Iatrogenic disorders include neuroticism. Category III iatrogenia - pathological processes, unusual fatal reactions, including those caused by inadequate, erroneous or incorrect medical effects, which caused lethal

The common phrase "to err is human" is often used as an excuse in cases of any mistakes. It's scary to make a mistake, but it's even scarier not to admit it. Especially if we are talking about a medical error, the payoff for which is the health of the patient.

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

Definition and classification of iatrogenics

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

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

1. Iatrogenia resulting from a violation of medical ethics. The reason for such iatrogeny is the incorrect communication of the medical staff with the patient.
2. Food (alimentary) iatrogenesis. It appears in cases where the diet prescribed by the doctor is not followed and this leads to the development of complications of diseases.
3. Iatrogenicity due to adverse side effects medical preparations. This is a fairly common form of iatrogenic, and its consequences are various allergic reactions, bleeding, shock conditions.
4. Iatrogenia, which is the result of medical manipulations. This includes failures diagnostic procedures: biopsy (taking a piece of tissue for research), endoscopic procedures (examination of organs using a special apparatus - an endoscope).
5. Anesthesia-resuscitation iatrogeny. This is one of the most dangerous types of iatrogenic, which is caused by complications during resuscitation, anesthesia. Its result can be cardiac arrest, breathing.
6. Iatrogenia as a result of surgical (surgical) interventions. This type of iatrogenic is complex and often leads to disability of the patient.
7. Iatrogenicity due to exposure to radiation energy: the pathological effect of high doses x-ray radiation, laser beams.

Iatrogeny on practical examples

Some cases of iatrogeny 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 "lie", which in the old days meant "to speak". Since ancient times, it has been said that the doctor heals in three ways: with a word, with a plant 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 the disease. For example, when examining a patient, feeling his stomach, the doctor inadvertently asks: “Have you among your relatives any patients with malignant diseases?” What should the patient think after such a question? Naturally, he may well convince himself that he has a cancerous tumor. This example demonstrates iatrogenicity resulting from a violation of medical ethics.

An example of iatrogenic due to surgical intervention: The patient underwent an operation 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 occur, and they are subject to mandatory analysis at special clinical and anatomical conferences.

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

Prolonged uncontrolled use steroid hormones, which are prescribed for the treatment of joint diseases, can lead to the development of acute ulcer defects in the stomach and duodenum accompanied by bleeding. Therefore, the intake of 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 iatrogenic from an adverse (side) effect of a drug.

Many similar examples can be cited, but it is not the facts that are more important, but the answer to the question: how to reduce the number of iatrogenic diseases? Reducing the number of iatrogenies is a difficult task, but doable. And for its implementation, efforts are needed both on the part of the doctor and on the part of 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 follow the basic rules of medical ethics. For a real doctor, the welfare of patients should be above all, and this is what future doctors should be taught in medical universities. A lot depends on 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 steps to protect themselves from iatrogenic diseases. First of all, when contacting a medical institution, it is advisable to make inquiries about its credibility among other clinics, about the qualifications of the doctors working in it. 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 iatrogenic disease. These people become frequent visitors to medical institutions: for any, the most insignificant signs of ill health, they make an appointment with a doctor, undergo expensive examinations. And if, according to the doctor, the patient is healthy, such a patient hurries to see another doctor so that he can find a pathology in him. On the one hand tactics timely treatment to the doctor is correct: in the 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, people with hypochondriacal syndrome are in constant concern about their health. It is they who become "professional" patients who find symptoms of more and more new diseases. You should know that hypochondria belongs to the category of psychosomatic disorders, and such a person needs the help of a psychologist, and in some cases a psychotherapist.

