Iatrogenic diseases concept, types, possibility of prevention. Drug-type iatrogenicity. · Iatrogenesis II category - pathological processes, reactions and complications caused by medical effects, carried out according to reasonable indications and performed

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, and psychological.

In medicine, there are two definitions of this concept:

1. Various side diseases which are related to:

• 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 argue that there is no problem as such - medical error, iatrogenic diseases say 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.

Types of iatrogenesis

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 Kalitievsky.
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 occurred after surgical intervention or as a result of 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, risk side effect 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, there can be no talk of any sanctions against the medical institution.

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 stress resistance, susceptibility, tolerance medicines. 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 may 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

IN Lately new concepts have appeared:

• "Sistergeny" - mental disorders 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 cases 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, medical personnel themselves may suffer from such a pathology - everyone knows “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 makes a claim against a doctor regarding an incorrect attitude or improper treatment, as a result of which he received a disease, then in order to file 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 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. 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 drug iatrogenicity, the doctor must be well aware of the effect of the drug on the body and 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.

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, hysteria, the development of various phobias, as well as other work disorders nervous system patient. 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. This and allergic reactions after taking medications, and all kinds 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, and surgery. Traumatic iatrogeny is also burns that can have different nature(chemical, thermal, radiation), and injuries (accidental or not). Invasive methods research has recently gained wide popularity, because they provide 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, medical institution, which 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.

Iatrogenesis is a complication of the underlying disease or the original cause of death itself, caused by erroneous or inadequate actions of a doctor, or a disease pathological processes, unusual reactions caused by medical influence during the examination of patients, performing diagnostic and preventive procedures (V.V. Nekachalov, 1998). In ICD-10, iatrogenies are considered adverse consequences medicinal or diagnostic measures and manipulations, activities carried out due to an erroneous diagnosis, accidental harm to a patient during a planned or emergency operation, transfusion of foreign or low-quality blood, as well as complications drug therapy. In the 15th grade, iatrogenic pathology in obstetrics is not presented under a general heading, but is scattered in various sections, for example, in obstetric trauma and anesthetic complications. To avoid a "prosecutorial" approach, the pathologist must understand that some iatrogenies, even with fatal, but with correctly provided medical care or rational surgical tactics, they should be considered as a complication of the underlying disease, since the severity of their course is explained mainly by the weakening of the woman’s body due to the underlying disease. However, in obstetric practice there are accidental damage neighboring organs at operative delivery(intersection of the ureter, large vessel, etc.), which due to their volume become the initial causes of MS. More often, a pathologist or forensic expert analyzes inadequate reactions to medications, transfusions of foreign or low-quality blood, and blood substitutes. All of them are included in the heading O75.4 “Complications caused by obstetric surgery and other procedures,” except for complications of anesthesia, surgical wound, suture dehiscence, hematoma and infection. The concept of “procedures” corresponds to that part of the definition of obstetric causes of MS, which refers to omissions and improper treatment(see 1.1).

Reactions to drugs are rarely cited as the initial causes of MS. Thus, in our advisory material we met deaths at intramuscular injection penicillin (anaphylactic shock), intravenous administration but-shpy at the initial satisfactory condition women. Pathological verification of an individual response to drugs is extremely complex and is usually based on chronological coincidence sharp deterioration the woman’s condition immediately after administration of the medicine. According to I.V. Timofeev (1999), among drugs that sometimes cause an anaphylactic reaction in somatic patients, antibiotics are in first place, especially penicillin, bicillin, streptomycin, tetracycline, etc. They are followed by pyrazolidine drugs (analgin, amidopyrine), local anesthetics (novocaine, dicaine, anesthesin), as well as vaccines and hormones (pituitrin, mammophysin, prednisolone). This list should also be taken into account in obstetric practice, since many of these drugs are used during pregnancy and in postpartum period. Unfortunately, the number of mothers who died due to blood transfusion - hemolyzed, bacterially contaminated, overheated and even of a different group (5-7 women per year) is not decreasing. Currently, obstetrics is dominated by a very cautious attitude towards transfusion of whole canned blood. In our country, its group affiliation is determined only by the ABO system and the Rh factor; the blood of the donor and recipient is still not typed according to the HLA system. Canned blood quickly undergoes biochemical and morphological changes: microclots are formed, the number of which reaches dangerous level- 100,000 in 1 ml. Rapid administration of citrated blood leads to the accumulation of potassium in the plasma and massive hemolysis of red blood cells. Moreover, 1/4 of the total oxygen capacity transfused donated blood is not utilized in the recipient's body. It is believed that the only reason for transfusion of whole preserved blood is complete absence see your doctor for other treatments.

