Optimized healthcare failed to identify "Kazan shooter"

The question immediately arose as to how the psychiatrist signed the "psycho" certificate to obtain a weapon permit.

The medical community explained why, even if the future shooter had serious deviations, doctors could hardly identify psychosis during examination and prevent a tragedy of this kind.

It is even more difficult to solve this problem in the system of "optimized Russian healthcare".

A psychotherapist shared her opinion Svetlana Oskolkova:

"About the tragedy in Kazan.

Almost the main question in the comments on this topic is who gave the guy permission? Where the psychiatrists looked - they say, he is clearly abnormal... We'll figure out.

First, the permit was issued three months ago. In three months, you can go crazy and be cured. In any case, an acute psychosis in such a time frame can easily meet. The psychiatrist conducts an examination at the time the certificate is issued, and if there are no acute symptoms, then they will not see it.

Secondly. The time for examination was given according to the protocol for twenty to thirty minutes, in reality - five. More is possible, but then the procedure for obtaining certificates with the participation of a psychiatrist will drag on for years. I remember the days when up to three hundred people applied to the m / s a day. Thirty minutes should be allocated for each. We count. Three hundred by thirty is nine hundred minutes. This is how much a doctor should spend on a medical examination of all citizens who applied for a day. Nine hundred minutes is 150 hours of working time. The doctor's working day for a medical examination is eight and a half hours, i.e. it will take more than six working days to examine three hundred people with a nine-hour working day, i.e. more than a week. In other words, all those that I examined during the day should have been watched for a week. By preliminary turn, which is drawn up three years before. Draw your own conclusions. Or the quality and the queue for years, or a very superficial examination, but all with references.

Thirdly. What does examination give us? It doesn’t give much. Shows the state of a person exactly in those minutes in which he is being examined, sits in front of the doctor. Everything! And this does not give any guarantees to anyone. It is in psychiatry that it happens that in the morning a person is still nothing, and by the evening he is already completely sick. It is much more important here why the changes in the state of mind and mental state were not noticed by his relatives and classmates in studies, teachers at the university, neighbors, subscribers in social networks? But this does not interest anyone.

Fourth, try to be a doctor. You are examining a guy of about nineteen for a gun permit. According to the law of the Russian Federation, from the age of 18 he can acquire weapons. Let's say there is no data on the base of psychiatry for him. This means that he has not been to psychiatrists for a year and is not registered with a chronic mental illness on the dynamic dispensary, that is, he was not treated in a hospital, was not called for an outpatient appointment, the diagnosis was not confirmed by the staff of the Department of Psychiatry. The information entered in the certificates in the form is not taken from the heads of doctors, all this is regulated by federal laws. And human rights, if that.

Still, they love to scold and vilify the Soviet system of monitoring mentally ill people, everyone blames its punitive nature - that's it. Now human rights, including mentally ill people, are in the first place, and cases such as the shooting in Kazan are again returning to discussions - totalitarianism or security is relative. Overdiagnosis, strict monitoring of every dubious citizen, years of unnecessary treatment and pills, the inability to be removed from the register, even if he recovered. It was like that before. Case histories and maps have been stored for decades, now the documents are kept for a year. If a person does not appear, is not treated, they must be destroyed, and the old personal medical data cannot be used after that.

Go ahead. The guy is studying at the university, he looks neat and does not express his ideas at the reception. You never know who hates whom, how do you know about it if you are a doctor and see a person for a maximum of five to ten minutes? Well, you don't like him, so what? This is your subjective opinion, most often it is wrong. It is also illegal to refuse a certificate on the basis of personal antipathy. Refusal must be justified, otherwise the personl will go to court, and you will have problems.

You can, of course, send for additional examination. Characteristics, testing by a clinical psychologist, neurologist, laboratory tests. Based on the results, a medical commission consisting of three psychiatrists is held. This procedure takes up to three months, and this is always a conflict with court threats. Threats, insults to doctors. Still, they consider themselves healthy, even if they then go and arrange an execution in their former school.

But the truth is that even with a detailed examination (by a medical commission), you can make a mistake and miss someone who should not be allowed to pass.

Are you surprised? This is the reality. Once again, either a tough monitoring system and human rights violations or such tragedies.

And further. The person himself always has a choice. Even in a person with a disorder. Always. The most tormented by problems and hatred of others have a choice not to commit a crime. This is a tough personal choice. The victim of bullying does not always go to shoot their offenders. Much more often they still go to relatives, friends, to psychologists. And here the immediate environment is much more important than a cursory examination by a psychiatrist three months ago.