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

Conclusion

The topic of iatrogenics is very complex and painful not only for patients and their relatives, but also for doctors. For a real doctor, each of his mistakes, 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 administered cocaine transrectal (into the rectum) to the patient for the purpose of anesthesia, after which the patient died. The attending physician then shot himself. Another, the German doctor Blok, poisoned himself after lethal outcome of his patient, to whom he tried to remove part of the lung during the tuberculosis process. Dr. 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 the Lord God, and he, like any person, tends to make mistakes. And therefore the most main defense from iatrogenic - this is an independent, systematic care of one's own health. But you must admit, few of us consciously do this.

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

Such disorders (as a result of the impact on the patient of the eloquence and actions of the doctor) have been known since antiquity. The term "iatrogenic" was coined in 1925. Since then, it has been studied by various specialists. It's good to have something to explore. Moreover, some experts tend to attribute to iatrogenic not only deontological errors, 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 it - not from the point of view of researchers, but our understanding? We interpret. Iatrogenic diseases (iatrogenies) are painful conditions based on such statements of the doctor (or such actions of the doctor) that provoked negative impact on the patient's psyche, as a result of which the latter has new pain and even severe conditions.

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

Positive without optimism

And what? Examination by a specialist consultant. Consultation. A misreading of a stupidly written health education publication. Dissemination of medical information among the population (lectures, television and radio broadcasts). The patient's special attention to the doctor's words, to his behavior, facial expressions, intonations - in any situation. And accordingly, ill-conceived remarks of the doctor. For example, "hooked stomach" ... Typical manifestation iatrogenic.

Well, the fact that women are more prone to iatrogenic than men is that people are more susceptible to an increased risk of iatrogenic 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. It just puts dots over the "i".

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 iatrogenic ( adverse effect during the examination)
Silent iatrogenics (a consequence of the inaction of the health worker).

After this short list, we can recall that the observance of moral and ethical standards by a medical worker implies not only the fulfillment of duties, but also the responsibility for unprofessionalism. For mistakes. For offenses. Remembered? So what?

Good health - no matter what

The main method of treatment of iatrogenic diseases is psychotherapy. If additional treatment is expected, it is supplemented. 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 - to everyone personally. Well, if respected medical workers begin to comment on this wish, advise and intervene in it, a prosperous prognosis ceases to be prosperous. good health, however.

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

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

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

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

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

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

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

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

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

Iatrogenic diseases (Greek iatros + gennaō create, produce; synonymous with iatrogenic)

psychogenic disorders arising as a result of deontological errors of medical workers - incorrect, careless statements or actions.

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

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

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

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

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

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

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

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

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

See what "Iatrogenic diseases" are in other dictionaries:

Modern Encyclopedia

- (iatrogenies) (from the Greek iatros doctor and ... gene) psychogenies, due to the careless statements or behavior of medical workers, which create a person's idea that he has any disease or of particular severity ... ... Big Encyclopedic Dictionary

Iatrogenic diseases- (iatrogenics) (from the Greek iatros doctor and ... gene), psychogenics due to careless statements or behavior of medical workers that create an unreasonable idea in a person that he has any disease or ... ... Illustrated Encyclopedic Dictionary

IATROGENIC DISEASES- (iatrogenic) psychogenic, due to careless (or misinterpreted) statements or behavior of a doctor (medical workers), because of which a person begins to think that he has some kind of illness, or about an existing illness that she ... ... Russian encyclopedia of labor protection

- (iatrogeny) (from the Greek iatrós doctor and ... gene), psychogeny, due to the careless statements or behavior of medical workers, which create in a person the idea that he has any disease or of particular severity ... ... encyclopedic Dictionary

- (iatrogeny) (from the Greek. iatros doctor and ... gene), psychogenic, due to careless statements or behavior of honey. workers, to rye create in a person the idea of the presence of c. l. disease or about the special severity of his existing ... ... Natural science. encyclopedic Dictionary

- (from the Greek iatros doctor and ... gene (See ... gene)) iatrogenic, mental disorders caused by the traumatic influence of statements and (or) behavior medical staff; belong to psychogenies (See Psychogenies). Mental trauma... Great Soviet Encyclopedia