When transfusion of low-quality blood occurs, post-transfusion shock occurs due to toxic properties hemolyzed red blood cells and denatured plasma proteins. Bacterial contamination of blood can be the result of its improper preparation, transportation, storage and inadequate transfusion techniques: repeated punctures with a needle through a stopper, the use of blood residues, etc. As a rule, the isoserological properties of the donor’s blood correspond to those of the recipient, but after transfusion (after 20- 40 min) a clinic of infectious-toxic shock occurs: the woman develops stunning chills, hyperthermia, nausea and collapse, then - coma due to toxin poisoning. The pathological picture of transfusion of contaminated or hemolyzed blood does not differ from that of Rhesus conflict (see below). To establish a diagnosis, an extremely important element is the examination of the remains of transfused blood, which must be stored for at least 6 hours after transfusion. In addition, citrate shock is possible, which is observed with the rapid injection of large volumes of preserved blood and is explained by the direct toxic effect of sodium citrate, a hemopreservative. It is enough to inject 100-150 ml of blood within a minute to create the danger of citrate intoxication and sudden changes in the ratio of calcium and sodium.

The syndrome of massive transfusions (blood, blood substitutes and other fluids) occurs if more than 30-40% of the required volume of blood volume is introduced into the bloodstream during the day. Thrombocytopenia, leukopenia and vascular collapse occur, and subsequently - hemostasis disorders, hypokalemia, ventricular fibrillation, acute renal or respiratory failure. Incompatibility of transfused blood according to the ABO system and the Rh factor occurs in two phases. The first phase is characterized by signs of shock already with a transfusion of 25-100 ml of blood: sudden severe pain in the lower back and abdomen, fever, chills and tachycardia. In the second phase, renal failure rapidly progresses - oliguria, then anuria and increased blood pressure. Disorders of hemostasis are added - disseminated intravascular coagulation syndrome as a result of massive hemolysis of red blood cells. In the end, icteric discoloration of the skin and toxic signs shock. At autopsy the prevailing picture anaphylactic shock: liquid state of blood in large vessels, intravascular hemolysis, yellow staining of the aortic intima or manifestations of acute renal failure(example 13).

At massive blood loss in women and lack of single-group blood they use universal blood I (0) group, which contains its own antibodies, sometimes causing a severe post-transfusion reaction. In these cases, it is especially important to re-determine the compatibility of the blood of the donor and recipient in the remainder of the vial and the cadaveric blood of the woman if the autopsy was performed within 24 hours after death.

Among fatal complications blood transfusions are rare acute DIC syndrome after intraoperative reinfusion of blood from abdominal cavity, usually after ectopic pregnancy and placental abruption. Aspirated blood contains fibrin thrombi, microparticles of placental tissue, and components of abdominal secretions, which are powerful thromboplastic substances. Reliable purification of autoerythrocytes is achieved only with the help of special, expensive devices (V.I. Kulakov et al., 2000). With simple filtration of autologous blood through gauze, its thromboplastic properties are preserved. Analysis of iatrogenic pathology is the most difficult section of the work of a pathologist and forensic expert, since they have to balance on a “fine line”, on the one hand, an overly harsh approach to the attending physician, on the other, an imaginary collegiality, administrative dependence on the chief physician. It is important to emphasize that the final decision on the presence of iatrogenic pathology as the initial cause of MS is determined at a clinical and anatomical conference. In cases where the pathologist does not agree with the decision of the conference, he must record his dissenting opinion.

At the end of the section “Obstetric causes”, cardiomyopathy in the postpartum period, hepatorenal syndrome and postpartum thyroiditis, which were not found in our material, are also listed. It ends with the section “Obstetric death in unspecified reason"(O95). It is used if the cause of death of a woman is not determined at the autopsy, but microscopic examination organs for some objective reason turned out to be impossible, for example due to pronounced autolysis of internal organs.

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

Health disorders that arise as a result of the influence of a doctor’s words and actions on a patient were already known to ancient physicians. However, the term “iatrogenics” became widespread only after the publication in 1925 of the work of the German psychiatrist Bumke (O.S.E. 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 experts, especially abroad, attribute to them pathology that arises as a result of not only deontological errors (see. Medical deontology), but also any actions of the doctor (from complications of an incorrectly performed manipulation or procedure to the occurrence of the so-called medicinal disease), i.e. any negative consequences of medical intervention. Some researchers designate such conditions as iatropathies, or somatic iatrogenies.

