Iatrogenesis: what it is, characteristics and examples

The word iatrogenic is widely heard in the health sciences, Whether it is medicine, psychology, psychiatry or any other associated. Basically, it refers to any damage that is the cause of the therapeutic intervention.

While this idea of ​​primates may seem fairly straightforward, there is debate as to the extent to which iatrogenicity includes malpractice and other unethical behavior in healthcare settings.

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

    What is iatrogenic?

    The iatrogenic or iatrogenic (from the Greek “iatros”, “doctor”; “gene”, “produce” and “-ia”, “quality”) is a negative alteration that occurs in the patient as a result of the therapy applied to him. That is to say, it is the damage caused by the intervention of a health professional, whether it is a doctor, a psychologist, a psychiatrist, a nurse , pharmacist, dentist or any other health science.

    Although the word “iatrogenic” is often used to refer to any harm caused by a professional action on the patient, the truth is that its more specific meaning refers to the moment when this harm occurs even though the professional has applied the treatment in such a way. appropriate and ethical, without negligence, error or omission. The practitioner may know that the treatment has 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 iatrogen is unwanted or intended harm to the health of the patient, caused or induced as a side effect inevitable and unpredictable by a legitimate and guaranteed act of health, intended to cure or improve the patient’s state of health. The processing was carried out correctly, with skill, care and diligence.

    History of the idea

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

    Several centuries later, around 400 BC. C. Hippocrates recommended in his treatises the principle “to help, or at least not to harm”. This same idea would be the one which would later be transformed into the Latin aphorism “primum non nocere”, that is to say first of all not to hurt “, attributed to Galen. has spread to the rest of the health sciences and is legally punished for not following it in many countries.

    As a historical example of iatrogenic damage, totally unintentional and, contextually, ethically indisputable, we have it at the beginning of the 19th century in many European hospitals. At that time, there was not as much knowledge about pathogens as today, being very common that in maternity wards there would be a high mortality due to puerperal sepsis. The germs were transmitted 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 is to wash your hands between surgeries. This is why both before and after washing hands with disinfectant concentrate, applying the protocol to all surgical staff and reducing mortality in maternity hospitals. It is thanks to his hand washing that many infections, both bacteriological and viral, were prevented.

    Currently the greatest iatrogenic damage, at least in the field of medicine, this is mostly what happens due to the side effects of drugs. These effects, although rare, are known and it is known that a percentage of patients will experience them. This is a minor ailment compared to the benefits of taking the drug for the disease they are suffering from. It is true that they suffer damage associated with the drugs, but in turn enjoy the benefits of the therapeutic effects.

      Examples of iatrogenic effects

      Below we will see two cases of iatrogenic effects, that is, the intervention of the therapist leads to some harm to the patient, but this harmful effect is largely counteracted by the beneficial effects of the treatment.

      Almost 1. Treatment of tuberculosis

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

      This is harmful to the patient, but since it is an effective drug against the tuberculosis bacillus, the use of streptomycin becomes necessary. Although you run the risk of ear damage, its main therapeutic effect, that of not dying from tuberculosis, clearly neutralizes it.

      Case 2. Amputation in diabetes

      Some diabetic patients suffer from diabetic foot, A condition due to the fact that the nerves in that limb are damaged by high levels of sugar, making them less sensitive.

      As a result, patients with diabetic foot are more likely to have foot injuries, and when they don’t realize it, they get infected and eventually gangrene.

      To prevent it from spreading to other parts of the body, it is decided to amputate the foot. This is detrimental to the patient as he loses a limb, but the rest of his body is prevented from getting infections and eventually dying.

      What is not iatrogenic?

      In its strictest sense, iatrogenicity would involve any damage caused as a result of the application of therapy without being acted inappropriately. So it can either be something that could neither be foreseen nor avoided, or it could have been avoided, but there was no other less harmful alternative.

      Based on this definition, there would be no iatrogenic effect per se when the doctor does not act responsibly or consciously harms the patient. Therefore, technically, there would be no iatrogenic in the event of professional misconduct, mourning, torture applied by doctors, 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 synonymous with harm related to therapy, which be it good or bad. been done.

      Bad practice

      Professional misconduct is a legal concept that implies professional misconduct has been committed. This implies not having worked fully in a professional, careful, diligent and adequate manner in the field of health sciences.

      If the professional does not work properly, he deals with aspects that are beyond his abilities and training, he is aware that the situation is beyond his skills and yet he continues to work, he would commit bad practices.

      Dolo

      Mourning occurs when the professional acts with the clear and conscious intention of harming the patient, that is to say, he renounces the principle of “primum non nocere”. This damage can range from minor injuries to homicide..

      Likewise, this conscious and intentional damage must be separated from the strict idea of ​​iatrogenicity, since there is no intentional damage, even if the risks are known.

      Examples of bereavement would be the case of a doctor who overdoses his patient to increase the risk of suffering side effects, or the case of a surgeon who does not take the necessary antiseptic measures with the intention of doing so. suffer the patient from infection. After the operation.

      Non-compliance or discontinuation of treatment

      The damage that the patient may suffer they would not be iatrogenic per se if he himself has abandoned the treatment or is not following it correctly.

      Failure to comply or abandon treatment can be due to various reasons such as laziness, incomprehension, fear of side effects or simply with intention. get worse in order to get some kind of benefit in the form of disability or paid disability.

      Bibliographical references:

      • Steel K, Gertman PM, Crescenzi C, Anderson J. (1981). Iatrogenic disease in a general medicine department of a university hospital. N Engl J Med. 304: 638-42.
      • Moos, RH (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.

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