Iatrogenic disease commonly refers to a physician-induced disease and more generally to a disease state caused by the commission of acts by the physician rather than the omission of needed treatment. The word iatrogenic comes from the root iatro, the Greek word for physician, or more generally a healer, and the word genic, meaning to come from or be created by. Thus, iatrogenic disease literally means a disease state that is brought forth by those who intend to heal. More broadly, however, the term iatrogenic disease has been referred to any adverse event that is associated with a healthcare provider, including a nurse or medical technician, or treatment. Iatrogenic disease poses itself as a risk to patients, and it can be the result of several factors including negligence, medical error, and/or the adverse effect of treatments. It is estimated that iatrogenic disease is the third leading cause of death in the United States.
Iatrogenic disease has been cited as a widespread national problem. In 2000, the national Institute of Medicine (IOM) released a report titled To Err Is Human: Building a Safer Health System. This landmark report estimated that between 44,000 and 98,000 deaths occur each year in the nation's hospitals from medical errors. An earlier report about medical errors in New York hospitals spurred the Joint Commission to create a sentinel event-reporting system. After the IOM report, the Joint Commission created a set of national patient safety goals that were incorporated into the accreditation process to reduce medical errors.
The most obvious example of iatrogenic disease is medical errors. Common medical errors include performing an operation on the wrong body part or dispensing the wrong medicine due to negligence; however, this is only a small part of iatrogenic disease. The greatest amount of iatrogenic disease is caused by the unintended side effects or adverse effects caused by drug interactions. These adverse effects may range from mild disease states, such as impaired sleep or indigestion, to severe consequences, such as heart failure, stroke, and death. Sometimes, the adverse effects are known and accepted by the patient because the positive effects of the treatment outweigh the adverse effects. In these cases, while the resulting disease state is in fact iatrogenic, the term is often not applied because iatrogenic disease is generally used pejoratively.
Iatrogenic disease may also result in hospitalized patients acquiring nosocomial infections. For example, hospital staff may unintentionally transmit microbes during the routine patient encounter because of improperly sterilized medical equipment and through the use of unclean or ungloved hands.
Another example of iatrogenic disease derives from interventions that are done or not done as a result of financial incentives. For example, when a healthcare provider decides to use a certain medication because of its association with a pharmaceutical company, any disease state that results from choosing the particular medicine over a more effective alternative is considered to be an iatrogenic disease. Thus, the referral for an intervention for the purpose of profit rather than for the best interest of the patient also results in iatrogenic disease. Many studies of physician behavior have documented that financial incentives change practice patterns.
Physicians also change their behavior in response to potential litigation, which can be brought on by medical negligence, an action punishable in the U.S. judicial system. This practice, often referred to as defensive medicine, may have positive outcomes because the behavior of the provider changes to try to avoid negligence. However, this behavior may also lead to unnecessary tests, procedures, and treatments, which ultimately result in iatrogenic disease.
A more complicated example of iatrogenic disease is the use of unproven diagnostic and therapeutic modalities. Many practice patterns in modern medicine are not definitively proven to be beneficial. The recently debunked routine practice of prescribing estrogen replacement therapy at menopause for women is a case in point. In this instance, a substantial amount of basic science data, as well as data from observational studies in women, strongly suggested that postmenopausal estrogen protected against heart attacks. However, the results from a randomized controlled trial (RCT), considered the gold standard of evidence-based medicine, showed that hormone replacement therapy actually caused myocardial infarctions. As a result, many women were having iatrogenic heart attacks for decades because of poor-quality data. Similarly, the currently accepted protocol for prostate cancer screening and treatment in men has been studied, and the findings suggest that these processes may lead to iatrogenic disease. To prevent this type of large-scale iatrogenic disease, modern medicine needs the right kind of evidence to guide its actions.
Iatrogenic disease is not limited to conventional medical practices, however. Alternative-medicine practitioners can also cause iatrogenic disease. For example, ephedrine, an active ingredient in many alternative weight loss products, was withdrawn from the market because it was shown to cause strokes.
Iatrogenic disease is a consequence of modern medicine; however, much of this burden can be reduced through a number of changes. For instance, medical errors are being tackled through error reduction strategies—a technique that has been successfully used in the aeronautics industry. Furthermore, the National Institutes of Health (NIH) funds large RCTs on many important treatment modalities, including alternative medicine. Additionally, many organizations have implemented incentives to improve healthcare quality, which are now being considered by Medicare. With new safety-oriented procedures, financial incentives geared toward patient safety and quality, tort reform, and emerging scientific evidence, iatrogenic disease can be overcome.
Adverse Drug Events, Evidence-Based Medicine (EBM), Joint Commission, Malpractice, Medical Errors, National Patient Safety Goals, Patient Safety, Quality of Healthcare
American Iatrogenic Association: http://www.iatrogenic.org
Association for Professionals in Infection Control and Epidemiology (APIC): http://www.apic.org
Hospital Infection Society (HIS): http://www.his.org.uk
International Federation of Infection Control (IFIC): http://www.theific.org
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