For development iatrogenic diseases(in the traditional interpretation) both the doctor’s behavior and the patient’s personality traits (degree of emotionality, suspiciousness, etc.) matter. Many of the sick people suffer not only from the disease, but also from the anxiety, fears, and concerns about the outcome it generates. This explains the patient’s special attention to both the doctor’s words and his behavior, intonation, and facial expression. Moreover, depending on the type nervous activity, personality type and mental characteristics, different patients react differently, sometimes in the opposite way, to certain words and behavior of the health worker. Not only ill-considered remarks can have a pathogenic meaning (“Your heart attack is the first call”; “... main vessel the heart allows blood to pass through by 30%”, etc.) or the unclear meaning of some words and expressions (“hook-shaped stomach”, “myocardial dystrophy”, etc.), but sometimes even interjections or prolonged silence of the doctor, which can be interpreted patients as signs of particular difficulty in diagnosing or treating their illness, its particular severity, and the hopelessness of the prognosis.

Risk of occurrence iatrogenic diseases ceteris paribus is not the same among individuals of different ages, gender, education. Women are, on average, more likely to have iatrogenic disease than men. Age groups at increased risk of development iatrogenic diseases are the people of the so-called transitional ages- adolescents and people in menopause (especially women with pathological menopause), as well as elderly people, among whom there are many who emphasize the inevitability of involutive changes in them and the increased likelihood of death of the 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 disseminated among the population (popular lectures, television and radio broadcasts), when the symptoms of a particular dangerous disease, attention is focused on its early manifestations, and frightening prospects for “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 the psychotrauma and premorbid personality characteristics, autonomic disorders may be generalized or expressed by predominant dysfunction of the cardiovascular (heart arrhythmia, changes in blood pressure, etc.), digestive (heartburn, vomiting, bowel 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 for treatment to be carried out by a psychotherapist or psychiatrist. It is unacceptable to inform the patient that he does not have the disease and does not need treatment. Doctors should remember that we're talking about about a disease that requires a thorough study of the patient’s personality characteristics and knowledge of his social environment. Psychotherapy requires establishing the characteristics of this iatrogenic disease and the factors that contributed to its occurrence. A great psychotherapeutic effect can be achieved by a convincing conclusion from an authoritative council or a highly qualified specialist, brought to the attention of the patient

Forecast Ya. z. in most cases it is favorable; with timely and correct therapy, recovery occurs within 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 neuroses, as well as a progressive increase in the number of people in older age groups, increase the risk of iatrogenic events. Against this background, the responsibility of doctors for “verbal asepsis” increases, the need to constantly monitor their behavior (intonation, glances, gestures), which can be misinterpreted by the patient. IN modern conditions, when, as a rule, not one, but several doctors, as well as middle and junior health workers, communicate with the patient, the possibility of iatrogenic disease increases. Therefore, as a warning iatrogenic disease It is necessary to carry out systematic work with all personnel communicating with patients. The content of medical documentation issued to patients must be thoughtful. Particular care should be taken when providing assistance to health care workers who have iatrogenic diseases are relatively frequent, and their treatment is difficult due to the often increased refractoriness of health workers to psychotherapy.

Iatrogenesis

The term “iatrogenics” began to be widely used in medical practice after the publication of Bumke’s article “The Doctor as the Cause of Mental Disorders” in 1925.

The term iatrogenic has Greek origin: iatros (doctor) and genes (origin). This term means a psychogenic disease or neurosis that arises under the influence of the doctor’s actions, behavior or words.

At the beginning of the 20th century. Swiss psychiatrist Yes. Bleuler wrote that the disease can intensify, become more complicated, or arise as a result of “undisciplined thinking medical worker"This is most often observed when examining a patient, when early signs of illness are detected and the patient is concerned about changes in well-being and is very sensitive to the words of a medical professional.

Until the middle of the 20th century. Iatrogenesis was understood as diseases arising as a result of careless statements of a medical worker. Subsequently, there was a tendency to call all diseases resulting from medical error iatrogenic.

However, not all diseases resulting from medical interventions can be attributed to medical errors. Iatrogenesis includes diseases or deaths resulting from side effects pharmacological drugs.

Iatrogenic diseases and reactions are listed in International classification diseases (ICD), where they can be found both in three-digit headings and in additional classification E.

When analyzing iatrogenic pathology, the following features are determined: - medical and biological (pathogenetic); -medical and social; - legal.

