of interaction and not being afraid of use the right to a reasoned refusal to provide a service. In his opinion, this approach protects the doctor from consumer extremism, and the patient – from ineffective treatment.

Aleksey Pisarev, Deputy Head of the Directorate for St. Petersburg State University’s Information Technology Service at the Pirogov Clinic of High Medical Technologies, urologist, also confirmed the importance of communication. He reminded his colleagues that «the best medication is a hope», and digital tools should help the doctor convey it to the patient, without replacing a live dialogue. He also agreed that for a modern doctor, the skill to build communication and deal with objections is a key one.

Regulatory challenges

Regulating breakthrough areas has become a separate and extremely difficult challenge. Egor Prikhodko, CEO of the POKROVSKY Centre for Cell-Based Technology, used the example of biomedical cell-based products, in order to show how the imperfect legislation can block developing entire industries. While several modern drugs have already been registered in neighboring Belarus, the process of introducing certain drugs in Russia is extremely bureaucratic. Following the speaker’s words, only technology and doctors’ desire are not enough to introduce innovations. A flexible and modern regulatory framework that would not slow down progress, but would guarantee patient safety, is needed.

A vivid example of how advanced technologies directly help in clinical diagnostics was the presentation by Petr Vasiliev, Candidate of Medicine, Associate Professor at St. Petersburg State University’s Department of Faculty Therapy, therapist at St. Petersburg State Budgetary Institution of Healthcare «St. George City Hospital». He spoke about the laser Doppler flowmetry (LDF) method for assessing microcirculation in patients with type 2 diabetes mellitus and nicotine addiction. «This is a non-invasive method intended for specifically assessing microcirculation», explained Petr Vasiliev, «which is extremely important for the early diagnosis of diabetic microangiopathy».

His research revealed clear correlations between glycated hemoglobin and microvascular disorders, which paves the way for more efficient monitoring of complications. Summing up the expert’s presentation, it should be noted that technologies like LDF are a bridge between fundamental science and everyday clinical practice. They provide the doctor with an objective tool for early diagnosis and evaluating the treatment efficiency, which is especially critical for chronic diseases.

It’s about money again

Natalia Smirnova, lawyer and member of the Expert Council of the State Duma Committee on Health Protection for Rare (Orphan) Diseases, raised an acute systemic problem. Her presentation was devoted to financing the care of patients with orphan diseases. Starting in 2026, the new mechanism of co-financing shall be launched in Russia, however, according to Natalia Smirnova, it is initially inoperable and will not affect many patients. «We don’t have all the patients counted», she stated. According to her, federal registers are kept for only 28 orphan diseases, while patients with over 100 such diseases require help. Moreover, the criteria proposed for receiving federal funds are so strict that only a few regions, including St. Petersburg, can fall under them.

However, the problem of regulating and financing is systemic, whether it is related to innovative cell-based technologies or providing medicines to patients with rare diseases. The imperfection of the legislation and keeping the registers of patients with rare diseases directly affects the availability and quality of medical care, creating blank spots in the responsibility of the state and doctors.