Iatrogenicity in medicine. It is believed that any contact of a person with the medical field can be fraught with iatrogenic. If a person is predisposed to it. Therefore, the true causes of iatrogenicity are rooted both in the behavior of medical workers and in personal

Iatrogenic diseases (Greek: iatros doctor + gennaō to create, produce; synonymous with iatrogenic) psychogenic disorders arising as a result of deontological errors medical workers- incorrect, careless statements or actions.

Health disorders resulting from the impact on the patient of the words and actions of the doctor were already known to physicians of antiquity. However, the term "iatrogenic" became widespread only after the publication in 1925 of the work of the German psychiatrist Bumke (OSE Bumke) "The Doctor as the Cause of Mental Disorders." Since that time, the concept of iatrogenics has been actively studied by specialists of various clinical profiles. There is a steady trend of broad interpretation Ya. z. Many experts, especially abroad, refer to them as a pathology resulting not only from deontological errors (see Medical deontology), but also from any actions of a doctor (from complications of an incorrectly performed manipulation or procedure to the occurrence of the so-called medicinal disease), i.e. any negative consequences medical intervention. Some researchers refer to such conditions as yatropathies, or somatic iatrogenies.

For the development of Ya. (in the traditional interpretation) both the behavior of the doctor and the characteristics of the patient's personality (degree of emotionality, suspiciousness, etc.) matter. Many of the sick people suffer not only from the disease, but also from the anxiety, fears, fears for the outcome generated by it. This explains special attention the patient and to the words of the doctor, and to his behavior, intonations, facial expressions. However, depending on the type nervous activity, personality and mental characteristics, different patients react differently, sometimes oppositely, to certain words and behavior of a health worker. Not only ill-conceived remarks (“Your heart attack is the first call”; “... the main vessel of the heart passes blood by 30%”, etc.) or the incomprehensible meaning of some words and expressions (“hook-shaped stomach” , “myocardial dystrophy”, etc.), but sometimes even interjections or a prolonged silence of the doctor, which can be interpreted by the patient as signs of a particular difficulty in diagnosing or treating his illness, its particular severity, hopelessness of the prognosis.

Risk of emergence I. h. ceteris paribus is not the same in individuals different ages, sex, education. Women are more likely to be iatrogenic than men. Age groups increased risk development Ya. made up of people called transitional ages- adolescents and persons in the period of menopause (especially women with pathological menopause), as well as the elderly, among whom there are many involutive changes accented on the inevitability of them and increased likelihood lethal outcome emerging illness.

The factors that can contribute to the appearance of I. z. should include the not always justified expansion of the volume of medical information distributed among the population (popular lectures, television and radio programs), when the symptoms of one or another are described. dangerous disease, attention is fixed on her early manifestations, frightening prospects of "late conversion" are drawn.

Iatrogenic diseases are manifested mainly by neurotic reactions in the form of phobias (carcinophobia, cardiophobia) and various options autonomic dysfunction. Their development is facilitated by increased emotionality and suggestibility. Depending on the nature of psychotrauma and premorbid personality traits autonomic disorders may have a generalized character or are expressed by predominant dysfunction of the cardiovascular (cardiac arrhythmia, changes in blood pressure, etc.), digestive (heartburn, vomiting, stool disorders) or other systems in combination with senestopathies, a negative effective background.

Treatment I. h. coincides with the treatment of neuroses. The main method is Psychotherapy, supplemented if necessary. symptomatic treatment depending on the nature of manifestations of autonomic dysfunction. It is preferable that the treatment is carried out by a psychotherapist or psychiatrist. It is unacceptable to inform the patient that he does not have a disease and does not need to be treated. Physicians should remember that we are talking about a disease that requires a thorough study of the characteristics of the patient's personality, knowledge of his social environment. Psychotherapy requires the establishment of the features of this I. h. and the factors that contributed to its occurrence. A great psychotherapeutic effect can be achieved by a convincing conclusion of an authoritative council or a highly qualified specialist, brought to the attention of the patient.

Forecast I. z. in most cases favorable, with timely and correct therapy recovery occurs in a few weeks or months. Late recognition Ya. contributes to its protracted course and worsens the prognosis.

