Pathogenic and therapeutic effects of the word. · Post-vaccination reactions and complications. Strive to obtain maximum information with a minimum paraclinical examination. Indications for prescribing invasive research methods must be strictly

Ministry of Health of the Republic of Belarus

EE "Vitebsk State Order of Peoples' Friendship Medical University"

Department of Propaedeutics of Internal Diseases

Essay

on the topic of:

"Types medical institutions. Structure and organization of work of a typical treatment and preventive organization"

Prepared by: 2nd year student, 11th group

Faculty of Medicine

Radchenko S.G.

Checked by: Izmailov V.E.

Vitebsk, 2014

Introduction

At certain periods in the development of human society, “winged” words appear and acquire a ubiquitous sound, reflecting the anxieties and aspirations of people. Currently, such words have become “danger”, “safety” and “ecology”, and ecology is considered primarily from the standpoint of the danger of the habitat for human health and life.

The danger comes from two groups of factors: natural and anthropogenic. In the process of evolution of the Earth and human society, the circle and role natural factors Risks to human health and life gradually decreased, while anthropogenic ones increased rapidly. In the second half of the 20th century, during the era of the modern scientific and technological revolution, this danger increased to a scale threatening the existence of mankind. Among anthropogenic factors, iatrogenics play a special role.

Doctors were among the first to understand the danger of their professional activities for the life and health of people. Already in the 4th century. BC e. The Hippocratic oath contained the doctor's promise: "... I will protect the sick from everything harmful and unsuitable for them." About 2 thousand years ago, this became the principle of treatment: “Primum non nocere” (First of all, do no harm), “Nihil nocere” (Do no harm), which was perceived as the first commandment of the doctor. Subsequently, diseases associated with the provision of medical care began to be called iatrogenies - diseases of medical origin. iatrogenic disease medical

The detonating factor in the modern doctrine of iatrogenics was the publication in 1925 of O. Bumke’s work “The Doctor as the Cause of Mental Disorders.” In the subsequent period, the term “iatrogeny” was used to refer to diseases caused by the psychogenic influence of medical workers on patients. This interpretation of iatrogeny can also be found in modern works. Currently, the prevailing trend is towards an expanded understanding of iatrogeny, towards the inclusion in iatrogenics of diseases caused by the action of medical factors of a physical, chemical and mechanical nature.

1. Iatrogenesis, classification

Initially, the concept of iatrogenics was expanded to diseases associated with erroneous actions of a doctor, and then to all diseases and injuries associated with any medical interventions. So, I.F. Kalitievsky et al. They offer two definitions of iatrogenesis:

1- any new side disease (including functional) associated with the actions (treatment, diagnostic tests, prevention, behavior, etc.) of medical workers, regardless of whether they were right or wrong;

2-complications of the underlying disease caused by erroneous or inadequate actions of the doctor. A.P. Krasilnikov and A.I. Kondrusev, arguing that a significant part of iatrogenic diseases, especially infectious and psychogenic ones, develops without medical interventions, suggest that iatrogenics be understood as any diseases that occur in a patient as a result of medical interventions or communication with medical workers, regardless of the place of medical care and the causative factor. However, even this definition from modern positions does not fully reflect the phenomenon of iatrogenesis, since it does not take into account medical injuries and medical workers, who also often suffer from iatrogenia.

Iatrogenic diseases are all diseases and injuries that occur in patients and healthcare workers as a result of any type of medical care.

To designate diseases associated with the provision of medical care, the following names were also proposed: hospitalism, pathology of treatment and diagnosis, adverse (side) consequences (effects) of diagnosis and treatment.

There are several classifications of iatrogenesis. S. Ya. Doletsky distinguishes iatrogeny of communication and iatrogenic influence. E. S. Belozerov distinguishes among iatrogenics general reactions of the body, damage to individual organs and tissues, drug teratogenesis and oncogenesis, and side effects of drugs. P. F. Kalitievsky et al. classify iatrogenies as those caused by medicinal, surgical, physical and other methods of treatment. V. L. Kovalenko et al. in the iatrogenic group, there are diseases associated with diagnostic studies, drug treatment, preventive measures, iatrogenic pseudo-diseases, informational and other iatrogenics. E. D. Cherstvoy et al. The classification was based on the type of medical intervention, highlighting the groups of iatrogenics associated with drug therapy, surgical interventions, diagnostic procedures and preventive measures. M. M. Balyasny distinguishes between jatropsychogeny, jatropharmamacogeny, and yatrophysiogeny.

