Chapter 24: Beware of Medical Care !
|Most people think that medical care is good for you.
The fact is that some medical care is good for you, a great deal is irrelevant, and unfortunately, some of it is harmful.
- Lester Breslow
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 physicians 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 doctors 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 staffs mercy! If you think that a stay in the hospital could endanger your health, youre 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 dont 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 oclock pills till eight oclock, 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 havent 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 doctors 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
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 !