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Medical Iatrogenesis

In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance.

Globally, 4 in 10 patients are harmed in primary and outpatient healthcare with 80% of this harm being preventable. Medical iatrogenesis is referred to as the causation of disease, harmful complications or other ill effects by any medical activity. This includes diagnosis, intervention, error or negligence. Medical iatrogenesis is the 5th leading cause of death in the world: causing 5-8% of all deaths.

Causes of Iatrogenesis:

The most common causes of medical iatrogenesis include ADRs (adverse drug reactions), overuse of drugs (leading to antibiotic resistance) and prescription drug interactions. On the healthcare worker’s part, faulty procedures, techniques, information (illegible handwriting and typos), methods and negligence can also lead to iatrogenesis. Often misdiagnoses can lead to a faulty treatment plan which in some cases can aggravate the original illness. Nosocomial infections or infections acquired in a hospital or other healthcare facility is also a leading cause of iatrogenesis. This often happens when healthcare professionals act as carriers of disease from an ill to susceptible patient.

Iatrogenesis in LEDCs:

Iatrogenesis is even more common in Less Economically Developed Countries (LEDCs) with almost a quarter of patients experiencing some form of iatrogenesis. This is due to the fact that resources and funds are limited in these countries. Understaffed hospitals often mean that doctors and nurses work overtime resulting in fatigue and impaired judgement or reasoning. Fewer resources often result in healthcare workers having to use the same equipment for multiple patients, increasing the risk of infections spreading between patients. Same needle usage and the reuse of syringes in venipuncture is one of the leading causes of the spread of AIDS in these countries.

The Libby Zion case in the United States was a pivotal case in reducing iatrogenic events due to negligence. An 18-year-old college student who died of a fatal drug interaction after being treated by a fatigued intern and resident in a New York hospital led to the establishment of the Bell Commission in 1987. The commission aimed to address physician training hours. Apart from this, incentivization to pursue medicine through grants, funds and scholarships can attract more medical students reducing the problem of understaffing.

What can patients and healthcare workers do to reduce the occurrence of iatrogenic events?

Patients can also practice a few things to reduce the incidence of iatrogenic events. Firstly, they should follow the doctor’s instructions. Many patients often don’t finish their dose of antibiotics because they start to feel better. This has led to widespread antibiotic resistance, which wouldn’t spread as much if patients completed their dose in the first place. Patients should also be engaged in their treatment plan by asking questions and fully understanding procedures.

As healthcare workers, we can take extra effort to effectively communicate vital information to patients. We should also inform patients of all the possible risks and side effects of a treatment so they are aware as well.

Summary:

Adverse drug reactions and nosocomial infections are the most common iatrogenic event.
Rates of iatrogenic events are higher in LEDCs due to a lack of resources and funds.
The Libby Zion case was pivotal in reducing resident doctor working hours leading to less burnout.
Patients and healthcare workers can actively try to be more engaged and establish a stronger therapeutic alliance to reduce the incidence of iatrogenic events.