Iatrogenia (dr. Greek ιατροσ doctor + other Greek γενεα I give birth) the term was proposed in 1925 by the German psychiatrist Bumke (O.S.E. Bumke)) changes in the patient's health for the worse, caused by a careless word of a doctor or a misunderstanding of medical ... ... Wikipedia

The request "Sick" is redirected here Illness, disease (Latin morbus) is a violation of normal life, working capacity, socially useful activity arising in response to the action of pathogenic factors, ... ... Wikipedia

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Hosted at http://www.allbest.ru/

STATE BUDGET EDUCATIONAL INSTITUTION OF HIGHER PROFESSIONAL EDUCATION PETROZAVODSK STATE UNIVERSITY

MEDICAL FACULTY DEPARTMENT OF PROPADEUTICS OF INTERNAL DISEASES

ABSTRACT

Subject: Iatrogenic. Causes , prevention

Performed:

Student 104 group

Kremneva A.V.

Petrozavodsk 2013

Content

What is iatrogenic?
Types of iatrogenic
Symptoms
Iatrogenic pathology
Causes of iatrogenic
Consequences of iatrogenic
Examples of iatrogenic
Conclusion
Bibliography

What is iatrogenic?

Iatrogenia is a type of psychogenic disorder that occurs as a result of incorrect behavior of medical workers (careless statements or actions, popular science lectures built in a pessimistic plan, etc.)

It is assumed that any contact of a person with medical field may be iatrogenic. If a person is predisposed to it. Therefore, the true causes of iatrogenesis are rooted both in the behavior of medical workers and in the personality of the patient.

Lack of trusting relationship with the patient, neglect of the mental components of any medical procedure or their recommendations, contributes to the emergence of iatrogenic disease.

Sometimes it is not even the information that the doctor gives to the patient that could cause iatrogenia that is important, but the tone in which this information was said.

The risk group is made up of women, people of transitional ages (teenagers and people in the period of menopause), as well as elderly people who are waiting for the "inevitable senile changes" to appear.

The existing trends towards an increase in the elderly and an increase in neurosis make the problem of iatrogenic diseases more and more urgent. After all, iatrogenic can appear in any person, in your family and friends, and even in yourself ...

Iatrogenicity and its first appearance

Iatrogenicity is a change in a patient's health for the worse, caused by a careless action or word of a doctor.

iatrogenic psychogenic disorder

Considerable interest in the question of the influence of the psyche on various physiological and pathological processes in the human body arose among doctors and researchers at the beginning of the 20th century.

The term "iatrogenic" was coined by the German psychiatrist Oswald Bumke.

In the work "The Doctor as the Cause of Mental Disorders" in 1925, and in the Russian-language medical literature was first used in the works of such psychiatrists and therapists R. A. Luria, K.I. Platonov.

O. Bumke (O. Bumke) in the article "Doctor as the cause of mental disorders", drew attention to these harmful effects incorrect behavior of the doctor on the psyche of patients and called this kind psychogenic illnesses"iatrogenic damage". Focusing on these, in essence, well-known diseases to every doctor, Bumke correctly notes that salient feature they are that the participation of the medical council in the origin of the iatrogenic disease remains unknown to the doctor himself, who participated by his word, behavior or advice in the psychogenesis of the disease .

The cause and origin of the disease is established by another doctor, and often after a considerable period of time, when the patient appears with the suffering suggested to him by the doctor and lost as a result of this. peace of mind. In this case, the patient is either completely a healthy person, or suffers from a minor organic disease that does not justify either a serious recognition or a poor prognosis of a doctor who expresses his fears to the patient in one form or another and showed him with something that it is a serious form of the disease.

("In May 1990, the first congress of the International Society for the Prevention of Iatrogenic Complications (ISPIC) was held in Elsinore. The Congress adopted a special "Statement on safety in health protection", in which iatrogenics are considered as the final negative result functioning of the health care system as a whole.

"Anglo-American dictionary sources include in the consequences of iatrogenic not only mental, but also somatic disorders, introducing the concept of intent, and determine the stage of the doctor's activity.