The existing prerequisites for an increase in the frequency of neuroses, as well as a progressive increase in the number of older people age groups increase the risk of iatrogenesis. Against this background, the responsibility of doctors for "verbal asepsis" increases, the need constant control their behavior (intonation, looks, gestures), which may be misinterpreted by the patient. IN modern conditions, when not one, but several doctors, as well as middle and junior health workers, as a rule, communicate with the patient, the possibility of the occurrence of I. z. increases. Therefore, to prevent Ya. it is necessary to carry out systematic work with all personnel communicating with patients. The content of medical documentation issued to patients should be thought out. Particular care must be taken when assisting health workers who have Ya. are relatively common, and their treatment presents difficulties due to the often increased refractoriness of health workers to psychotherapy.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984

The term "iatrogeny" in medicine ( iatrogenic) includes the definition of unfavorable disease state, caused in the patient by an authoritative person for him as a result of unintentional or intentional suggestion. The most common causes of iatrogeny are medical errors.

The mental problem of iatrogenesis is important in the occurrence of extremely undesirable psychological changes in the consciousness, emotional and vegetative sphere of the patient's personality, provoking various psychogenic reactions. The consequences of iatrogenics are manifested in the form of the development of certain types of neuroses ( iatrogenic disorders).

Very important in medical practice trusting relationship the doctor and the patient, since the success of the diagnosis and treatment of diseases, disorders and disorders will largely depend on this. After all, a doctor, a paramedic, nurse– medical professionals who are always and to the greatest extent authority figures for their patients.

Types of iatrogenic, its classification includes

Certain types of iatrogeny, or forms of it, can be distinguished, if we adhere to the broader modern interpretation this concept:

• unsuccessful therapeutic effect;
• side effects;
• lack of effect from drugs due to their repeated use;
• poor drug compatibility;
• doctors' mistakes;
• incorrect fulfillment of medical appointments not due to negligence, but due to typos and blurry handwriting;
• negligence itself.

The classification of species and forms of iatrogeny includes five groups:

1. Psychogenic iatrogenics are various forms neurotic disorders, neurasthenia, depressions, phobias. Appear when the patient misunderstood the doctor's statements.
2. Medicinal - when they appear side effects drugs or their ineffectiveness.
3. Traumatic - adverse effects of therapeutic and surgical interventions.
4. Infectious iatrogenic - when a patient becomes infected with nosocomial infections and others.
5. Mixed iatrogenic - when iatrogenic develops due to a combination of the above factors.

Thus, the diagnosis of iatrogenic can sound like "Psychogenic, medicinal, traumatic, infectious or mixed."

Examples

As mentioned above, iatrogenia can be caused by a doctor unintentionally and intentionally. The use of the term is acceptable in the following examples:

1. An example of unintentional iatrogenics would be careless commenting aloud on a client's unimportant state.
2. Deliberately induced iatrogeny takes place when some specialists, who lack the concepts of mercy, morality and only desire for profit, use intimidation for the future state of the client, so that he becomes dependent on them - "doctors" and additionally pays for their "medical expenses". " services. This phenomenon in our lives, unfortunately, is not uncommon.

We understand that iatrogenic is synonymous with suggested disease. But is it possible to inspire a disease in oneself? Certainly! Iatrogenia can be freely and unintentionally self-inflicted. This often occurs in students of medical schools and universities when studying specific diseases. Iatrogenicity also occurs when patients are actively interested in medical literature and, so to speak, try on the studied diseases. So the problem of iatrogenesis sometimes becomes more and more sensitive and relevant.

In general, the concept of iatrogenics and its term were originally introduced by the German psychiatrist Bumke Oswald in 1925. And now, in medicine, iatrogenic is defined more broadly as any adverse effect medical interventions, diagnostic procedures, preventive measures leading to violations of body functions, limitation of self-service, complications medical procedures as a result of both erroneous and right action doctor.

Prevention

Prevention of iatrogenic, respectively, should be carried out in the exclusion of the above points, as well as a stable moral medical basis and self-control of medical workers when communicating with patients.

Medications should be administered prudently and prudently, taking into account the patient's condition and possible side effects from medical preparations. What can outweigh in each situation: positive medicinal effect or side?

