The organization of medical care the mentally ill will be the main issue of the nearest public council at the Ministry of Health. Requirements of experts urgently to discuss the situation in psychiatry linked to the terrible tragedy that took place in Nizhny Novgorod, where, according to investigators, schizophrenic man killed his six children, wife and mother. What could make the society to prevent the incident, reflects a psychiatrist and writer Maxim Malyavin.
– Nothing. Society greeted the collapse of Soviet psychiatry, society did not say anything when the staff of psychiatric establishments equated to earnings for workers performing various kinds of unskilled physical labor, society gleefully shouted: “Do not like it – bring down,” now we have taken even harmful benefits working conditions, it is clear to the remnants of the staff fled – and silence.
Let’s assume that there is. There is – there is nobody to work. At nearly one million Togliatti, where I live and work, – 12 district psychiatrists. Twelve.
Usually, minus one or two on holiday, one in the decree is gone, someone at school, on a business trip or on sick leave, but we will not waste time on trifles, let 12. Explanatory nurse – on its weight in gold. We have a strong composition of nursing, so we pray for them, not only to left.
A patient with schizophrenia who are disabled should be under medical supervision. What does it mean? This means that the district psychiatrist, serving a territory with a population of similar patients, organizes its outpatient appoint his treatment determines the frequency with which it should appear at the reception, organizes hospitalization if necessary, decide for himself or other employees of his clinic social issues, etc. That’s the theory, to which we aspire. What is the reality?
The first question: what if a patient does not want to go to the reception? What did we do before? They sent a nurse to visit and inviting. If the patient is dangerous – asked her to go spetsbrigady for insurance. For patients with more complex did not send any nurse, they went themselves to the same spetsbrigady. The patients had a reduced fare on public transport (and they are usually very rich, and this is important), and our entreaties to come and not for broke on a logical “yes, I have no money to get you.”
If the patient is actively persisted in its unwillingness to regularly see a psychiatrist, and existing symptoms did not allow him to wave his hand, we have the right to obtain information about it from the same local policeman or the senior on the house and, accordingly, react.
Now – God forbid, the secret identity, and a policeman, I mean the police will send, he now we do not owe anything.
car away from the outpatient service in the late 90′s. At the clinic, there is one, but it is the pharmacy, analyzes lucky the bosses to a meeting. That is not present.
Nurse send? Well, firstly, it has long been not issue a travel and wander for their very little money, it does not burn desire. To not send dangerous – so can not substitute human and spetsbrigady we also took, and insure no one. Himself to go? Also no travel, go on your own. We arrived, the door is closed, the neighbors know they know nothing. What to do? Previously, query in the address table slalom, where a person is missing, we need very much. Already ten years money is not allowed.
Okay, come and inspected. We see that bad. Overcoming the resistance of the patient and relatives, uboltali miracle hospitalization. Stowed. A month later – Hello, I was discharged. Because koykooborot, insurance penalties, and in general he did not want to be treated. You understand that the patient got a little order on the medications that he immediately throws a drink after discharge than Cyclodolum, and everything will be back to what it was. And a week to go to him again? Again, on your own? Raschetku show again?
How do I get to take medication at home? Nothing. Sometimes, showing miracles of persuasion and adequate connecting relatives, we will cope with this task. Sometimes not.
Either forces in the belief there is no or relatives such that hospitalization is necessary all the crowd, but the law in any way, or just time for miracles is over.
As the gulf from the field of psychiatry in general? Yes to move at least in the nearby town for help and there need not apply. All. No single database, the physician has no idea that its territory had such a bomb, and the patient remains without any assistance and supervision.
The current law on psychiatric care and guarantees of citizens’ rights is very good. It is wonderful to work in vitro. In vivo it handles so-so, thanks to the enthusiasm remnants of the Soviet era psychiatrists. And while we’re there, we really try very hard to anything like us accountable for the territory did not happen. But we have come to an end, I’m sorry. And health is not the same, and no strength, so we’re a little more poskripev, and then do not know.
There is a legitimate question: what to do?
It seems that no one is going to do anything, but if suddenly … How’s Mikhail Shcherbakov?
Raschest at least the basics of career
monarch must be able to blind.
Throw all take action.
Sit down, write it down. I dictate.
first. Eliminate staff shortages. This is the base, without it anywhere. If there will be nobody to work, then simply say nothing. Measures to eliminate you know, not children.
second. right now. Leave a doctor of its specialized medical and preventive work. All. Do not need a psychiatrist to ship inspection fluoroscopy and pediculosis, let her heal.
third. Take the damn medical examinations and professional examinations. We do not have time to heal. Give back Minzdravsotsrazviyu his orders 302n, to which we now have to look all job seekers, including janitors. There is no one to watch! You have survived all the doctors, let those who are left, to do their work. Who invented the watch all the kids to school and kindergarten? Whose brilliant idea took it head on clinical examination year-olds? We have four child psychiatrists in the entire city! For many years the four of them will be able to explore them all?
Fourth. Find the accounting forms that doctors filled in the 80s. Found?
And now all you napridumyvali top over the past decade, cross please.
You can not? Then come and perceive themselves to fill, Ted cards and stuff, it’s a report you need, not us.
The fifth. The same goes for benefits. Bring back our vacation in 62 days. I understand that you feel sorry for. I understand that we do not have, and we have to work harder to somehow cope. But holiday – that’s what allowed us to save at least the remnants of a healthy psyche. Without it, we will end a lot faster. Oh, it will have problems the next minister? Was naive, I’m sorry.
Sixth. Take our insurance companies. Forget these periods of hospitalization as a nightmare.
It takes a cold for a week. A bout of schizophrenia can take months, maybe six months. And from what we write human nedolechennaya well be just your report.
seventh. Allow legislative controls to adequately observe the person representing not Only a direct, momentary, but a potential danger. Yes, this is the field for abuse, so its controller. The current law in this situation perfectly protects patients, but too bad – around.
The eighth. Give us a real opportunity to help a sick person not only medicines. They need legal support (you spawn darkness lawyers, they still have no place to work), they need social workers attached, they need psychological support group. They need help in employment, oh, I’m sorry, again, the law 302n think of to him.
The ninth. Education. It is not necessary here these training courses and so on. Computers We have put you, do an online newsletter, lectures on Skype – doctors peresmenku gather once a week, let them listen to something left in my head yes.
And then, when there will be new doctors, when it will be possible to pay at least some attention to the sick person, not a piece of paper – demand. Require mandatory. Check the map, see how a person works, if all do to help. Without control in any way. But before demand – let the doctor to carry out their work.
The author – a district psychiatrist with twenty years, writer, author of “Notes of a psychiatrist, or all of haloperidol on the house,” “New Notes psychiatrist or Barbuhayka, to leave,” a popular textbook “Psychiatry – the people! Doctor – brandy! “, As well as a new book in the series” Notes of a psychiatrist, “which is expected to be released in September. Together with his wife Oksana (district psychiatrist, too ) is popular Livejournal «Blog of good mental health.”
The opinion of the author and do not necessarily represent those of
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