Iatrogenesis: what it is, characteristics, and examples

A summary of this concept specific to the health sciences.

The word iatrogenic is often heard in the field of health sciences, be it medicine, psychology, psychiatry or any other associated field.be it medicine, psychology, psychiatry or any other associated field. It refers, broadly speaking, to any harm that is due to therapeutic intervention.

Although this idea may seem quite clear at first glance, there is some debate about the extent to which iatrogenesis includes malpractice and other unethical behavior in the health care setting.

Below we will take a closer look at this idea, as well as understand its historical origins, some clear examples in professional practice, and how it differs from other undesirable phenomena in the application of therapy.

What is iatrogenesis?

Iatrogenesis or iatrogenesis (from the Greek "iatros", "physician"; "geno", "to produce" and "-ia", "quality") is a negative alteration that occurs in the patient as a result of the therapy that has been applied to him or her. In other words, it is the damage caused by the intervention of a health professional, be it a doctor, psychologist, psychiatrist, nurse, pharmacist, dentist or any other health science.

Although on many occasions the word "iatrogenic" is used to refer to any harm produced by professional action on the patient, the truth is that its more specific meaning refers to when this harm occurs even when the professional has applied the treatment in an appropriate, ethical manner, without negligence, errors or omissions. The professional may know that the treatment involves risks, but knows that these risks are, in principle, much less than the beneficial effects of the therapy.

Based on this stricter definition, we can understand that iatrogenesis is unwanted and unintended harm to the patient's health, caused or provoked as an inevitable and unpredictable side effect of a legitimate and endorsed side effect caused or provoked by a legitimate and endorsed health care act aimed at curing or improving the patient's state of health. The treatment has been carried out correctly, with due expertise, prudence and diligence.

History of the idea

Since the beginning of medical practice, it has been known that physicians can unintentionally cause harm to their patients by applying therapy properly. In the Code of Hammurabi (1750 B.C.), specifically in paragraphs 218 to 220, the knowledge that civil society used in ancient Mesopotamia to defend itself against negligence, errors and risks of physicians in their professional practice..

Several centuries later, around 400 BC. Hippocrates recommended in his treatises the principle of "help or, at least, do no harm". This same idea would later become the Latin aphorism "primum non nocere", i.e., above all, do no harm, attributed to Galen. This principle is one of the bases of medical ethics, which has been extended to the rest of the health sciences, and it is legally punishable not to follow it in many countries.

As a historical example of iatrogenic damage, totally involuntary and, contextually, ethically unquestionable, we have it at the beginning of the 19th century in many European hospitals. At that time there was not as much knowledge of pathogens as there is today, and high mortality due to puerperal sepsis in maternity wards was very common.. Germs were passed from room to room by the hands of the surgical staff who did not wash their hands.

Fortunately, Ignaz Philipp Semmelweis, an Austrian surgeon and obstetrician, realized how important it was to wash hands between surgeries. This is why he washed his hands with a disinfectant concentrate both before and after surgery, applying the protocol to all surgical personnel and reducing mortality in maternity wards. It is thanks to hand washing that many bacteriological and viral infections have been avoided.

At present, the greatest iatrogenic damage, at least in the field of medicine, is above all that caused by the side effects of pharmaceuticals.. These effects, although rare, are known and it is known that a percentage of patients will manifest them. This is a lesser evil compared to the advantages of taking medication for the disease they suffer from. It is true that they suffer damages associated with the drug, but at the same time they receive the advantages of the therapeutic effects.

Examples of iatrogenic effects

Below we will see two cases of iatrogenic effects, i.e. the therapist's intervention involves some harm to the patient, but this harmful effect is greatly counterbalanced by the beneficial effects of the treatment.

Almost 1. Treatment in tuberculosis

Tuberculosis is an infectious disease that is treated with antibiotics, including streptomycin. This drug has a known harmful effect, which is related to its chemical structure: it is toxic to the ear..

This is a harm to the patient but, since it is an effective drug against the tuberculosis bacillus, the use of streptomycin becomes necessary. Although there is a risk of hearing damage, its main therapeutic effect, that of not dying from tuberculosis, clearly counteracts it.

Case 2. Amputation in diabetes

Some patients with Diabetes suffer from diabetic footThis condition is due to the fact that the nerves in that limb are damaged by high sugar levels, causing them to have less sensitivity.

As a consequence of this, patients with diabetic foot are more prone to suffer wounds in the foot and, not realizing it, they become infected and end up gangrenous.

To prevent it from spreading to other parts of the body, the foot is amputated. This is detrimental to the patient, since he loses a limb, but it prevents the rest of his body from becoming infected and eventually dying.

What is not iatrogenic?

In its strictest sense, iatrogenesis would imply any harm caused as a result of the application of a therapy without any improper action having been taken. Thus, it may be either something that could not have been foreseen or avoided or something that could have been avoided, but there was no less harmful alternative. there was no less harmful alternative.

Based on this definition, there would be no iatrogenic effects per se when the physician does not act responsibly or consciously harms the patient. Thus, technically there would be no iatrogenic effects, technically, there would be no iatrogenic effects when there is malpractice, malicious intent, torture by physicians, unethical medical experimentation, failure to act responsibly or consciously harm the patient.unethical medical experimentation, non-compliance or abandonment of treatment by the patient.

Likewise, other health professionals and jurists include, in the typification of these harmful phenomena in the context of therapy, the adjective "iatrogenic", more in its generic sense as a synonym for therapy-related harm, regardless of how well or badly it has been done.

Malpractice

Malpractice is a legal concept that implies that professional misconduct has been committed.. It implies a failure to work in a fully professional, cautious, diligent and appropriate manner in the field of health sciences.

If the professional does not work properly, treats aspects that are beyond his capabilities and training, is aware that the situation is beyond his competence and yet continues to work, he would be committing malpractice.

Dolo

Malice is when the professional acts with the clear and conscious intention of causing harm to the patient, i.e., denies the "primum non nocere" principle. This harm can range from minor injury to homicide..

Likewise, these conscious and voluntary harms must be separated from the strict idea of iatrogenic, since in this case there is no intentionality of harm, even if the risks are known.

Examples of malice would be a case of a physician who is overdosing his patient to increase the chances of suffering adverse effects, or the case of a surgeon who does not take the necessary antiseptic measures with the intention of causing the patient to suffer an infection after the operation.

Non-compliance or neglect of treatment

The damage that the patient may suffer would not be iatrogenic would not be iatrogenic per se if he himself has abandoned the therapy or is not following the therapy as intended.

Non-compliance or abandonment of therapy may be due to various reasons such as lack of interest, lack of understanding, fear of adverse effects, or simply with the intention of getting worse in order to gain some kind of advantage in the form of paid disability or handicap.

References:

• Steel K, Gertman PM, Crescenzi C, Anderson J (1981). Iatrogenic illness on a general medical service at a university hospital. N Engl J Med. 304:638-42.
• Moos, R.H. (2005). "Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention". Addiction. 100 (5): 595-604. doi:10.1111/j.1360-0443.2005.01073.