Possible comments to the patient should be thoughtful and careful. And we must not allow all the doctor's attention to be absorbed by the disease, because then we will forget about the patient.
The fight against the disease is not only composure, but also, to a greater extent, mercy and compassion for the patient.

Degree of iatrogenic disorder

In order for iatrogenic disorders to develop actively, it is necessary important condition: the patient should be suspicious, insecure, prone to anxiety, vulnerable.

The peculiarity of the patient's character is an important predictor of the extent to which the neurosis can take possession of the patient and how long it will take for the person to get out of it.

With suspicious patients, when communicating in order to prevent iatrogeny, one must be extremely careful, discussing the features of their health.

Iatrogenic diseases(Greek iatros doctor + gennaō create, produce; synonymous with iatrogeny) - psychogenic disorders that arise as a result of deontological errors of medical workers - incorrect, careless statements or actions.

Health disorders resulting from the impact on the patient of the words and actions of the doctor were already known to physicians of antiquity. However, the term "iatrogenic" became widespread only after the publication in 1925 of the work of the German psychiatrist Bumke (OSE Bumke) "The Doctor as the Cause of Mental Disorders." Since that time, the concept of iatrogenics has been actively studied by specialists of various clinical profiles. There is a steady trend of broad interpretation iatrogenic diseases . Many specialists, especially abroad, refer to them as a pathology resulting not only from deontological errors (see. Medical deontology), but also any actions of a doctor (from complications of an incorrectly performed manipulation or procedure to the occurrence of a so-called drug disease), i.e. any negative consequences of medical intervention. Some researchers refer to such conditions as yatropathies, or somatic iatrogenies.

For development iatrogenic diseases(in the traditional interpretation) both the behavior of the doctor and the characteristics of the patient's personality (degree of emotionality, suspiciousness, etc.) matter. Many of the sick people suffer not only from the disease, but also from the anxiety, fears, fears for the outcome generated by it. This explains the special attention of the patient to the words of the doctor, and to his behavior, intonations, facial expressions. At the same time, depending on the type of nervous activity, personality type and mental characteristics, different patients react differently, sometimes oppositely, to certain words and behavior of a health worker. Not only ill-conceived remarks (“Your heart attack is the first call”; “... main vessel the heart passes blood by 30%, etc.) or the incomprehensible meaning of some words and expressions (“hook-shaped stomach”, “myocardial dystrophy”, etc.), but sometimes even interjections or a prolonged silence of the doctor, which can be interpreted patients as signs of a special difficulty in diagnosing or treating his illness, its particular severity, and the hopelessness of the prognosis.

Risk of occurrence iatrogenic diseases ceteris paribus is not the same for people of different ages, sex, education. Women are more likely to be iatrogenic than men. Age groups at increased risk of developing iatrogenic diseases are people of the so-called transitional ages - adolescents and persons in the period of menopause (especially women with pathological menopause), as well as elderly people, among whom there are many involutive changes accented on the inevitability of them and an increased likelihood of a lethal outcome of an emerging disease.

Factors that may contribute to the emergence iatrogenic diseases, one should also include the not always justified expansion of the volume of medical information distributed among the population (popular lectures, television and radio programs), when the symptoms of a particular dangerous disease are described, attention is fixed on its early manifestations, frightening prospects for “late treatment” are drawn.

Iatrogenic diseases are manifested mainly by neurotic reactions in the form of phobias (carcinophobia, cardiophobia) and various variants of autonomic dysfunction. Their development is facilitated by increased emotionality and suggestibility. Depending on the nature of psychotrauma and premorbid personality traits, vegetative disorders can be generalized or expressed by predominant dysfunction of the cardiovascular (cardiac arrhythmia, changes in blood pressure, etc.), digestive (heartburn, vomiting, stool disorders) or other systems in combination with senestopathies, negative effective background.

Treatment iatrogenic diseases coincides with the treatment of neuroses. The main method is psychotherapy, supplemented, if necessary, with symptomatic treatment, depending on the nature of the manifestations of autonomic dysfunction. It is preferable that the treatment is carried out by a psychotherapist or psychiatrist. It is unacceptable to inform the patient that he does not have a disease and does not need to be treated. Doctors should remember that we are talking about a disease that requires a thorough study of the characteristics of the patient's personality, knowledge of his social environment. Psychotherapy requires establishing the features of this iatrogenic disease and the factors that contributed to its occurrence. A great psychotherapeutic effect can be achieved by a convincing conclusion of an authoritative council or a highly qualified specialist, brought to the attention of the patient.