The Oxford Advanced Learners Dictionary (1988) defines iatrogenics as "mental or bodily disturbances, symptoms, etc., unintentionally caused by a physician as a result of his diagnosis, behavior, or treatment."

The American Heritage Dictionary (1981) speaks of "changes that occur in the patient as a result of the doctor's words or actions." …

Webster's Encyclopedic Dictionary (1989):

"nervous or physical disturbances due to the diagnosis, course of action, or treatment of an internist or surgeon";

International Society for Prevention of Iatrogenic Complications (1991):

"complications arising from the functioning of the health care system as a whole, including all human, technical and organizational aspects of the process medical care"….

Professional assessments of iatrogenics are even more diverse:

"These are functional and organic diseases, the cause of which is the influence or actions of a doctor, or medicine in general (medical literature), or the patient's personality traits"

"Iatropathogeny (abbreviated as iatrogeny) is a way of examining, treating or carrying out preventive measures as a result of which the doctor harms the health of the patient

"The essence of iatrogenics can be described by three groups of words:

1) describing the mechanism of occurrence of iatrogenic (action, intervention, influence, behavior, deeds, statements, mistakes);

2) answering the question "what happened?" (changes, consequences, violations, disorders, case, complications, diseases);

3) and, finally, giving a qualitative assessment of the past events (unfavorable, negative, negative, harmful, undesirable, side).

It should be noted here that the original interpretation of iatrogenics, oddly enough, does not contain either an assessment of the consequences of the doctor's activity (favorable or unfavorable), or an object for applying his knowledge and experience.

It is neutral and only highlights its source. It is not clear at what point in the history of medicine iatrogenics acquired a negative connotation. Attempts based on linguistics to discover the possible roots of this transformation have not been successful. One can only assume that since medical activity is always, in essence, ambivalent, i.e. includes both positive and possible negative consequences, there was a need to somehow highlight these negative aspects for the patient.

According to the definition given in the pre-war edition of the Great Medical Encyclopedia, iatrogenic is "a term denoting the negative effect of a doctor on a patient, when instead of therapeutic effect the patient has ideas that aggravate him disease state, or a psycho is formed. new disease complex

Also iatrogenic is characterized as "negative psychotherapy"

From the pre-war period until the 1970s, the term continued to be used primarily to refer to psychogenic illnesses arising from a careless statement by a doctor.

The term is now used broadly, and according to ICD-10, iatrogenic is understood as any unwanted or adverse effects preventive, diagnostic and therapeutic interventions or procedures that lead to impaired bodily functions, limitation of habitual activities, disability or death; complications of medical measures that have developed as a result of both erroneous and correct actions of a doctor.

Also a variant of yantrogenic diseases are the so-called "third-year diseases", when a medical student, studying the propaedeutics of internal diseases, finds symptoms of a non-existent disease.

Types of iatrogenic

IN Depending on the cause, the following types of iatrogenic are distinguished:

1) Psychogenic

2) medicinal

3) traumatic

4) infectious

5) mixed

Psychogenic iatrogenics.

Psychogenic iatrogenies manifest themselves in the form of various mental disorders: neurosis, neurasthenia, hysteria, phobias, depression, anxiety. 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 iatrogenies also develops in cases of treatment failure, distrust of the doctor, fear of diagnostic methods, treatment, and a sharp change in lifestyle.

Medicinal iatrogenics.

Drug iatrogenic disorders are disorders caused by the action of drugs, including allergies to them.

There are several groups of such disorders:

· Side effects of drugs;

Drug poisoning due to drug abuse;

drug allergy

Non-allergic drug intolerance

· drug addiction

Drug-induced psychoses

Complications of the disease caused by the incompatibility of simultaneously administered drugs

Post-vaccination reactions and complications

Among these groups of medicinal iatrogenics, the first three are in the lead. Of these, allergies are the most insidious.

