Psychology of communication with the patient iatrogenic diseases. Iatrogenesis is a change in a patient’s health for the worse caused by a careless action or word of a doctor. Iatrogenic infectious diseases

Iatrogenic diseases are manifested mainly by neurotic reactions, including various options autonomic dysfunction. Depending on the nature of the psychotrauma and personality characteristics, autonomic disorders can be generalized or expressed by predominant dysfunction of the cardiovascular (heart arrhythmia, changes in blood pressure, etc.), digestive (heartburn, vomiting, stool disorders) and other systems in combination with various pathol. feelings and depression.

The main method of treating iatrogenism is psychotherapy, supplemented if necessary symptomatic treatment- use of tranquilizers, antidepressants and other psychotropic drugs. It is unacceptable to inform the patient that he does not have the disease and does not need treatment. Health care workers must remember that iatrogeny is a disease that requires a careful study of the patient’s personality characteristics and knowledge of his social environment. At severe course Iatrogenic diseases require the help of a psychotherapist or psychiatrist.

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

Prevention begins with the highly moral, humanistic education of physicians in the process of their training and work, with the deep assimilation by future medical workers of the principles of medicine. deontology, which is based on sensitive attitude and compassion for the patient. Health workers must be aware of the responsibility for “verbal asepsis”, the need constant monitoring their behavior (intonation, glances, gestures), which can be misinterpreted by the patient. The content of the honey given to patients must be carefully considered. documentation. Particular caution should be exercised when providing medical care to the health workers themselves, in whom iatrogenies are relatively frequent, and their treatment is difficult due to often increased resistance to psychotherapy. To prevent iatrogenic diseases, it is necessary to carry out systematic educational work with all personnel communicating with patients. Medical system education of the population should exclude superficial, amateurish training in self-diagnosis, which contributes to the spread of iatrogenic diseases.

Several rules for preventing iatrogenic diseases

• 1. Based on the priority of quality of life. If “illness is a life limited in its freedom” (K. Marx), then examination and medicine should not be worse than the disease itself.
• 2. Many deontological problems can be solved by rationally informing patients.
• 3. When making a diagnosis, one should rely on classical neurological topical diagnostic criteria. Paraclinical studies should be used as auxiliary components of diagnosis. The use of these methods should be considered through the prism of prognosis: whether this or that method will make any significant contribution to improving the prognosis and quality of treatment of the patient.
• 4. Strive to obtain maximum information with a minimum paraclinical examination. Indications for use invasive methods research must be strictly justified.
• 5. Introduction into practice of diagnostic and treatment standards (protocols) based on the latest achievements sciences, and their creative use.
• 6. When meeting with a patient, the doctor should ask the question not “Which drug should I prescribe?”, but “What is the reason for the patient’s complaints?” and "How can I help him?"
• 7. Before you start drug treatment, find out whether basic hygiene standards are being violated ( rational organization work and rest schedule, sleep, sports, taking certain food products, smoking, excessive consumption of coffee, other “dopings”), and try to regulate them. Many diseases are "self-limiting" and without treatment medicines pass on their own.
• 8. Avoid polypharmacy. Select the main disease in the “bouquet” of diseases and the key links in pathogenesis and influence them, giving preference to drugs that have proven themselves for at least 5 years and drugs that meet the requirements evidence-based medicine. Strict recording of complications of pharmacotherapy and notification of them to the relevant authorities.
• 9. Start treatment psychotropic drugs from small doses, gradually increasing them to effective ones (dose titration), and gradually withdrawing them. In elderly people, given the altered pharmacokinetics, try to use medications at a dose less than the recommended one and at a longer interval. Preference is given to long-acting drugs.

Let’s try to figure out how this is possible and what iatrogenic diseases are. Diseases resulting from incorrect diagnosis.

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 direct or indirect effects medical workers. When we turn to doctors, we sometimes don’t even suspect that in addition to existing illnesses we may still develop problems. The concept of iatrogenic diseases includes those conditions and diseases that were provoked by medical intervention or influence.

Iatrogenic pathology.

What is interesting is that iatrogenics includes all diseases and injuries that can occur not only in patients, but also medical personnel during the provision medical care. Despite the fact that many argue that there is no problem as such - medical error, iatrogenic diseases say the opposite.