Forecast I. z. in most cases favorable, with timely and proper therapy, recovery occurs in a few weeks or months. Late recognition iatrogenic disease contributes to its protracted course and worsens the prognosis.

The existing prerequisites for an increase in the frequency of neurosis, as well as a progressive increase in the number of people in older age groups, increase the risk of iatrogeny. Against this background, the responsibility of doctors for "verbal asepsis" increases, the need for constant monitoring of their behavior (intonations, attitudes, gestures), which can be misinterpreted by the patient. In modern conditions, when not one, but several doctors, as well as middle and junior medical workers, usually communicate with the patient, the possibility of iatrogenic disease increases. Therefore, to warn iatrogenic disease it is necessary to carry out systematic work with all personnel communicating with patients. The content of medical documentation issued to patients should be thought out. Particular care must be taken when assisting healthcare workers who have iatrogenic diseases are relatively common, and their treatment presents difficulties due to the often increased refractoriness of health workers to psychotherapy.

IATROGENIC DISEASES(Greek iatros physician + gennao create, produce; synonym iatrogenic) - psychogenic disorders arising as a result of the deontological errors of medical workers - incorrect, careless statements or actions.

The study of cultural monuments that reflect the development of ethical norms and rules of conduct for a doctor (see Medical deontology, Medical ethics) allows us to conclude that health disorders resulting from ill-conceived words and actions of a doctor were already known to physicians of antiquity. However, the term "iatrogenic" became widespread only after the publication in 1925 of the work of the German psychiatrist Bumke (OS E. Witke) "The Doctor as the Cause of Mental Disorders." Since that time, the concept of iatrogeny has been actively studied by specialists of various clinical profiles. Of the domestic scientists, R. A. Luria made a significant contribution to its development.

Some clinicians (for example, I. A. Kassirsky) used the concept of "iatrogenic diseases" in a broader sense, referring to them any pathology resulting from the actions of a doctor - from complications of an incorrectly performed manipulation or procedure to the occurrence of a so-called drug disease, that is those negative consequences medical interventions, which a number of researchers designate, in contrast to iatrogenies, as iatropathies, or somatic iatrogenies. Expansion of the content of the concept of "iatrogenic diseases" is not justified, since, on the one hand, some negative consequences of medical interventions are still inevitable (for example, trauma caused by surgical intervention), and on the other hand, complications caused by improper examination or treatment of the patient belong to the category of medical errors (see) or even medical offenses (see) and constitute a very special etiological group. Therefore, it is generally accepted to use the concept of "iatrogenic diseases" in its traditional sense, that is, to refer to health disorders caused by the psycho-traumatic effect of ill-considered, deontologically incorrect statements or actions of health workers.

MS Lebedinsky and VN Myasishchev (1966) pointed out that both the doctor's behavior and the characteristics of the patient's personality (the degree of emotionality, suspiciousness, etc.) are important for the development of iatrogenic diseases. Many of the sick people suffer not only from the disease, but also from the anxiety, fears, fears for the outcome generated by it. This explains the special attention of the patient to the words of the doctor, and to his behavior, intonations, facial expressions. At the same time, depending on the type of nervous activity, personality type and mental characteristics, different patients react differently, sometimes oppositely, to certain words and behavior of a health worker. Not only ill-conceived remarks (“Your heart attack- this is the first call; “... the main vessel of the heart passes blood by 30%”, etc.) or the incomprehensible meaning of some words and expressions (“hook-shaped stomach”, “myocardial dystrophy”, etc.), but sometimes even interjections or prolonged silence doctor, which can be interpreted by the patient as signs of a particular difficulty in diagnosing or treating his illness, its particular severity, and the hopelessness of the prognosis.