Medical and biological features of iatrogenesis. The development of iatrogenicity depends on the individual characteristics of the patient, his reactivity, stress resistance, individual inadequacy of actions pharmaceuticals, other treatment and diagnostic methods.

In biomedical rice, iatrogeny can be attributed to a bona fide mistake by a doctor, associated with his insufficient qualifications, as well as when introduced into medical practice new diagnostic or treatment methods.

Medical and social features of iatrogenicity. The development of iatrogenics is possible due to errors in the diagnosis of the disease associated with the use of old equipment whose useful life has expired. With insufficient funding for the healthcare industry, such iatrogenies are no longer rare case in medical practice.

Legal features of iatrogenic diseases are associated with the need to compensate for harm caused to human health as a result of medical intervention.

Illness or death of a patient caused by medical negligence also refers to iatrogenic pathology. In this case, we should talk not only about economic sanctions, but also about criminal liability. Complications or development of the disease due to failure to provide medical care and iatrogenicity do not apply.

Classification of iatrogeny

Today there is no single generally accepted classification of iatrogenics. Therefore, in the healthcare industry several variants of classification of iatrogenics are used:

o the etiology of the disease;

o according to the International Classification of Diseases;

o behind Kalityaevsky;

o for Rykov.

Classification according to the etiology of the disease. The classification distinguishes iatrogenic pathologies based on the etiology of the disease, its significance for the course of the disease and thanatogenesis. According to this scheme, the following classes of iatrogenies are distinguished:

I. Iatrogenesis associated with preventive measures.

II. Iatrogenesis associated with the diagnosis of diseases.

III. Iatrogenesis associated with the use of pharmacological drugs.

IV. Iatrogenesis caused by radiology diagnostics or treatment.

V. Iatrogenesis associated with the use of medical instruments and materials (introduction of alloplastic materials into the cardiovascular system, catheterization of blood vessels, use of cardiac pacemakers, etc.).

VI. Complications arising during blood transfusion.

VII. Death due to anesthesia.

VIII. Iatrogenesis that occurs as a result of surgical interventions.

IX. Iatrogenesis of a deontological nature.

Classification according to the International Classification of Diseases. The classification of iatrogenic diseases, developed on the basis of the International Classification of Diseases, is widely used in a number of countries. There are the following classes of iatrogenic diseases:

1. Iatrogenesis arising from surgical diseases and surgical interventions, with clarification of the disease and the nature of the surgical intervention.

2. Iatrogenesis caused by drug treatment.

3. Iatrogenesis associated with preventive measures.

4. Iatrogenesis of diagnostic measures.

5. Death from anesthesia, including with premedication.

Classification according to Kalityaevsky. A feature of this classification is that each class of iatrogenic pathology is divided into subclasses.

I. Iatrogenesis associated with treatment.

1.1. Drug iatrogenies.

G1.1.Iatrogenesis", caused by the side effects of medications or their individual tolerance.

G1.2. Iatrogenesis caused by inadequate or erroneous use of pharmacological drugs.

1.2. Surgical iatrogenies.

D2.1. Iatrogenesis due to the risk and severity of surgery or anesthesia.

I.2.2. Iatrogenesis caused by errors in surgical technique or anesthesia, incorrectly chosen tactics or method of surgical intervention.

1.3. Physical methods of treatment.

I. 3.1. Side effects of radiation and other types physical methods treatments and their individual tolerance.

I.3.2. Iatrogenesis caused by inadequate and erroneous use of radiation and other physical methods of treatment, equipment malfunctions.

1.4. Other iatrogenic diseases associated with treatment.

II. Iatrogenesis associated with the diagnosis of diseases.

11.1. Diseases associated with the risk of using the same diagnostic method or diagnostic tools used.

11.2. Diseases caused by errors during diagnostic procedures, malfunctions in equipment. Excessive diagnostic testing.

III. Iatrogenesis associated with conduction preventive measures(vaccinations).

111.1. Iatrogenesis caused by the risk of side effects of the drug or the method itself.

111.2. Diseases associated with errors during preventive measures.

IV. Information iatrogenies.

V.! Diseases caused by the actions of a medical worker on mental condition patient.

^.2. Self-medication (use of pharmacological drugs that were not prescribed by a doctor).

V. Iatrogenic pseudodiseases.

V.!. Diseases that were recorded in medical statistics but did not cause undesirable consequences in patients.

V. 2. Iatrogenesis that was a consequence misdiagnosis what led to harmful effects for the patient's health.

VI. Other iatrogenies.