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Iatrogenic illnesses are those dirty little secrets
of the medical world which no one likes to talk
about. An iatrogenic (Iatros = physician
and gen = producing) illness is one which
is caused by medical treatment. It is defined as
an adverse effect caused by a physician's actions,
including reactions from prescribed drugs or from
medical procedures. Some iatrogenic problems, such
as multiple pregnancy after in vitro fertilization,
may be unavoidable, and are considered as part of
the risk-benefit ratio of the treatment. However,
many iagtrogenic complications occur as a result
of clinical errors, either of omission or of commission.
Errors of omission occur when a doctor neglects
to take certain precautions (for example, he does
not check whether a patient is allergic to a drug
before prescribing it, or does not check the blood
group label on the bag before transfusion). Errors
of commission occur when a doctor misinterprets
a situation and carries out an action which he should
not have (for example, he misdiagnoses a benign
abnormality on an ECG as indicative of heart disease
and starts unnecessary treatment). Some iatrogenic
problems (such as not giving an injection on time),
are minor, self-limited, and of little importance.
However, some problems may be major (for example,
operating on the wrong leg) and can lead to disastrous
consequences ! However, do bear in mind that not
every bad medical outcome is a result of an error;
sometimes the condition of a patient may take a
turn for the worse or he may even die, although
the medical care has been superb !
According to a recent estimate, 13 per cent of hospital admissions result
from the adverse effects of medical diagnosis or treatment. At present,
iatrogenic illness has come to be recognized as a significant risk factor
in medical care. The tragedy is that this is a relatively modern phenomenon;
the price we pay for delivering medical technology to ailing patients
concentrated in large hospitals.
The reason why iatrogenic illness is such an uncomfortable topic to talk
about is that all of us would like to pretend that doctors (and other
health care professionals) are infallible; to put it differently, the
notion that we are in safe hands can be very reassuring when we are ill!
The ideal held by medical professionals has always been to do no harm
- 'premium non nocere' being the doctor's first maxim. However, shocking
accounts of medical blunders resulting in debilitating side-effects, permanent
disability, and even death abound. Since almost 70 per cent of iatrogenic
complications are preventable, what can you do to protect yourself from
them?
Most iatrogenic errors occur when patients are admitted to a hospital,
because here they are virtually at the medical staff's mercy! If you think
that a stay in the hospital could endanger your health, you're absolutely
right! Recent studies show that errors or accidents may harm up to 20
per cent of all hospitalized patients.
Iatrogenic illnesses may be divided into four broad categories. The first
is the most obvious, which is damage that occurs as the direct result
of an invasive procedure ( for example, a blood vessel being torn during
laparoscopy). The second is an insult due to therapy with a medication
(examples are aplastic anemia resulting from chloramphenicol therapy and
immune suppression resulting from chemotherapeutic drugs). The third type
of iatrogenic illness is a new disease caused by the treatment (for instance,
leukemia resulting from radiotherapy). The fourth category is subtle and
the most difficult to recognize: a disease which progressively leads to
complications because it remains undiagnosed or is improperly managed
by the physician. One should always bear the possibility in mind that
an adverse situation might be a result of the medical care itself, rather
than assuming it stems from the disease !
Until recently, the unintended mishaps that occur in a hospital were hardly
ever mentioned. However, today many hospitals and doctors are addressing
the problem seriously, and taking effective steps to improve safety. These
steps include: openly acknowledging the potential for error in medicine;
analyzing medical accidents more carefully; and targeting areas where
patients face the highest risk in order to minimize the scope for errors.
As a patient, however, you are at the receiving end of medical care. What
can you do to make your hospital stay as safe as possible? The best way
of averting errors when you are admitted to the hospital can be summarized
in two words: Speak up ! While most doctors and nurses put in their
best efforts to provide excellent care, remember that hospitals are staffed
by human beings who sometimes make human mistakes. Although serious errors
are the exception, and not the rule, they can occur at any time, and at
any hospital, with serious consequences. Unfortunately, most patients
are so intimidated by complex hospital routines and the seemingly overworked
personnel that they try to stay out of the way and create as little trouble
as possible. But despite such a scenario, you should never forget that
the hospital is one place where it definitely pays to be involved and
assertive!
During the period of hospitalization, do ask questions about anything
you don't understand. Be polite and pleasant, but be persistent. Try to
understand the purpose and the schedule of every medication you are given.
If you are given a medicine that looks unfamiliar, ask for details about
it. If you know you suffer from a drug allergy, make sure everyone else
knows about it too. If you have not been given your dose of six o'clock
pills till eight o'clock, do inform someone. If a person comes
into your room and fails to identify himself, find out who he is and what
he wants. If you are wheeled off for a test that you haven't been expecting,
ascertain why it is necessary.
Most of the time, you will find that everything is going exactly the way
it is supposed to , and someone was just too forgetful or busy (or rude)
to let you know. But every once in a while, you will identify a real problem.
Which you will be able to resolve because of your alertness! Admittedly,
being involved in your medical care can be difficult if you are feeling
ill or run down; so try to recruit someone to be your advocate, i.e.,
a friend or a relative who will ask the relevant questions on your behalf.
And a final precaution: Make sure that everyone who enters your room to
examine you washes his or her hands before and afterwards. Medical personnel
should actually thank you for reminding them about this activity: hand-washing
is the single best proven method of minimizing hospital infections!
Of course, iatrogenic illnesses are not restricted to hospitals only;
any medical procedure could lead to potential problems. However, if you
are aware of the possibility of these problems occurring, you can actively
help prevent them.
What if an iatrogenic error does occur? Most patients would naturally
like to be informed about this error. They would expect the doctor to
provide an explanation or an apology, and to rectify the error. In fact,
this is what the doctor's ethical obligation to the patient is. However,
given the fear of a malpractice lawsuit being slapped on them, most doctors
today react to iatrogenic errors by trying to cover them up and hiding
them from the patient. Such a step is retrogressive, because it often
makes a bad situation worse. Recent surveys have shown that most patients
who finally end up pursuing litigation usually experience multiple complaints
including
- professional failure in diagnosis or treatment,
- a lack of communication on the part of the doctor; and
- some form of insensitivity on the part of the doctor that has emotionally
upset them.
This sorry state of affairs implies that insult has been added to injury.
Such a development not only destroys the relationship of trust between
doctor and patient but it also makes the patient more vengeful if he does
find out about the medical botch-up through another source. All said and
done, honesty is still the best policy !
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