The risk of iatrogenic diseases, other things being equal, is not the same in people of different age, sex, education. Women are more likely to be iatrogenic than men. Age groups with an increased risk of developing iatrogenic diseases are people of the so-called transitional ages - adolescents and people in the period of menopause (especially women with pathological menopause), as well as elderly people, among whom there are many involutive changes accentuated on the inevitability of them and an increased likelihood of death arising illness.

The factors that can contribute to the emergence of iatrogenic diseases include the not always justified expansion of the volume of medical information distributed among the population (popular lectures, television and radio programs), when the symptoms of a particular dangerous disease are described, attention is paid to its early manifestations, drawings daunting prospects of "late conversion".

The nature of iatrogenic diseases depends on the prevalence and effectiveness of the treatment of certain diseases. So, at the beginning of the 20th century, among those suffering from iatrogenic diseases, people who assumed they had tuberculosis or syphilis were more common; currently, cancerophobia and cardiophobia are more common.

Iatrogenic diseases are manifested mainly by neurotic reactions in the form of various variants of autonomic dysfunction. Their development is facilitated by increased emotionality and suggestibility. Depending on the nature of psychotrauma and premorbid personality traits, vegetative disorders can be generalized or expressed by predominant dysfunction of the cardiovascular (cardiac arrhythmia, changes in blood pressure, etc.), digestive (heartburn, vomiting, stool disorders) or other systems in combination with senestopathies, negative affective background.

Establishing a relationship between iatrogenic diseases and neuroses (see Neurosis) presents certain difficulties. According to B. D. Karvasarsky (1980), iatrogenies are detected in about 1/3 of patients with neuroses. However, iatrogenic diseases are not included in the nomenclature of neuroses as one of their independent forms.

Treatment

The main method of treatment of iatrogenic diseases is psychotherapy (see), supplemented if necessary by symptomatic treatment - the use of tranquilizers, antidepressants and other psychopharmacological agents (see). It is unacceptable to inform the patient that he does not have a disease and does not need to be treated. Doctors should remember that we are talking about a disease that requires a thorough study of the characteristics of the patient's personality, knowledge of his social environment. Psychotherapy requires establishing the characteristics of this iatrogenic disease and the factors that contributed to its occurrence. A convincing conclusion of an authoritative council or a highly qualified specialist, brought to the attention of the patient, can have a great psychotherapeutic effect. At severe course iatrogenic diseases require the help of a psychotherapist or psychiatrist.

Forecast

The prognosis of iatrogenic diseases in most cases is favorable, with timely and proper therapy, recovery occurs in a few weeks or months. Late recognition of iatrogenic diseases contributes to its protracted course and worsens the prognosis.

Prevention

Prevention of iatrogenic diseases begins with a deep assimilation by future doctors of the principles of medical ethics and deontology, which are based on a sensitive attitude, compassion for the patient, as well as with a highly moral, humanistic education of health workers in the process of their training and activities (see Medical deontology, Medical ethics). An important factor in the prevention of iatrogenic diseases is the doctor's knowledge of the basics of psychology (see).

The existing prerequisites for an increase in the frequency of neurosis, as well as a progressive increase in the number of people in older age groups, increase the risk of iatrogeny. Against this background, the responsibility of doctors for "verbal asepsis" increases, the need for constant monitoring of their behavior (intonations, attitudes, gestures), which can be misinterpreted by the patient. At present, when not one, but several doctors, middle and junior medical workers, registrars, as a rule, communicate with the patient, the possibility of iatrogenic diseases increases. Therefore, in order to prevent iatrogenic diseases, it is necessary to carry out systematic educational work with all personnel who communicate with patients. Thoughtful should be the content of honey issued to patients. documentation. Particular care must be taken when assisting health workers in whom iatrogenic illnesses are relatively common and difficult to treat because of the often increased refractoriness of health workers to psychotherapy.

The system of medical education of the population should exclude superficial amateurish training in self-diagnosis, which contributes to the spread of iatrogenic diseases.

The legal aspects of iatrogenic diseases have not been developed; they should be referred to medical law, the problems of which in the conditions of scientific and technological progress have become especially relevant.