IN modern society We especially often have to deal with the callousness and shamelessness of our doctors. According to the etiology of the disease. Iatrogenesis that occurred after surgical intervention or as a result surgical disease. Iatrogenesis provoked by drug treatment.

The Kalitievsky classification differs in that each class of the disease is further divided into subclasses. 1. Iatrogenesis associated with treatment. Diseases that are caused by the risk of using a diagnostic method or means. Diseases caused by erroneous prevention. 5. Pseudodiseases, that is, those iatrogenies that arose as a result of an incorrect diagnosis.

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.

Iatrogenic diseases of psychogenic origin in children

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. Iatrogenic diseases do not have strictly and clearly defined symptoms. If this is iatrogeny of a psychological nature, then it can manifest itself complete refusal from treatment this doctor or these methods.

Iatrogenic diseases are most often treated with psychotherapy if it is associated with mental problems. If as a result of 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.

Chapter 18 of iatrogenic pathology and its MEDICAL AND LEGAL SIGNIFICANCE

Depending on the type of disease, the duration of therapy can take from several weeks to several months. Prevention of physical iatrogenies should involve the judicious use of diagnostic methods and indications for surgical intervention. 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 and safety of medical care

Iatrogenic diseases of psychogenic origin in pediatric practice in pure form are less common than in adults and have their own characteristics in different age groups. It is manifested, in particular, by a profound change in the child’s psyche, which is also reflected in the somatic status.

This primarily applies to children who have a history of neurotic reactions to injections; obsessive fears and sharply negative reactions(failures) before the procedure.

We know, for example, cases when complaints of “heart pain”, “palpitations”, etc. appeared after the doctor paid too close attention to functional changes hearts.

Iatrogenic effects on parents, in our opinion, play an important and often even greater role compared to the impact on the child himself. In a broader sense, the sanitary culture of parents (i.e., the level of sanitary knowledge, attitude towards this knowledge and use of it in practice) largely determines the health of the child.

The common task of a doctor and nurse communicating with parents is to provide objective information about the health of their child and recommendations for creating optimal conditions for its development. Any advice that does not comply with this provision can be a source of iatrogenic harm. We do not stop at giving parents incorrect advice or recommendations that may be misinterpreted; in these cases, the incorrect actions of the medical professional are obvious.

Iatrogenic harm mediated by parents is especially common during a child’s illness. 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.

The term "Iatrogenesis" in medicine ( iatrogeny) includes the definition of unfavorable painful condition, evoked in the patient by a person who is authoritative for him as a result of unintentional or intentional suggestion. The causes of iatrogenism are most often medical errors.

The mental problem of iatrogeny 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 iatrogenism manifest themselves in the form of the development of certain types of neuroses ( iatrogenic disorders).

In medical practice it is very important trusting relationship doctor and patient, since the success of 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 iatrogenics, its classification includes

We can distinguish some types of iatrogeny, or its forms, if we adhere to a broader modern interpretation this concept:

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

The classification of types and forms of iatrogenics includes five groups:

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

Thus, the diagnosis of iatrogenicity may sound like “Psychogenic, drug, traumatic, infectious or mixed.”

Examples

As stated above, iatrogenies 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 iatrogenic behavior would be carelessly commenting out loud about a client's poor condition.
2. Intentionally induced iatrogeny occurs when some specialists, who have no concepts of mercy, morality and only a 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 " services. This phenomenon is, unfortunately, not uncommon in our lives.

We understand that a synonym for iatrogenicity is suggested illness. But is it possible to induce illness into oneself? Certainly! Iatrogenesis can be freely and unintentionally self-inflicted. This often happens among students of medical schools and universities when studying specific diseases. Iatrogenesis also occurs when patients are actively interested in medical literature and, so to speak, try on the diseases being studied. So the problem of iatrogenics sometimes becomes more and more sensitive and urgent.

In general, the concept of iatrogenics and its term were originally introduced by the German psychiatrist Bumke Oswald in 1925. And now, in medicine, iatrogeny is defined more broadly as any adverse consequence therapeutic interventions, diagnostic procedures, preventive measures leading to disturbances in bodily functions, limitation of self-care, and complications medical procedures as a result of both erroneous and right actions doctor

Prevention

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

Medicines should be prescribed judiciously and carefully, taking into account the patient's condition and possible side effects from medicinal drugs. What can outweigh in each situation: positive medicinal effect or side?