Recognizing the scientific validity and practical usefulness of these classifications, we note that the main thing in the construction of classification schemes for iatrogenics should be causative factor, pathogen. Based on this, iatrogenics should be divided into 5 groups:

psychogenic,

medicinal,

traumatic,

infectious,

mixed.

Psychogenic iatrogenies manifest themselves in the form of neuroses, psychoses, neurasthenia, hysteria, phobias, depressions, feelings of anxiety, depressive and hypochondriacal disorders. They are caused by careless and misunderstood statements by a medical worker about the state of health of a patient, familiarization with one's own medical history and special medical literature, listening to public lectures, especially on television. They are also called “diseases of the word.” This group of iatrogenics also develops in cases of ineffective treatment, mistrust of the doctor, fear of diagnostic methods, treatment, abrupt transition from active image life to a passive one, from the usual conditions of family and work collective to a group of people with heightened and altered personal perception (in the words of A.F. Bilibin, “to people with a suffering self”).

The addition of iatrogenesis complicates the course of the underlying disease and increases the likelihood of developing new diseases, for example, hospital-acquired diseases. Unfortunately, psychogenic iatrogenies are not taken into account; we did not find any data from sample studies in the literature. R.A. Luria believes that they occur often and are difficult, and sometimes end tragically. Thus, an article analyzing the causes of suicide, published in the World Health Forum, states that the majority of people who committed suicide had recently visited a doctor general practice or other health care professionals.

Drug iatrogenies. For medicinal skin rashes E.A. Arkin proposed the term “medicinal diseases”. Since the main manifestation side effects drugs - a disease, and the cause of the disease is a medicine prescribed by a doctor, the term “drug disease” can be extended to all clinical forms of diseases associated with the direct or indirect damaging effect of certain components of drugs and impurities to them. Objections to this term are based on understandable, but subjective, and, moreover, corporate considerations. Most medicinal diseases are iatrogenic in nature. Only for diseases caused by self-medication and violation of doctor’s instructions, there are no grounds for inclusion in iatrogenics, but they naturally are included in the group of medicinal diseases. Some authors suggest calling them chemical, drug iatrogenies. These names do not seem very successful to us, especially since some drugs, for example, vaccines, immune serums, bacteriophages, lysozyme, and bacterial preparations, are not of a chemical, but of a biological nature.

Drug iatrogenies are diverse in their manifestations, and their classifications are numerous. Let us give only one etiopathogenetic classification, which is the result of a generalization of the work of many researchers. According to this classification, the following groups of medicinal diseases are distinguished:

1-pharmacologically negative effects (for example, hypoglycemic shock after insulin administration);

2-drug intoxication, including toxic, mutagenic, oncogenic, teratogenic, embryotoxic, immunosuppressive effects;

3-drug allergy;

4-drug intolerance of pseudo-allergic nature;

5-drug dependence;

6-drug psychoses;

7-exacerbation reactions, for example bacterial (endotoxic) shock;

8-complications of the underlying disease caused by physicochemical, pharmacodynamic and pharmacokinetic incompatibility of simultaneously administered drugs;

9-post-vaccination reactions and complications.

There are many other, less complete classifications of medicinal diseases. For example, Anderson distinguishes among medicinal diseases (in his terminology - drug reactions) organ-specific reactions (skin, blood, liver, head); generalized reactions (systemic anaphylaxis, anaphylactoid reactions, generalized urticaria, angioedema, drug fever, autoimmune reactions, drug-induced vasculitis, serum sickness-like reactions); pseudo allergic reactions.

There is no mandatory registration of medicinal diseases. Data presented in the literature are based on voluntary reports from treating physicians or best case scenario on sample studies. The general conclusion from acquaintance with even such obviously incomplete data in comparison with the scale of drug therapy is this: drug-induced infections are extremely common. According to G. Mazhdrakov and I. Popkhristov, adverse reactions develop in 7%, according to A.S. Lopatin, I.M. Stankovskaya - in 10-12%, according to B.M. Pukhlik - in 15-40% of people taking medications. In the USA, 1-2 million cases of side effects of drugs are registered annually, 2-5% of the total number of hospitalizations are due to this pathology. About 30% of hospitalized patients acquire a drug-induced disease during treatment. The incidence of adverse reactions to antimicrobial therapy ranges from 1 to 50%. Allergic reactions after taking medications develop in 0.5 - 60% of people.

Traumatic iatrogenic. For diseases caused by the action of medical damaging factors of a physical and mechanical nature, the term “medical injuries and their consequences” (adverse consequences of surgical treatment methods) is usually used. The epithet “medical”, not as clearly as “iatrogenic”, indicates the connection of injuries with the provision of medical care. Based on this, as well as the need to combine them into one group with psychogenic, medicinal and infectious iatrogenies, it is more logical to call them traumatic iatrogenies.