Bibliography: Karvasarsky B. D Neurosis, M., 1980; Kassirsky I. A. On healing, Problems and thoughts, M., 1970; Lakosina N. D. and Ushakov G. K. Tutorial in medical psychology, M., 1976; Lebedinsky M. S. and Myasishchev V. N. Introduction to medical psychology, L., 1966; Luria R. A. Internal picture of diseases and iatrogenic diseases, M., 1977; Elstein N. V. General medical problems of therapeutic practice, Tallinn, 1983; Bernades P. Conditions de survenue des gastropathies iatrogfcnes, Rev. franQ. Gastroent., no. 178, p. 21, 1982; B u m k e O. Der Arzt a Is Ursache seelischer Storungen, Dtsch. med. Wschr., S. 3, 1925; Nelson R. L., A b c a r i-a n H. a. P g a s a d M. L. Iatrogenic perforation of the colon and rectum, Dis. Colon Rect., y. 25, p. 305, 1982; S with h i p-kowensky N. Iatrogenie oder befreien-de Psychotherapie, Lpz., 1965.

H. V. Elshtein.

Iatrogenic diseases(Greek iatros doctor + gennaō create, produce; synonymous with iatrogeny) - psychogenic disorders that arise as a result of deontological errors of medical workers - incorrect, careless statements or actions.

Health disorders resulting from the impact on the patient of the words and actions of the doctor were already known to physicians of antiquity. However, the term "iatrogenic" became widespread only after the publication in 1925 of the work of the German psychiatrist Bumke (OSE Bumke) "The Doctor as the Cause of Mental Disorders." Since that time, the concept of iatrogenics has been actively studied by specialists of various clinical profiles. There is a steady trend of broad interpretation Ya. z. Many specialists, especially abroad, refer to them as a pathology resulting not only from deontological errors (see. Medical deontology ), but also any actions of a doctor (from complications of an incorrectly performed manipulation or procedure to the occurrence of a so-called drug disease), i.e. any negative consequences of medical intervention. Some researchers refer to such conditions as yatropathies, or somatic iatrogenies.

For the development of Ya. (in the traditional interpretation) both the behavior of the doctor and the characteristics of the patient's personality (degree of emotionality, suspiciousness, etc.) matter. Many of the sick people suffer not only from the disease, but also from the anxiety, fears, fears for the outcome generated by it. This explains the special attention of the patient to the words of the doctor, and to his behavior, intonations, facial expressions. At the same time, depending on the type of nervous activity, personality type and mental characteristics, different patients react differently, sometimes oppositely, to certain words and behavior of a health worker. Not only ill-conceived remarks (“Your heart attack is the first call”; “... the main vessel of the heart passes blood by 30%”, etc.) or the incomprehensible meaning of some words and expressions (“hook-shaped stomach” , “myocardial dystrophy”, etc.), but sometimes even interjections or a prolonged silence of the doctor, which can be interpreted by the patient as signs of a particular difficulty in diagnosing or treating his illness, its particular severity, hopelessness of the prognosis.

The risk of I.

The factors that can contribute to the appearance of I. z. include the not always justified expansion of the volume of medical information distributed among the population (popular lectures, television and radio programs), when the symptoms of a particular dangerous disease are described, attention is fixed on its early manifestations , frightening prospects of "late conversion" are drawn.

Iatrogenic diseases are manifested mainly by neurotic reactions in the form of phobias (carcinophobia, cardiophobia) and various variants of autonomic dysfunction. Their development is facilitated by increased emotionality and suggestibility. Depending on the nature of psychotrauma and premorbid personality traits, vegetative disorders may be generalized or expressed primarily as cardiovascular dysfunction (cardiac arrhythmia,

Treatment I. h. coincides with the treatment of ov. The main method is psychotherapy, supplemented, if necessary, with symptomatic treatment, depending on the nature of the manifestations of autonomic dysfunction. It is preferable that the treatment is carried out by a psychotherapist or psychiatrist. It is unacceptable to inform the patient that he does not have a disease and does not need to be treated. Doctors should remember that we are talking about a disease that requires a thorough study of the characteristics of the patient's personality, knowledge of his social environment. Psychotherapy requires the establishment of the features of this I. h. and the factors that contributed to its occurrence. A great psychotherapeutic effect can be achieved by a convincing conclusion of an authoritative council or a highly qualified specialist, brought to the attention of the patient.

Forecast I.

Existing prerequisites for increasing the frequency