Traumatic iatrogenic.

This is the name of the problems caused by the action of medical instruments and devices.

In this group there are:

Surgical (with surgical operations)

Manipulation (with injections, etc.)

・Random medical injuries

Burns

The consequences and complications of surgical and manipulation injuries and burns are especially serious and numerous.

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 iatrogenics

Infectious iatrogenies are also called iatrogenic infections. These include all cases of infectious diseases, infection occurred in the process of providing any type of medical care. They are more often (more sparing for the conscience and honor of the doctor) are called nosocomial (hospital) infections, which does not fully reflect the essence of the phenomenon, since these diseases also occur when providing medical care in clinics and at home, and secondly, they do not include diseases, infection that occurred outside the hospital.

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 XVIII-XIX centuries. they have become widespread.

By the end of the XIX century. When the causes of infectious diseases were discovered, various disinfectants and antibiotics began to be used, but it is still not possible to completely cope with iatrogenic infections.

Symptoms

There are no typical signs iatrogenic diseases, especially considering their polyetiology. Psychogenic pathology can manifest itself as a refusal of treatment, and vice versa, by increased visits to doctors, fortune-tellers, healers.

Infectious diseases proceed with a typical clinical picture, but, as a rule, are less treatable.

One should not blame only medical workers for the occurrence of iatrogeny (unless, of course, there are absolutely obvious reasons for this).

There are a lot of factors leading to this pathology, and most of them are subjective, that is, they stem from the characteristics of the human body and psyche. By the way, iatrogenic diseases also develop in physicians themselves, such as, for example, the "burnout syndrome" familiar to many.

"Burnout Syndrome" is a concept introduced into psychology by the American psychiatrist Freudenberger in 1974, manifested by increasing emotional exhaustion. May entail personal changes in the sphere of communication with people.

The development of this state is facilitated by the need to work in a monotonous or intense rhythm, with an emotional load when interacting with a difficult contingent. This is also facilitated by the lack of proper remuneration (not only material, but also psychological) for the work performed, which makes a person think that his work has no value.

Freidenberger pointed out that such a state develops in people prone to sympathy, an idealistic attitude to work, at the same time unstable, prone to dreams, obsessed with obsessive ideas.

In this case, the burnout syndrome may be a mechanism psychological protection in the form of partial or complete exclusion of emotions in response to traumatic effects.

Iatrogenic pathology

In the current medical literature, there is a large number of various classifications iatrogenic pathology, most of which is based on the division of iatrogenic developed during the provision of various kinds medical care (surgical, medicinal, diagnostic, preventive). From the point of view of forensic doctors, it seems to us that the classification proposed by V.V. Nekachalov (1998), who proposed subdividing iatrogenics into the following three categories:

Iatrogenia category I - pathological processes, reactions that are not pathogenetically associated with the underlying disease or its complication and do not play a significant role in the overall thanatological assessment of the case.

Category II iatrogenia - pathological processes, reactions and complications caused by medical exposure, carried out according to substantiated testimony and done correctly.

Category III iatrogenia - pathological processes, unusual fatal reactions, including those caused by inadequate, erroneous or incorrect medical influences, which caused a lethal outcome.

Of great interest, from the point of view of forensic medicine, is the medical and legal classification of iatrogenics proposed by Yu.D. Sergeev et al. (2001). In it, from the point of view of modern Russian legislation The authors subdivided iatrogenic pathology according to the following principle:

1. Guilty risk - iatrogenic, entailing criminal liability or mixed liability in combination with civil liability.

2. Natural risk.

3. a) Involving civil liability.

4. b) Not liable.

Taking into account both of the above classifications, and also taking into account true meaning definition of iatrogeny (literally: generated by a doctor), it seems to us appropriate to somewhat expand the existing generally accepted criteria for the formation of one or another type of iatrogenic pathology.

The negative attitude towards the term iatrogenic that has been formed for a long time leads to the fact that many truly iatrogenic processes are usually masked under various formulations.

