MEDICAL, LEGAL AND ECONOMIC ASPECTS TO DIAGNOSE SELFMUTILATION, IMITATING DELIBERATE ACUTE SURGICAL PATHOLOGY. CLINICAL CASE

Introduction. To date, in penal institutions of the Russian Federation annually there are not less than 10000 accurately registered facts of self-mutilation, causing immediate or delayed medical care in terms of surgical hospital. In this context, the main objective of this work is to analyze cases of self-mutilation, simulating an acute surgical pathology, to show essential diagnostic difficulties and medico-economic effects upon inadequate therapy in this group of patients, exemplified by clinical cases.  Materials and methods. The research covered the analysis of 150 cases of selfmutilation, to simulate acute surgical pathology, among penitentiaries of the Republic of Bashkortostan in the period 2014-2016. Results. The findings showed that all the facts of self-mutilation are characterized by a certain typology of the process: localization, self-mutilation mechanism, means of implementation, and reduced compliance of patients. It is shown that the development of complications is due to the late delivery of adequate treatment because of false anamnesis provided by the prisoners. A specific clinical example showed how a false version of the disease development, despite the use of the most expensive and modern methods of research and diagnosis leads to tactically wrong treatment strategies. It is shown that understanding the true situation for a doctor is important both in terms of preventing medical errors as prescribing unfounded invasive research methods, polyprognosis and/or intensification of therapy, and economic considerations, since damage to health resources in treating complications of self-mutilation may be quite substantial. Conclusion. All medical personnel with at least a small chance to encounter medical assistance to prisoners should have access to special training programs that have to be implemented even at the stage of teaching at higher medical schools. These programs should include peculiarities and internal organization of different types of correctional institutions, ethical risks that relate to their activities on health protection.

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