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Introduction
One of the unanswered question from the Covid 19 pandemic is how many people caught Covid after entering hospital. The fact is that doctors make you ill. Not every time, clearly. But it happens.
And it’s probably a myth to say that in every case when you are ill you’re better off in hospital. That a broad statement and there are obvious exceptions.
Going back to the question of how many people caught Covid when they entered hospital, The Guardian newspaper made a Freedom of Information request in 2022.
This revealed that at least 11,688 people who died in English hospitals between March 2020 and March 2022 were likely to have caught COVID-19 while there for other treatment.
The truth is we’ll probably never know the truth.
Sadly, hospital acquired infections are not uncommon, indeed, quite the opposite.
Whilst there are clearly high profile exceptions, the overwhelming majority of people working in health care want to do good.
Iatrogenesis, is an all-too-real aspect of modern healthcare. Iatrogenesis refers to the unintentional harm caused by medical treatment or interventions.
The term comes from the Greek words “iatros,” meaning physician, and “genesis,” meaning origin.
So, let’s have a closer look at how doctors make you ill, or iatrogenesis.
Historical Context of How Doctors Make You Ill
Iatrogenesis isn’t a new problem. In fact, history is riddled with examples of treatments that did more harm than good.
Sometimes doctors are at the mercy of the prevailing medical orthodoxy. And if you want a good example of how doctors make you ill from following medical orthodoxy look no further than bloodletting.
It seems almost impossible to believe that even in the 1800s blood letting was still popular. Indeed, a medical textbook from 1942c written by William Osler identified bloodletting as treatment for pneumonia.
Bloodletting whilst, in most circumstances, well-intentioned, often weakened patients further, sometimes with fatal consequences. Similarly, the use of mercury for various treatments in the past led to significant poisoning and death.
As medical knowledge has evolved, so too has the understanding of iatrogenesis. What was once seen as the best available treatment might now be viewed as harmful.
This evolution reflects the progress in medical science, but it also serves as a reminder that what we consider safe today may be questioned tomorrow.
Types of Iatrogenesis
Iatrogenesis can take many forms, each with its own unique challenges and implications.
1. Medical Errors
One of the most recognised forms of iatrogenesis is medical error. These include surgical mistakes, incorrect diagnoses, and medication errors. Even a small error in medication dosage can lead to severe complications, illustrating how critical attention to detail is in healthcare.
2. Side Effects and Complications
While some side effects are mild and manageable, others can be severe and life-threatening. These unintended consequences are a form of iatrogenesis that often comes as a bitter surprise after a treatment that was supposed to help.
3. Overdiagnosis and Overtreatment
In our technology-driven medical world, there’s a growing tendency to diagnose conditions that may never actually cause harm. This can lead to overtreatment, where patients undergo unnecessary procedures, which themselves carry risks.
4. Psychological Iatrogenesis
The impact of medical treatment isn’t always physical. Psychological iatrogenesis occurs when a treatment or diagnosis leads to mental health issues. For instance, a false-positive cancer diagnosis can cause immense anxiety and stress, even after it’s corrected.
5. Social Iatrogenesis
Beyond the individual, iatrogenesis can also have societal impacts. This is particularly evident in the medicalisation of natural life processes, like childbirth, where interventions are sometimes performed not because they are necessary, but because they have become the norm.
Causes and Risk Factors
The causes of iatrogenesis are as varied as the types of harm it can cause. Understanding these factors can help you, as a patient, navigate the healthcare system more safely.
1. Complexity of Modern Medicine
Today’s healthcare system is incredibly complex, and this complexity increases the risk of iatrogenesis. With multiple specialists, advanced technologies, and complicated treatment protocols, the margin for error grows.
2. Communication Breakdowns
Miscommunication among healthcare providers, or between providers and patients, is a significant cause of iatrogenesis. Even simple misunderstandings can lead to incorrect treatments or missed diagnoses.
3. Technological Factors
While technology has revolutionised healthcare, it can also contribute to iatrogenesis. Overreliance on machines and algorithms can sometimes lead to misdiagnoses or inappropriate treatments.
4. Patient Factors
Your own characteristics, such as existing health conditions or how well you understand medical instructions, can also influence the risk of iatrogenesis. For example, elderly patients, who often have multiple health issues, are at higher risk.
Case Studies and Real-World Examples
To understand the real-world implications of how doctors make you ill, let’s look at some cases.
Case Study 1: A Surgical Mishap
Consider the case of a patient who underwent surgery for a relatively minor condition. Due to a mix-up in the operating room, the wrong body part was operated on.
This error not only failed to address the initial problem but also caused significant harm, requiring additional surgeries and leading to long-term complications.
Read the story of Willie King.
Case Study 2: The Dangers of Overdiagnosis
Another example involves overdiagnosis. A woman was diagnosed with ductal carcinoma in situ (DCIS), a non-invasive form of breast cancer.
Although DCIS may never progress to invasive cancer, she underwent a mastectomy, a drastic treatment for a condition that might not have caused harm during her lifetime. This overtreatment led to physical and psychological distress.