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

Degree of iatrogenic disorders

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

The patient's character is an important predictor of the extent to which neurosis can take hold of the patient and how long it will take for the person to emerge from it.

When communicating with suspicious patients in order to prevent iatrogenics, you need to be extremely careful, discussing the features of their health.

The common phrase “to err is human” is often used as an excuse when something goes wrong. It's scary to make a mistake, but it's even worse not to admit it. Especially if we're talking about about a medical error, the price for which is the patient’s health.

As in any field of activity, mistakes happen in medicine. But if an error in a technical or economic field can be corrected with minimal losses, even if it is difficult, then doctors’ errors are very difficult to correct, and often impossible. After all, we are talking about human health and life - the most valuable and dear thing that each of us has. Medical errors give rise to a group of diseases called iatrogenies.

Definition and classification of iatrogenics

The modern classification of diseases defines iatrogenic diseases as the result of any medical intervention that had an adverse or undesirable consequence for the patient. This group includes all diagnostic, therapeutic, and preventive medical procedures that disrupt the normal functioning of the human body, leading to disability or even death. Iatrogenesis should also be understood as complications of medical procedures, which can result from both erroneous and correct actions of medical workers. That is, the patients themselves are partly to blame for iatrogenesis.

Iatrogenic diseases can occur for a number of reasons. Professor Stanislav Yakovlevich Doletsky identified the following types of iatrogenics:

1. Iatrogenesis resulting from a violation of medical ethics. The reason for such iatrogenicity is improper communication between the medical staff and the patient.
2. Food (nutritional) iatrogeny. It appears in cases where the diet prescribed by the doctor is not followed and this leads to the development of complications of the disease.
3. Iatrogenesis resulting from an adverse side effect medical supplies. This one is enough common form Iatrogenesis, and its consequences are various allergic reactions, bleeding, shock.
4. Iatrogenesis, which is the result of medical manipulations. This includes unsuccessful cases of diagnostic procedures: biopsy (taking a piece of tissue for examination), endoscopic procedures(organ studies using special apparatus- endoscope).
5. Anesthesia and resuscitation iatrogenics. This is one of the most dangerous species Iatrogenesis, which is caused by complications during resuscitation and administration of anesthesia. Its result can be cardiac and respiratory arrest.
6. Iatrogenesis as a result of surgical (surgical) interventions. This type Iatrogenesis is complex and often leads to disability of the patient.
7. Iatrogenesis due to exposure to radiation energy: pathological effect high doses x-ray radiation, laser beams.

Iatrogenesis using examples from practice

Some cases of iatrogenics arise due to the fact that medical workers do not know the methods of psychology and psychoprophylaxis. It is known that the word “doctor” comes from the word “to lie,” which in the old days meant “to speak.” Since ancient times it has been said that a doctor heals in three ways: with words, with plants and with a knife. And the word was put first. In some cases, the word can contribute to the recovery of the patient, and in others, on the contrary, provoke illness. For example, when examining a patient, palpating the stomach, the doctor inadvertently asks: “Did you have any sick people among your relatives?” malignant diseases? What should the patient think after such a question? Naturally, he may well convince himself that he has cancer tumor. This example demonstrates iatrogenicity resulting from a violation of medical ethics.

An example of iatrogenicity due to surgery: a patient underwent surgery to remove a retroperitoneal tumor. The tumor was removed, but during the operation the inferior vena cava (large blood vessel), from which it began heavy bleeding. The patient died from blood loss. Unfortunately, such tragic cases do occur, and they are subject to mandatory analysis at special clinical and anatomical conferences.

Diagnostic procedures can also be fraught with danger. A patient suspected of having an intestinal disease was referred for a colonoscopy ( endoscopic examination intestines). During a colonoscopy, as a result of rough handling of the device, the wall of the large intestine was damaged and it ruptured. Similar complications occur during fibrogastroduodenoscopy (endoscopic examination of the esophagus, stomach and duodenum). Such cases can occur in doctors with little practical experience carrying out these procedures.

Long-term uncontrolled use steroid hormones, which are prescribed for the treatment of joint diseases, can lead to the development of acute ulcerative defects in the stomach and duodenum accompanied by bleeding. Therefore, taking such drugs should be carried out under the strict supervision of a doctor, supported by the results of blood tests for the content of platelets (cells responsible for blood clotting). This example is a classic case of iatrogenicity from an adverse (side) effect of a drug.

