Iatrogenic disorders

• ANATOMY OR SYSTEM AFFECTED: All
• CAUSES: Inherent medical risk, misdiagnosis, physician malpractice, medication error, surgical error
• SYMPTOMS: Wide ranging
• DURATION: Varies from acute to fatal
• TREATMENTS: Depends on circumstances

DEFINITION: Health problems caused by medical treatments

Causes and Symptoms

Iatrogenic disorders may be attributable to inefficient or uncaring physicians, complex treatment protocols, communication breakdowns, or the risks inherent in necessary or life-saving medical procedures. Such disorders are usually divided into those caused by medications, surgery, and medical misdiagnosis.

The average patient of any age expects physicians and the medical infrastructure to deliver perfect cures for all diseases. This is not possible because some diseases have no cure and because medical treatment always involves some potential risk to the persons being treated. In fact, a percentage—usually a small one—of the patients treated for any disease develop unexpected health problems (adverse reactions) that can be diseases themselves.

The term “iatrogenic disorder” is a catchall used to encompass the many different adverse reactions that accompany the practice of modern medicine. The number of such problems has grown as medical science has become more sophisticated. They are often blamed entirely on physicians and other medical staff involved in cases producing iatrogenic disorders.

This blame is correctly directed in instances where a physician and other staff involved are uncaring, inattentive, careless, or incompletely educated. However, iatrogenic disorders often result from the nature of modern medicine. Doctors frequently attempt therapeutic methods (such as surgery) that are innovative efforts that cure serious diseases, but have some inherent risk of failure. They may also use therapeutic drugs that are powerful agents for the cure of specific disease processes, but that have side effects causing other health problems in some people who take them. In addition, doctors will often utilize complicated overall therapy having adverse consequences that patients may not acknowledge despite physicians’ attempts to explain them orally and with consent forms.

Treatment and Therapy

Despite careful efforts of most physicians—who are informed, caring, and efficient—iatrogenic disorders accompany many medical procedures. However, public attention is focused most on the effects of therapeutic agents, drugs, and vaccines, because patients are often unaware that no therapeutic agent in use is ever perfectly safe. Even a clear physician description of the dos and don’ts associated with such therapy may be flawed by biological variation among patients, causing problems in one individual but not others. Furthermore, the emergence of new diseases and new variants of existing diseases since the late 1980s has led to more complex treatment regimens, increasing the opportunity for iatrogenic disorders to occur.

In the early twenty-first century, iatrogenic disorders became particularly germane in the treatment of older adults, those with compromised immune systems (such as patients with human immunodeficiency virus/acquired immunodeficiency syndrome [HIV/AIDS]), and very young patients. Hence, several rules must be followed concerning therapeutic agents. First, wherever possible, these medications should be used only after other means fail and the benefits to be gained clearly outweigh the risks entailed. Second, therapy should begin with the lowest possible effective dose, and all dose increases should be accompanied by frequent symptom relief and toxicity monitoring. Third, patients and their responsible family members must be informed of all possible adverse symptoms, how to best counter them, and the foods or other medications to be avoided to minimize iatrogenic potential. Such problems in older adults are due to biochemical changes that alter their tolerance for many medications.

Many iatrogenic disorders are caused by the presence of bacterial contamination in wounds and the fact that surgical maintenance of sterility is not absolutely perfect. For example, iatrogenesis occurs in some patients after surgical procedures carried out at heavily contaminated surgical sites (such as emergency surgery of abdominal wounds). In addition, the use of antibiotics can be problematic. In many cases, the large doses of these therapeutic agents required to fight primary bacterial infection can cause superinfection by other microbes, such as fungi. Furthermore, wide antibiotic use in hospitals has led to the creation of antibiotic-resistant bacteria.

For these reasons, treatment of surgical sites requires individualized attention. Clean wounds can be closed up immediately without high risk of infection, but deep wounds known to be contaminated prior to surgery are often best handled by closing up the interior tissues and leaving the skin and subcutaneous tissues open until it is clear that infection is under control. Many patients are frightened by such procedures and the pain involved, not understanding that it is in their best interest. Hence, they may resist treatment and accuse conscientious physicians of causing iatrogenic disorders. Such treatment is most crucial in older adults and young children. In older patients, the cause is a diminution of body defenses against infection (for example, the immune system). It has been reported that older adults experience a doubled or tripled chance of experiencing postoperative complications that may be seen as iatrogenic by their families. Young children are also more at risk than postpubertal individuals and “younger” adults, for reasons related to their incompletely developed immune systems. Patients with HIV/AIDS are at an increased risk compared to the general population, but the development of antiretroviral therapy (ART) has significantly decreased the rate and severity of iatrogenic disorders in patients with compromised immune systems.

Iatrogenesis resulting from misdiagnosis is too complicated an issue to be considered in depth here. In some cases, it is caused by physician inadequacy, but more often, such problems are attributable to the great difficulty in diagnosing any disease absolutely.

It is essential for patients and physicians to communicate effectively. Such interaction lowers the occurrence of iatrogenic disorders because patients can decide to forgo treatment or learn how to comply exactly with complex treatment protocols. Patients who do not receive adequate answers to their questions from physicians should seek treatment elsewhere. Physicians should thoroughly explain potential problems associated with therapeutic procedures through oral communication, informative consent forms, and well-informed counselors.

Because of the many iatrogenic disorders associated with medical therapy, physicians often believe that the best course of treatment—where a symptom is unclear and severe danger to patients is not imminent—is to monitor the patient so as to do no harm. This approach is often misunderstood by patients. To clarify the issue, the physician should explain that treatment can often be more dangerous than the perceived health problem.

It is hoped that the continued development of medical science, careful and complete therapy explanations by medical staff, and better medical understanding and better treatment compliance by patients will decrease the incidence of iatrogenic disorders.

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