This group includes surgical, manipulation and accidental medical injuries, burns (radiation, thermal, chemical) and consequences of injuries. The consequences and complications of surgical and manipulation injuries and burns are especially serious and numerous. Here is an incomplete list of them: surgical, bacterial, blood transfusion and anaphylactic shock, surgical collapse, acute cardiovascular failure, adhesive disease, post-resection syndrome, post-cholecystectomy syndrome, short bowel syndrome, operated lung disease, massive transfusion syndrome, air embolism, vascular thrombosis, pulmonary atelectasis, hemothorax, hydrothorax, bronchospasm, pulmonary edema, cerebral edema, cholestasis, emphysema subcutaneous tissue, bleeding, asphyxia, intestinal atony, infertility after removal of the uterus, radiation sickness and other less severe lesions.

This group of iatrogenics can also conditionally include the consequences of excessive intervention, intervention without indications (the so-called surgical aggression) and, conversely, leaving the patient without medical care and care.

Infectious iatrogenies (iatrogenic infections). These include all cases of infectious diseases contracted during the provision of any type of medical care. They are more often (more sparingly for the conscience and honor of the doctor) called nosocomial (hospital, nosocomial) infections, which does not fully reflect the essence of the phenomenon, since, firstly, these diseases also arise during the provision of medical care in outpatient clinics and at home, secondly, they do not include diseases contracted outside the hospital. The term "iatrogenic" directly indicates the connection of a disease or complication with the provision of medical care, which prompts the doctor to look for ways to prevent such phenomena in his practice. The term "nosocomial" may be reserved for iatrogenic infections that develop in hospitals.

Iatrogenic infections arose simultaneously with the opening of the first hospitals. As it expands inpatient care the number of iatrogenic infections increased, and in the 18th -19th centuries. they have become widespread. By the end of the 19th century. After the establishment of the microbial etiology of infectious diseases, the development and implementation of antiseptics, sterilization, disinfection, chemotherapy, asepsis, and isolation, the incidence of iatrogenic infections decreased sharply. A new period of growth and widespread spread of such infections began in the second half of the 20th century. and continues to this day, but not everywhere and not at the same pace as before. The average incidence of iatrogenic infections is currently estimated at 5-9% total number discharged from the hospital. In 4-5% of those who die in hospital, the only cause of death is iatrogenic infections. In certain categories of patients and in some hospitals, morbidity and mortality rates are several times higher.

Iatrogenic infections are diverse in their manifestations. A.P. Krasilnikov and A.I. Condrusev divide them into bacterial, fungal, viral, protozoal and metazoal; hospital, outpatient, home and industrial; endogenous, exogenous; metastatic and autoinfections; sick, medical workers, healthy patients; local, systemic, generalized; acute, primary-chronic and acute-chronic; related and not related to medical interventions. They are also divided according to the location of the pathological process: blood infections; surgical wound infections; infections urinary tract; bone and joint infections; infections of the cardiovascular system; central infections nervous system; pneumonia; lower respiratory tract infections; infections of the eyes, ear, throat, nose, mouth; digestive system infections; infections of the reproductive organs; skin and soft tissue infections; systemic infections.

Iatrogenic infections are caused by more than 200 species of bacteria, fungi, viruses, protozoa, and multicellular invertebrates. The leading position is occupied by conditionally pathogenic microbes that cause opportunistic diseases, i.e. diseases of persons with reduced function of natural and acquired immunity. Causative agents of iatrogenic infections are characterized by a wider range of properties and higher rates of their changes. The most dangerous direction in the evolution of this group of microbes is the continuous formation in hospitals of hospital strains and ecovars of leading pathogens, primarily staphylococci, pseudomonads, and enterobacteria. Hospital ecovars differ from community-acquired ones by higher virulence, multiple resistance to antibiotics, increased resistance to antiseptics and disinfectants, physical factors, and population polymorphism. They are well adapted to the hospital environment and are difficult to suppress. They are mainly associated with the most severe cases of the disease and group morbidity. IN last years Severe large outbreaks of iatrogenic infections caused by methicillin-resistant variants of staphylococci are being reported in many countries. Registration of infectious iatrogeny, which is better compared to other forms of iatrogeny (although cases of intentional or unintentional concealment are very frequent), as well as the introduction of epidemiological surveillance of medical institutions and a system of sanitary, preventive and anti-epidemic measures based on it, sharply reduce the incidence of iatrogenic infections .