The most common complication is treated as new pathological condition, which is not characteristic of the normal course of the underlying disease and is not a consequence of the progression of the underlying disease. This is a secondary pathological process in relation to the existing disease, arising either in connection with the peculiarities of the pathogenesis of the primary (main) disease in this patient, or as an unforeseen consequence of the diagnostic and medical measures. Of course, in the case when a complication of an existing disease has developed as a result of the characteristics of the course of the underlying disease, without any medical measures, this is a true complication and has nothing to do with iatrogenesis.

But imagine the developed purulent-septic complication in postoperative period. When purulent peritonitis develops as a result of violation of the rules of asepsis or antisepsis, or after "accidental" abandonment foreign body V abdominal cavity after the operation, this, of course, is referred to as the so-called "true iatrogenic" and the doctor who committed this violation should be held accountable. And what about such complications, in which there are no violations on the part of the doctor: technically, the operation was carried out flawlessly, but the patient due to reduced immunity, or due to exacerbation concomitant disease purulent inflammation of the surgical wound developed. Formally, there are no complaints about the doctor, but if there hadn't been an operation, there would have been no such complication. It seems to us that this is just the case that fits into the second category of iatrogenic (according to V.V. Nekachalov’s classification), i.e. pathological processes, reactions and complications due to medical effects, carried out according to reasonable indications and performed correctly. And according to the medical and legal classification of Yu.D. Sergeeva et al. this case can be attributed to iatrogenic natural risk, not entailing liability.

Another type of masking of iatrogenic pathology is the so-called medical error, i.e. wrong actions or inaction of medical personnel that caused deterioration or death of the patient. At the same time, a medical error as a legal category is understood as a conscientious error of a medical worker without signs of criminal negligence, criminal negligence, criminal arrogance or criminal ignorance.

Often, under the wording of a medical error, true iatrogenies can also "hide" when, due to the lack of sufficient skills, the doctor performs any manipulations leading to the development of iatrogenic pathology. But there may be erroneous medical actions taken for so-called objective reasons. For example, with an erroneous diagnosis - a severe brain contusion, the presence of a subdural hematoma - a craniotomy is performed, and during the operation it turns out that hemorrhages under the solid meninges No. Of course, in the conditions of a large city specialized hospital, with the availability of modern diagnostic equipment, such cases practically do not occur, but what about surgeons district hospital where such diagnostic equipment is not available. In this case, there is also an iatrogenic pathology, but developed as a result of the correct actions of the doctor and not subject to legal assessment.

Of course, the main burden of responsibility for identifying iatrogenic pathology lies with pathologists and forensic experts who examine the bodies of the dead and establish the validity and correctness of the medical manipulations.

It seems to us that this category of doctors should not be endowed with "prosecutory" functions. The pathologist or forensic expert should only indicate in his opinion what exactly was revealed during the autopsy, and later, when present at the commissions for the study of lethal outcomes, clinical expert commissions, explain what he saw from the point of view of the dissector. The decision as to whether this pathology Iatrogenic or not, should be taken collectively, taking into account all available data.

However, this does not mean that the commission, based on the principles of corporate solidarity, should hide the identified signs of iatrogenic. On the contrary, recognition that this pathology belongs to the category of iatrogenic is necessary for a more detailed analysis of the case, identification of possible ways of prevention and education of doctors.

Causes of iatrogenic

Causes of widespread and increasing iatrogenic diseases. The progress of medical science and technology, the expansion and improvement of medical care, an introduction to medical practice new highly active drugs and vaccines, on the one hand, provided more short time and greater completeness of recovery of patients, reduced disability and mortality, narrowed the area of their distribution. On the other hand, in parallel with this, the degree of danger of medical care, the number of iatrogenic diseases and mortality from them grew.

Medicine has come to a point where any visit to a doctor brings not only benefit, but also the risk of loss of health and even life.

