Iatrogenia: what it is, characteristics, and examples

The word iatrogenesis is widely heard within the field of health sciences, be it medicine, psychology, psychiatry or any other associated. Roughly speaking, it refers to all damage that is due to therapeutic intervention.

Despite the fact that this idea may seem quite clear at first, there is some debate about the extent to which iatrogenicity includes malpractice and other unethical behaviors in the health field.

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

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What is iatrogeny?

The iatrogenia or iatrogenia (from the Greek "iatros", "doctor"; “geno”, “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. 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 damage caused by professional action on the patient, the truth is that its meaning More specifically, it refers to when this damage occurs even when the professional has applied the treatment in an appropriate, ethical manner, without negligence, errors or omissions. The professional may be aware 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 the unwanted or wanted damage to the health of the patient, caused or provoked as a secondary effect inevitable and unpredictable by a legitimate and endorsed sanitary act, intended to cure or improve 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 doctors can inadvertently cause harm to their patients by applying the therapy properly. In the Code of Hammurabi (1750 a. 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 doctors in their professional practice.

Several centuries later, around 400 B.C. c. Hippocrates recommended in his treatises the principle of "help or, at least, do no harm". This same idea would later be transformed into the Latin aphorism "primum non nocere", that is, 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, in addition to being 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 today, It is very common for there to be high mortality in maternity wards due to puerperal sepsis.. Germs were carried from room to room by the hands of surgical staff who did not wash their hands.

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

Currently, the greatest iatrogenic damage, at least in the field of medicine, it is mainly that which occurs because of the side effects of drugs. 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 damage associated with the drug, but in turn receive the benefits of the therapeutic effects.

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Examples of iatrogenic effects

Next we will see two cases of iatrogenic effects, that is to say, that the intervention of the therapist implies some harm to the patient, but this deleterious effect is greatly offset 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 harmful 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 foot, a condition due to the fact that the nerves of that extremity are damaged by high levels of sugar, causing it to have less sensitivity.

As a consequence of this, patients with diabetic foot are more prone to foot injuries 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 prevents the rest of his body from suffering infections and ending up dying.

What is not iatrogenic?

In its strictest sense, iatrogenesis would imply any damage caused as a result of the application of a therapy without having acted improperly. So it may either be something that could not be foreseen or avoided, or it could have been avoided, but there has been no other less harmful alternative.

Based on this definition, there would be no iatrogenic effects per se when the doctor does not act responsibly or consciously harms the patient. So that, technically there would be no iatrogenesis when there is malpractice, fraud, torture applied by doctors, unethical medical experimentation, non-compliance or abandonment of a treatment by the patient.

Likewise, other health professionals and lawyers include, in the classification of these harmful phenomena in the context of therapy, the “iatrogenic” adjective, more in its generic sense as a synonym for damage related to therapy, regardless of how well or badly it has been done worked.

Bad practice

Malpractice is a legal concept that implies that a professional fault has been committed. It implies not having worked in a fully professional, cautious, diligent and adequate manner in the field of health sciences.

If the professional does not work adequately, he treats aspects that are beyond his capabilities and training, it is aware that the situation is beyond his competence and still continues to work, he would be committing a wrong praxis.

fraud

Intent occurs when the professional acts with the clear and conscious intention of causing harm to the patient, that is, he denies the principle "primum non nocere". This damage can range from minor injury to homicide..

Likewise, these conscious and voluntary damages must be separated from the strict idea of ​​iatrogenicity, since in it there is no intention of harm, even though the risks are known.

Examples of fraud would be a case of a doctor 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 making the patient suffer from an infection after the operation.

Non-compliance or abandonment of treatment

Damages that the patient may suffer they would not be iatrogenic per se if he himself has abandoned the therapy or is not following the therapy properly.

Non-compliance or abandonment of therapy may be due to various reasons such as neglect, misunderstanding, fear of the effects adverse or simply with the intention of making it worse in order to gain some kind of advantage in the form of paid disability or disability.

Bibliographic 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.