Often in modern medicine the term “iatrogenic” is used - this concept refers to those conditions that are directly or indirectly related to the actions of medical personnel. Often, the doctor even poses a certain danger to the patient and can cause injury to him by communicating incorrectly with him or performing certain manipulations.

Classification Psychogenic type

Depending on the causes of iatrogenesis, several types are distinguished. The first of them is psychogenic diseases, the second is organic. The latter are divided into medicinal, traumatic, and infectious. Iatrogenesis and mixed type. Heavy emotional condition the patient may arise from the careless words of the attending physician, the tactlessness of the staff from familiarizing the patient with his medical history. Also, mental balance is affected by the abundance of information, sometimes clearly exaggerated or biased.

Psychogenic iatrogeny is a state of depression, neuroses, hysterics, the development of various phobias, as well as other disorders in the functioning of the patient’s nervous system. A person develops distrust of the doctor’s words and actions; any manipulation frightens him. Of course, such types of iatrogenics significantly depend on the general patient and his balance. Often such people need the help of a psychologist or psychiatrist.

Drug-type iatrogenicity

This is a fairly large group of diseases that can develop as a result of improper medication use. Manifestations of such iatrogenies are varied. These include allergic reactions after taking medications, and all kinds of side effects: intoxication, state of shock, disruption of the functioning of other organs, mutagenic effects of drugs on the cells of the body. These types of iatrogenics include conflict when taking incompatible substances. These conditions can develop from poorly selected medications or their incorrect administration.

Also, drug iatrogenies include reactions and complications after vaccine administration. Most dangerous conditions- complications after administration of anesthesia, pain relief, emergency resuscitation. Iatrogenesis in medicine includes another type that develops when doses of X-ray and laser radiation are exceeded.

Iatrogenesis of a traumatic nature

Such conditions can develop as a result of medical manipulations, examinations, surgical intervention. Traumatic iatrogeny is also burns that can have different nature(chemical, thermal, radiation), and injuries (accidental or not). Invasive research methods in Lately have gained wide popularity, because they give more full picture diseases. However, if the doctor is insufficiently qualified, such manipulations are quite dangerous. Therefore, if it is possible to choose a less traumatic method, preference should be given to it.

Another category of iatrogenics of this type is the leaving of foreign objects in the body of the operated patient. This situation can be avoided by increased attention all doctors during the operation. This category also includes deprivation of medical care and so-called surgical aggression (that is, unnecessary surgical intervention for which there were no indications).

Iatrogenic infectious diseases

This is also a fairly large group of diseases. Sometimes they are called hospital-acquired infections, but in fact such conditions arise mainly due to medical procedures. Depending on the location of the lesion, iatrogenies of the blood, infections of wounds, genitourinary, cardiac systems, damage to the respiratory system, skin etc. The causative agents can be bacteria, fungi, and viruses. Infectious iatrogenics are consequences of disorders elementary rules asepsis, disinfection, improper patient care. Special attention must be given to materials for dressing wounds. This condition can also be observed among medical personnel (as a result of poor hygiene, neglect of protective equipment when working with patients). Factors that cannot be influenced include old equipment and staff shortages. Unfortunately, it is impossible to completely exclude the entry of microorganisms into the wound during surgery.

How to reduce the number of iatrogenic diseases: actions from doctors

Any medical worker must constantly improve his qualifications, improve his skills, and replenish his knowledge. When performing surgery, it is very important not to be distracted and carefully perform all manipulations. In addition, you should not forget about ethics when communicating with patients and about such a concept as Disclosure of information about a patient and his condition can cause nervousness, severe

Patient Actions

Patients, in turn, in order to avoid the development of iatrogenics, should study reviews about the doctor or medical institution they plan to contact. Very often, people who are in a state of hypochondria become, as it were, “professional” patients. They go from one specialist to another, undergoing a lot of examinations in order to find the disease. Often there is none at all. Such actions increase the risk of developing iatrogenic diseases. The causes of drug iatrogenicity are in frequent cases of uncontrolled medication use. Therefore, it is important to follow the rule: drugs are prescribed only by a specialist. Taking large quantities is also unjustified. medicines, because the mechanism of their interaction has been little studied, so all sorts of side reactions are possible.

IN modern world We can also talk about information iatrogeny. A large number of available information is one of the reasons for self-medication, which can lead to irreparable consequences. That is why prevention of iatrogenicity is about own health, which does not cross acceptable boundaries and is not fanatical.