A thorough scientific analysis of the causes of the increase and severity of iatrogenic diseases remains to be done. But all the causes mentioned in the literature can be grouped into four groups.

The first group is the ever-increasing frequency of contacts between the population and medical workers, which is directly related to the incidence of iatrogenic diseases. The sharp increase in the frequency of contacts is due, firstly, to the growth of independent requests for medical care by the population, caused by a more attentive attitude to one's health and expanded opportunities to receive it; secondly, by expanding the scope of active preventive assistance to the population; thirdly, the transition to specialization, hyper-specialization and multi-stage medical care, as a result of which the patient is currently in contact with dozens of medical workers in the process of treatment (instead of one or two at the beginning of the century).

The second group of reasons for the growth of iatrogenics is the expansion of the spectrum and the increase in the damaging power of mechanical, physical and biological factors that are used to prevent diseases, determine the state of health and restore it. The doctor sees only positive value in these factors and does not know whether he is forgetting or ignoring their negative side effect. Expanding the well-known statement of Paracelsus that any substance can be a poison, we add that any medical factor, regardless of its nature, under certain conditions, can become a factor of damage and lead to the development of iatrogenic diseases.

The third group of risk factors for the development of iatrogeny can rightly be attributed to an increase in the sensitivity of many modern people to damage factors, especially mental, chemical and biological (infectious) nature.

The fourth group includes medical factors of a subjective nature, including poor scientific development of the problem of the safety of medical care, especially methods for preventing iatrogenia; inattention to it by the health authorities; low level undergraduate and postgraduate training and the degree of competence of medical workers in matters of safety; ignoring safety requirements in the construction and operation of medical institutions, the creation and use of medical devices, tools, care items, methods and means of diagnosing, treating and preventing diseases; weak material base of a number of medical institutions; lack of a system of accounting, reporting, analysis of most forms of iatrogenic diseases; distrust of a significant part of the population in the activities of health authorities.

These groups of risk factors for the development of iatrogeny are of some importance for the distribution of all groups of iatrogeny, however, each of them has its own specifics.

Consequences of iatrogenic

\ Numerous literature data indicate that the medical, economic and social consequences of iatrogeny are diverse and severe.

Medical consequences are expressed primarily in an increase in morbidity, mortality, and mortality is complicated with the patient. Iatrogenic diseases often cause long-term loss of health and even disability. This is especially true for chronic infections, drug allergies and postoperative syndromes.

The economic consequences are expressed in the increase in the cost of treatment and care, labor losses, the cost of social Security, in a decrease in working capacity, economic losses for the patient's family.

The legal ethical aspect of the consequences of iatrogenesis is less developed. Here, the problem of the relationship between the doctor and the patient comes to the fore. The peculiarity of these relations is that the interests of the doctor and the patient completely coincide: the patient, on his own initiative, turns to the doctor for medical care, and the doctor, based on his professional and moral duty, ensures the fastest and most complete restoration of his health. In this case, the main regulator of relations is ethical categories: the patient's trust in the doctor and the conscience and duty of the doctor. However, when providing medical care, a doctor often harms a person’s health, and a patient, turning to a doctor to get rid of one disease, runs the risk of getting a new one, sometimes more severe than the one with which he went to the doctor. As a result, the relationship between doctor and patient is complicated.

Examples of iatrogenic

In sexology, the most characteristic example of mass iatrogenics can be, for example, the popularization of the views of scientists of the past and some modern experts on negative consequences onanism. This creates a false belief in some men that masturbation was for them. main reason violations in the sexual sphere.

The most frequent results iatrogenic lesions there are neuroses that, without qualified psychotherapeutic treatment, can take a protracted course, negatively affecting the patient's well-being.

There are also somatic iatrogenies (yatropathies), when harm is caused to the patient by drugs (allergic reactions to drugs or improperly prescribed treatment). The likelihood of iatrogenicity in people with sexual problems, increases significantly when seeking medical help not from professional sexologists, but from doctors of other specialties. Underestimation of the whole variety of factors affecting sexual function, often leading to misdiagnosis And improper treatment. There are cases when patients were completely unreasonably recommended surgical prosthetics of the penis as the only possible method elimination of sexual disorders.