Breast cancer overdiagnosis is all too common
Case Study 3: Psychological Impact
A patient who was falsely told they might have a terminal illness experienced severe anxiety and depression, even after further tests revealed the initial diagnosis was incorrect. The psychological impact of this misdiagnosis lingered, illustrating the profound effects of psychological iatrogenesis.
Few of us would say that diagnosis is an easy job. But misdiagnoses can lead to unnecessary treatment. In such cases the psychological impact is incalculable.
Ivan Illich and the Concept of Medical Nemesis
No discussion of iatrogenesis would be complete without mentioning Ivan Illich, a philosopher and critic of modern institutions, who introduced the concept of “medical nemesis” in his book Medical Nemesis: The Expropriation of Health. (This link is an Amazon affiliate link.)
Illich argued that the medicalisation of society had reached a point where medicine was causing more harm than good. He believed that over-reliance on medical interventions diminished our natural ability to deal with illness and pain, turning natural human experiences into medical problems that required professional intervention.
Indeed, Illich argues that the “medical industry” diminishes our well-being by encouraging dependence and discouraging self-care, individual responsibility and individual autonomy with regard to health care.
This is a provocative and important book. Although the book was published almost 50 years ago, anyone who has the slightest interest in the medicalisation of our lives should read it.
Consequences of Iatrogenesis
The consequences of iatrogenesis are wide-ranging, affecting not just individuals but the healthcare system and society as a whole.
1. Patient Impact
For you as a patient, the impact of iatrogenesis can be devastating. Physical harm, emotional trauma, and financial burdens are just some of the possible consequences. In some cases, the harm can be irreversible, leading to long-term disability or even death.
2. Healthcare System Impact
Iatrogenesis also puts a strain on the healthcare system. Treating the harm caused by medical interventions adds to healthcare costs and can undermine trust in medical institutions. When patients lose trust, they may avoid seeking care, leading to worse health outcomes overall.
3. Public Health Implications:
On a broader scale, iatrogenesis can affect public health. If medical interventions are widely perceived as harmful, it can lead to public scepticism about healthcare. This can have serious consequences, such as lower vaccination rates or resistance to public health measures.
Concerns for Seniors
Older adults are particularly vulnerable to iatrogenesis. As you age, your body becomes less resilient, making it harder to recover from medical errors or complications.
Seniors often have multiple health conditions, which can make it difficult to diagnose and treat new problems without causing harm. Additionally, older patients are more likely to be prescribed multiple medications, increasing the risk of adverse drug interactions.
For seniors, it’s essential to have a clear understanding of the risks and benefits of any treatment. It’s also important to communicate openly with healthcare providers about any concerns or symptoms, no matter how minor they may seem.
Prevention and Mitigation Strategies
Whilst its a fact that doctors make you ill: it’s a complex issue. And there are steps that can be taken to reduce the occurrence of iatrogenesis.
1. Improving Communication
Clear communication between healthcare providers and patients is crucial. Don’t hesitate to ask questions, seek second opinions, and ensure you fully understand your treatment options.
2. Training and Education
Continuous professional development for healthcare providers can help minimise errors. Keeping up-to-date with the latest research and best practices is vital in reducing iatrogenic harm.
3. Patient Empowerment
As a patient, being informed and involved in your care can significantly reduce the risk of iatrogenesis. Make sure you understand your diagnosis and treatment plan, and don’t be afraid to voice your concerns.
4. Use of Technology
When used correctly, technology can be a powerful tool in preventing iatrogenesis. Electronic health records and decision-support systems can help ensure that you receive the correct treatment.
5. Policy and System-Level Interventions
On a broader scale, healthcare policies that promote patient safety, such as mandatory reporting of medical errors and continuous monitoring of treatment outcomes, can help reduce the incidence of iatrogenesis.
Ethical Considerations
The ethical aspects of iatrogenesis are profound and should not be overlooked.
1. Informed Consent
One of the most critical ethical considerations is ensuring that you give informed consent. This means you should be fully aware of the potential risks and benefits of any treatment before agreeing to it.
2. Balancing Risk and Benefit
Healthcare providers must carefully weigh the risks and benefits of any treatment. In some cases, the risks of iatrogenesis may outweigh the potential benefits, and alternative approaches should be considered.
3. Transparency and Accountability
When iatrogenic harm occurs, it’s essential that healthcare providers are transparent and take accountability. This not only helps in addressing the specific incident but also in learning from it to prevent future occurrences.
Conclusion
Iatrogenesis is a complex and often overlooked aspect of healthcare, but it’s one that can have profound consequences.
By understanding the types, causes, and consequences of iatrogenesis, you can be better equipped to navigate the healthcare system and advocate for your safety.
Remember, while healthcare providers are there to help, it’s essential to be an informed and active participant in your care.
By doing so, you can help minimise the risks and ensure that your treatment leads to better health outcomes, rather than unintended harm.
Do you have experience of iatrogenesis? Leave a comment.