We live in a time when various diseases can occur not only against the background of problems in the body, but are also a consequence of the direct or indirect influence of medical workers. When we turn to doctors, we sometimes don’t even suspect that in addition to existing illnesses we may still develop problems. Let’s try to figure out how this is possible and what iatrogenic diseases are.

The concept of iatrogeny

Everyone knows perfectly well that the main commandment of any doctor is “Do no harm!” Most doctors try to do it, but even the most devoted to their profession make mistakes, and what can we say about those who simply occupy the wrong place and are not doing their job.

The concept of iatrogenic diseases includes those conditions and diseases that were provoked by medical intervention or influence. It could be like physical problems as well as psychological ones.

In medicine, there are two definitions of this concept:

1. Various side diseases that are associated with:

• Wrong treatment.
• Diagnostic studies.
• medical personnel.

2. Iatrogenic diseases include diseases that manifested themselves as complications of the underlying disease; they were caused by incorrect or erroneous actions of the doctor and nurses.

What is interesting is that iatrogenics includes all diseases and injuries that can occur not only in patients, but also in medical personnel during the provision of medical care.

Speaking about iatrogenics, you immediately remember the saying that a word can kill a person, so doctors must feel on a subconscious level which patient can be told the whole truth about his illness, and in which situation it is better to discuss this with relatives.

But, unfortunately, not all doctors in our medicine are good psychologists and think about the consequences of words spoken or actions. Despite the fact that many claim that there is no problem as such - medical error, iatrogenic diseases suggest the opposite.

For some impressionable patients, even the simple inattention of the doctor, his indifferent look and unfriendly attitude already cause mental anxiety.

IN modern society We especially often have to deal with the callousness and shamelessness of our doctors.

Varieties of iatrogenic

Until today, there has not been one generally accepted approach to the classification of iatrogenics, so several options are used:

1. According to the etiology of the disease.
2. According to ICD.
3. According to Kalitievskiy.
4. According to Rykov.

If we consider the classification according to the nature of the disease, then iatrogenies come in several classes:

1. Iatrogenesis associated with disease prevention.
2. Diagnostic related.
3. Triggered by drugs.
4. Iatrogenesis caused by therapy.
5. With the use of tools.
6. Complications after blood transfusion.
7. Death due to incorrect dose of anesthesia.
8. Iatrogenesis as a result of surgical operations.

According to the International Classification of Diseases (ICD) Iatrogenic diseases are classified differently. The classification may be as follows:

1. Iatrogenesis that occurs after surgery or as a result of a surgical disease.
2. Iatrogenesis provoked by drug treatment.
3. Diseases resulting from incorrect diagnosis.
4. Death from anesthesia.

Classification according to Kalitievsky differs in that each class of disease is further divided into subclasses.

1. Iatrogenesis associated with treatment.

• Drug iatrogenies.
• Surgical.
• Physical.

2. Iatrogenesis caused by diagnostic measures.

• Diseases that are caused by the risk of using a diagnostic method or means.
• Diseases resulting from incorrect diagnosis.

3. Iatrogenesis associated with preventive measures.

• For example, the risk of side effects of the method (vaccination).
• Diseases caused by erroneous prevention.

4. Information iatrogenies are most often associated with self-medication, that is, the patient is treated with drugs other than those prescribed by the doctor.

5. Pseudodiseases, that is, those iatrogenies that arose as a result of an incorrect diagnosis.

Rykov's classification based on the application of economic sanctions when iatrogenic events occur. There are several groups:

• Iatrogenesis arising on initial stage treatment.
• Diseases caused by an unexpected reaction of the body to medications and other therapies.
• Iatrogenesis caused by erroneous diagnosis and treatment.
• Iatrogenesis, which in the pathogenesis of the disease is superimposed on the main disease or concomitant one.
• Problems arising from self-medication. In this case, no sanctions against medical institution out of the question.

This is such a multifaceted classification, which just shows that the problem of iatrogenic diseases is not weakening, but, on the contrary, is becoming more acute every year.

Traits of iatrogenesis

If we analyze the iatrogenic pathology, we can highlight the following features:

1. Medical and biological. This means that the development of iatrogenics always depends on individual characteristics the patient, his resistance to stress, susceptibility, tolerance to medications. These same features also include the doctor’s misconceptions, which are not made on purpose, but are caused by his insufficient qualifications.
2. Medical and social features. The development of iatrogenic symptoms may be caused by diagnostic errors associated with outdated equipment.
3. Legal features. They concern compensation to a person for harm caused to his health as a result of medical intervention.

It must be taken into account that complications or diseases that arose as a result of refusal to provide assistance are not considered iatrogenic.