Treatment by a sexologist allows minimizing diagnostic errors and avoiding iatrogenic effects on patients with sexual disorders.

Prevention of iatrogenic diseases

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

The main method of treatment of iatrogeny is psychotherapy, supplemented if necessary by symptomatic treatment - the use of tranquilizers, antidepressants and others. psychotropic drugs. It is unacceptable to inform the patient that he does not have a disease and does not need to be treated. Health workers should remember that iatrogenesis is a disease that requires a thorough study of the characteristics of the patient's personality, knowledge of his social environment. In severe cases of iatrogenic diseases, the help of a psychotherapist or psychiatrist is required.

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

Prevention begins with a highly moral, humanistic education of physicians in the process of their training and activities, with a deep assimilation by future health workers of the principles of medical science. deontology, which are based on a sensitive attitude, compassion for the patient. Health workers should be aware of the responsibility for "verbal asepsis", the need for constant monitoring of their behavior (intonations, looks, gestures), which can be misinterpreted by the patient. Thoughtful should be the content of honey issued to patients. documentation. Particular care must be taken when providing medical care to the health workers themselves, in whom iatrogenia is 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 who communicate with patients. Medical system. education of the population should exclude superficial, amateurish training in self-diagnosis, which contributes to the spread of iatrogenic diseases.

A few rules to prevent iatrogenic diseases

1. Based on the priority of the quality of life. If "disease 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 with rational information of patients.

3. When making a diagnosis, one should rely on classical neurological topical diagnostic criteria. Paraclinical studies should be used as an aid to diagnosis. The use of these methods should be considered through the prism of the forecast: whether this or that method will make any significant contribution to improving the prognosis and quality of patient treatment.

4. Strive to obtain maximum information with a minimum paraclinical examination. Indications for appointment 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 if elementary hygiene standards are violated ( rational organization mode of work and rest, sleep, sports, taking certain food products, smoking, excessive consumption of coffee, other "doping"), and try to regulate them. Many diseases are "self-limiting" and resolve on their own without the use of drugs.

8. Avoid polypharmacy. Choose the main disease in the "bouquet" of diseases and the key links of pathogenesis and act on them, giving preference to drugs that have shown themselves well for at least 5 years, and drugs that meet the requirements evidence-based medicine. Strict accounting 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 with their gradual cancellation. In the elderly, given the altered pharmacokinetics, try to use drugs at a dose less than the recommended one and with a longer interval. Preference is given to prolonged preparations.

Conclusion

High risk of developing diseases in the process of receiving medical care, the use of psychiatry to persecute political opponents, the closed work of medical institutions, the patient's complete dependence on the doctor in relation to his health and life, the corporatism of the behavior of many doctors, many conflict situations between medical workers and patients have led to a decrease and even loss of trust in some doctors and medicine in general. Trust in a doctor no longer fully fulfills the role of a moral regulator of relations between a doctor and a patient, between the population and healthcare. The second moral regulator - the doctor's conscience and duty - due to a number of circumstances has lowered its threshold and is no longer a sufficiently reliable criterion for the safety of medical care.

Inability to solve complex ethical issues modern medicine appeals to patients about trust in doctors and doctors about their duty and conscience led to the promotion of a new concept of medical care, which was called the "partnership model" (cooperation). According to this model, the relationship between doctor and patient should be determined by the informed and voluntary consent of the patient (and sometimes his relatives) to all elements of medical care related to diagnosis, treatment and prevention.

Bibliography

1. www.wikipedia.ru

2. www.medklug.ru

3. www.mif-ua.com

4. N. V. Trunkina, A. B. Filenko "General care for the sick" // 2007.

5. www.ne-kurim.ru

6. www.sexece.ru

7. www.medpsy.ru

Hosted on Allbest.ru