Many similar examples can be given, but what is more important is not the facts, but the answer to the question: how to reduce the number of iatrogenic diseases? Reducing the number of iatrogenies is a difficult task, but feasible. And its implementation requires efforts from both the doctor and the patient.

What can a doctor do?

To reduce the number of iatrogenies, doctors of any specialty need to constantly improve their professional level and strictly adhere to the basic rules of medical ethics. For a real doctor, the welfare of patients should be above all, and this is what needs to be taught to future doctors in medical universities. Much depends on the leadership medical institutions: cases of iatrogenic diseases should never be ignored.

What can the patient do?

Any patient seeking medical care can and should take measures to protect themselves from iatrogenic diseases. First of all, when contacting a medical institution, it is advisable to inquire about its credibility among other clinics and the qualifications of the doctors working there. If you doubt the professionalism of a doctor, it is better to seek help from another specialist.

In addition, patients from the category of “professional” patients often become victims of iatrogenics. These people become frequent visitors medical institutions: at any, even the most insignificant signs of ill health, they make an appointment with a doctor and undergo expensive examinations. And if, according to the doctor, the patient is healthy, such a patient rushes to see another doctor so that he can find a pathology in him. On the one hand, tactics timely appeal see a doctor is correct: on early stages the disease is easier to cure. But on the other hand, excessively frequent diagnostic procedures give rise to an increase in iatrogenic diseases. There is no need to look for a disease where it simply does not exist.

Often in constant worry people with hypochondriacal syndrome are aware of their health status. They are the ones who become “professional” patients, finding symptoms of more and more new diseases. You should know that hypochondria belongs to the category psychosomatic disorders, and such a person needs the help of a psychologist, and in some cases, a psychotherapist.

If iatrogenic behavior has already occurred, then a mandatory investigation into the causes of the incident is necessary. And if the cause of an iatrogenic disease is the incorrect actions of the doctor, and the occurrence various kinds complications could have been prevented, then the patient has the right to demand compensation for the damage caused to his health.

Conclusion

The topic of iatrogeny is very complex and painful not only for patients and their relatives, but also for doctors. For a real doctor, every mistake he makes, and especially with fatal, often becomes a personal tragedy. History knows cases when, after the death of his patient, the attending physician took his own life. For example, Professor S.P. Kolomnin injected cocaine transrectally (into the rectum) into the patient for pain relief, after which the patient died. The attending physician then shot himself. Another, the German doctor Block, was poisoned after fatal outcome of his patient, from whom he tried to remove part of the lung during a tuberculosis process. Doctor Blok and his patient were buried at the same time.

This in no way justifies medical errors, but every patient must understand that the doctor is not God, and he, like any person, tends to make mistakes. And therefore the most main defense from iatrogenics is an independent, systematic care for own health. But you must admit, few of us consciously do this.

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 of 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 correct or incorrect;

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, develops without medical interventions, propose to understand iatrogenics as any diseases that arise in a patient as a result of medical interventions or communication with medical professionals, regardless of the place of medical care and the causative factor. However, this definition from modern positions does not fully reflect the phenomenon of iatrogenics, since it does not take into account medical injuries and medical workers, who also often suffer from iatrogenic diseases.

Iatrogenesis is all diseases and injuries that occur in patients and health care workers as a result of providing any type of medical care.

To designate diseases associated with the provision of medical care, the following names were 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, side effect medicines. P. F. Kalitievsky et al. Iatrogenesis is classified into those caused by medicinal, surgical, physical and other methods of treatment. V. L. Kovalenko et al. In the iatrogenic group, diseases associated with diagnostic studies, drug treatment, preventive measures, iatrogenic pseudo-diseases, informational and other iatrogenies are distinguished. E. D. Cherstvoy et al. The classification was based on the type of medical intervention, identifying 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 constructing classification schemes of iatrogeny 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, depression, anxiety, depressive and hypochondriacal disorders. They are caused by careless and misunderstood statements by a medical worker about the patient’s health status, familiarization with one’s own medical history and special medical literature, and 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 of the side effect of drugs is illness, and the cause of the disease is the medicine prescribed by the 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. We present only one etiopathogenetic classification, which is the result of a generalization of the works 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 intoxications, 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); pseudoallergic 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 iatrogeny. 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 .