Causes of iatrogenism

Iatrogenic diseases can be triggered by the following factors:

1. Careless or deliberate influence on the patient with words or non-verbal means of expression, for example, facial expressions, gestures.
2. Promptly inform the patient about the diagnosis and its prognosis. The worst thing is when it turns out that this information was wrong.
3. A pronounced inattentive attitude of medical personnel or even inaction.
4. Failure to comply with storage rules

Recently new concepts have appeared:

• “Sistergenia” is a mental disorder in a patient provoked by careless statements or actions of a nurse.
• “Egogenia” is the patient’s influence on himself through self-hypnosis.
• “Egrotogenies” are when patients directly or indirectly influence each other’s condition.

As practice shows, the most susceptible to iatrogenics are suspicious patients who exhibit emotional instability, are easily suggestible and are highly dependent on the opinions of others.

Symptoms of iatrogenic

Iatrogenic diseases do not have strictly and clearly defined symptoms. This is due to the variety of reasons that cause them.

If it is psychological in nature, then it may manifest itself complete refusal from treatment this doctor or these methods. In some cases, the patient, on the contrary, begins intensive treatment, constantly goes from one doctor to another, and does not bypass healers, psychics and fortune-tellers.

If iatrogenism occurs infectious diseases, then they have their typical symptoms, but are often more difficult to treat.

It is also worth remembering that there are times when medical workers are not at all to blame for the occurrence of iatrogenicity (if we recall self-hypnosis, the influence of patients on each other).

There are a great many factors that can provoke the development of iatrogenics, and therefore there are many manifestations. Most often, the reasons are subjective, therefore the course of the disease depends on the state of the psyche and the entire organism as a whole.

Oddly enough, myself medical staff may suffer from such a pathology - everyone knows the “burnout syndrome”.

Diagnosis of iatrogeny

For some, iatrogenicity is not special labor put correct diagnosis, for example, if a patient, undergoing treatment in a hospital for gastritis, suddenly catches infection, then it becomes more or less clear that this happened as a result of the presence of this infection within the hospital walls.

If a patient complains to a doctor about an inappropriate attitude, improper treatment, as a result of which he received an illness, then in order to bring a claim, this will still need to be proven. Perhaps the patient already had these diseases, but was not aware of them.

Treatment of iatrogeny

Iatrogenic diseases are most often treated with psychotherapy if it is associated with mental problems. To eliminate this condition, tranquilizers, antidepressants and other psychotropic drugs are prescribed.

If as a result medical intervention, misdiagnosis and therapy the patient receives another disease, then treatment is reduced to eliminating the symptoms of the disease.

When prescribing treatment for iatrogenic diseases, the doctor must take into account psychological characteristics the patient's body, his social environment. In some difficult situations, you may need the help of a psychiatrist or psychotherapist.

Prognosis for treatment of iatrogenic

In most cases, treatment of iatrogenic diseases ends favorably. Depending on the type of disease, the duration of therapy can take from several weeks to several months.

The earlier an iatrogenic disease is recognized, the more effective therapy. There are prerequisites for an increase in the number among older patients age group and children. In this regard, every medical worker must more carefully control all his words and gestures that concern the patient. Methods and methods of treatment and drug therapy must be carefully selected.

There are several unspoken rules for medical staff:

1. Think about who to tell.
2. Think carefully about how to speak.
3. Think about what you will say.

If at least these rules are followed, then it will be possible to talk about a decrease in the number of iatrogenies.

Prevention of iatrogenic

Considering the versatile nature of iatrogenies, we can talk about a variety of ways to prevent them.

1. To prevent medicinal iatrogeny, the doctor must be well aware of the effects medicinal product on the body, the possibility of complications. Carry out individual selection of dosage in each specific case.
2. Prevention of physical iatrogenies should involve the judicious use of diagnostic methods and indications for surgical intervention.
3. During surgical intervention Only proven techniques should be used that allow the patient’s organs and tissues to be handled as carefully as possible.

A general preventive measure can be called compliance by medical workers with medical ethics and showing compassion towards their patients. If doctors become a little psychologists and treat not the disease, but the person, then the prevention of iatrogenic diseases will not be required.

Iatrogenesis– one of the types of psychogenics, that is, mental illness or disorder mental activity caused by emotional shock.

The specificity of iatrogenics is that an emotional shock of this kind can happen to an individual only during his interaction with doctor or another health worker, that is, during those periods of life when he had to seek help medical care and become patient.

Iatrogenesis(from the ancient Greek iatros - doctor and genes - generating) is a disease provoked by a doctor.

This concept was first mentioned by a German psychiatrist ABOUT. Bumke also in 1925 year in the work “The Doctor as the Cause of Mental Disorders.” Sometimes in the literature there is a different spelling of the term “iatrogeny”, due to difficulties in translation - “iatrogeny”.

In ICD-10 ( International classification diseases) iatrogenics is interpreted more widely, like any doctor’s mistake that resulted in dysfunction of the body, disability or death of the patient. However, iatrogenics is still often interpreted more narrowly, as a disease that negatively affects specifically psyche sick.

Iatrogenesis happens because of incorrect, inadequate, unqualified actions or words of the doctor performing Not intentional (or maybe intentional) suggestive influence per patient. Roughly speaking, the doctor said or did something wrong, and this made the patient feel much worse.

For example, a doctor may say to a young patient: “You know, people with a disease like yours don’t even live to see forty!” How will the person feel after this? At a minimum - not very good, at a maximum - not much worse. Scientifically, this “can’t be worse” qualifies as a combination of depressive and hypochondriacal states.

Iatrogenic diseases are most often expressed in two forms:

1. Depression – mental disorder, characterized low mood, inhibition of mental and physical activity, decreased vital motivations, pessimistic assessments of one’s “I” and life situation, somatoneurological disorders.
2. Hypochondria– excessive attention to one’s health, fear of incurable diseases, belief in the presence of a disease when it is absent and disbelief in getting rid of a real disease (even not too dangerous).

Iatrogenesis is also called "negative psychotherapy", since the doctor’s duty is to help the patient feel better, more confident, more optimistic, but the opposite happens: only fear, horror, panic, apathy and lack of hope for the future.

Types of iatrogeny

Any careless gesture, look, action or inaction and, of course, the doctor’s word can become a real psychological trauma, provoke psychosis, neurosis, cause other harm to the psyche and body.

Recently, such types of iatrogeny How:

Identity of doctor and patient

Of course, how strongly the doctor’s words will affect the patient depends on the personality and individual psychological characteristics of each of them, on the type and severity of somatic disease the patient and from the moment when the impact was made.

The situation of an operation during which the patient is under anesthesia. The words spoken by the doctor at this time penetrate directly into the patient’s unconscious, bypassing consciousness.

If during interaction in a state of consciousness the patient can at least somehow resist what was said or any manipulations (perceive critically what was said, apply self-regulation techniques, refuse the procedure), then under anesthesia - not. The state of anesthesia is close to hypnotic sleep. In this case, the suggestion is carried out at an unconscious level. Doctors and nurses must monitor not only what they say in front of the patient, but also when they think that the patient cannot hear them.

Good hypnotists are doctors, differing:

• high self-esteem,
• the habit of “getting smart”
• harshness and callousness in words and actions,
• categoricalness in statements.

Easily people are suggestible:

• fearful,
• alarming,
• gullible,
• unsure of themselves,
• vulnerable,
• with rigid or imaginative thinking,
• prone to hypochondria.

People in our society for the most part Not trust doctors, but when coming to the hospital, any person hopes that he will come across the most best doctor. People trust, and sometimes even blindly believe, the doctors treating them, hence the all too frequent cases of iatrogenicity. But there are always two sides to a coin!

If a patient believes a doctor, why shouldn’t that doctor give him hope and faith in the best? If “dummy” pills have a placebo effect, then the words of an authoritative doctor can certainly provoke the same placebo effect, but this will no longer be negative (as in iatrogenics), but positive suggestion!

It is impossible to deceive patients, but is it possible not to leave them even hope? The words and actions of a doctor and other medical workers should act not as poison that poisons a person, but as medicine!

Prevention and treatment of iatrogenism

Iatrogenesis is a disease that is one of the most pressing problems modern medicine, along with euthanasia, abortion, surrogacy and others. This is not just medical, it's ethical Problems.

The medical profession is one of the most psychologically difficult. Dispassion and composure must be combined with the ability to be friendly, sympathetic, attentive, always ready to help anyone at any moment.

Indifference, inattention, dismissive attitude to patients only intensify the feelings with which they usually come:

• excitement,
• anxiety,
• confusion,
• fussiness,
• sadness,
• physical pain.

For the prevention of iatrogenic, by and large, all you need is a little - friendly communication, a guarantee of maintaining medical confidentiality and the doctor’s sympathetic attitude towards the patient. Meet the patient with smile– to some extent protect him from possible emotional shock.

To avoid becoming a victim physician errors, it is recommended:

1. Develop such personality qualities as self-confidence, optimism, criticality and flexibility of thinking, stress resistance. A doctor can be an erudite person, but when listening to him, one must remember to think and reflect on what is said, and not just blindly believe. Abandon the attitudes “The doctor knows best” and “As the doctor says, I’ll do it.” Doctors are people too, they can make mistakes.
2. Before going to a doctor, you need to find out what kind of specialist he is, find reviews from his patients (at least search on the Internet, on forums). You also need to carefully choose the medical institution where you will be treated, especially if you are expected to stay in a hospital.
3. Reserve the right to choose a doctor and medical institution. If you don’t like a doctor and you have the opportunity to go to another, you should do it. Don't put up with bad doctors!
4. When a diagnosis is made by one doctor, it is better to double-check it by visiting one or two more (especially if the diagnosis is serious). Often different doctors give different diagnoses to the same person.
5. Believe in your recovery! No matter what anyone says, you need to believe in yourself, in your strengths and capabilities! Think and imagine yourself healthy, convince yourself of your full recovery, continue to enjoy life!

In case of iatrogenic has already arrived, and there is no hope left, no faith in the best and no self-love, you need to turn to help psychotherapist or psychiatrist, these specialists will help you cope with the problem.

If you want to study in more detail such a complex phenomenon as iatrogenics, we recommend the following books:

1. V. Volkov “Iatrogenic psychoneurosomatic syndromes”
2. S. Kuznetsov “Compensation for damage to health from improper medical activities”
3. A. Anastasov “Drug disease (lesions due to the use of pharmacotherapeutic agents in therapeutic doses)”

Have you ever suffered from iatrogenic disease?

Let's get straight to the point so there's no ambiguity. Iatrogenic diseases are psychogenic disorders arising as a result of deontological errors (incorrect statements or actions) of medical workers. To whom something is still not clear, he can turn to the word. Iatros (Greek – doctor). Gennaō (Greek – to create). Iatrogenesis.

Such disorders (as a result of the influence of the doctor’s eloquence and actions on the patient) have been known since ancient times. The term "iatrogenic" was coined in 1925. It's been researched ever since. various specialists. It's good to have something to explore. Moreover, some experts tend to classify not only deontological errors as iatrogenics, but any actions of a doctor. That is, any negative consequences of a medical invasion. Such "consequences" are called yatropathies (or somatic iatrogenies).

What is this - not from the point of view of researchers, but from our understanding? Let's interpret. Iatrogenic diseases (iatrogenies) are painful conditions based on such statements by the doctor (or his actions) that provoked negative impact on the patient’s psyche, as a result of which the latter develops new painful sensations, and even severe conditions.

It sounds normal, but the impressions are sad. If only because the source of iatrogenism can be not only attending physicians, but also radiologists, laboratory assistants, and any personnel of medical institutions. Which, as a rule, are anxious, suspicious, impressionable, hysterical and hypochondriacal psychasthenics.

Positivity without optimism

And what? Examination by a specialist consultant. Consultation. Incorrect reading of a stupidly written health education publication. Dissemination of medical information among the population (lectures, television and radio broadcasts). The patient pays special attention to the doctor’s words, to his behavior, facial expression, intonation - in any situation. And accordingly, the doctor’s ill-conceived remarks. For example, “hook-shaped stomach”... Typical presentation Iatrogenesis.

Well, the fact that women are more prone to iatrogenicity than men is that increased risk people are more susceptible to iatrogenism transitional ages(teenagers, people in menopause, elderly humanoids) – does not add optimism. The mention of dysfunctions of the cardiovascular, digestive and other systems is also not encouraging. Just dots the i's.

Short list

By the way, even the “English Hippocrates” Thomas Sydenham (1624–1689) at one time emphasized the danger not only of the actions of a medical worker, but also of the consequences of medical manipulations. Perhaps that is why (or for another reason) there are such varieties:

• Manipulative iatrogenies ( adverse effect during the examination process),
• Silent iatrogenies (a consequence of the inaction of a health worker).

After this short list, we can remember that compliance by a medical worker with moral and ethical standards involves not only fulfilling duties, but also bearing responsibility for unprofessionalism. For mistakes. For offenses. Do you remember? So what?

Good health - no matter what

The main method of treating iatrogenic diseases is psychotherapy. If it is expected additional treatment- it is complemented. The only – but important – clarification. The later an iatrogenic disease is recognized, the worse its further prognosis. Today, the possibility of iatrogenic occurrence is increasing. Totally and regularly.

Therefore, it seems logical to wish everyone good health – everyone personally. Well, if respected medical workers accept this desire to comment, advise and intervene in it, a favorable prognosis ceases to be favorable. good health, however.