Iatrogenic diseases

Causes originating from the physician

Factors provoking the development of iatrogenesis on the part of medical personnel are most often subjective in nature:

• Negligence. Incomplete or superficial history taking, carelessness, and inattentiveness lead to misdiagnosis and the selection of incorrect management tactics.
• Insufficient competence. Lack of deep knowledge and the inability to correctly interpret laboratory or radiological data lead to irrational treatment. The physician must constantly study scientific literature.
• Psychogenic factors. A careless word from a specialist can have an extremely adverse effect on the patient's psyche.

Subjective errors can lead to missing a competing disease. For example, a routine round by the attending physician may cause the symptoms of acute myocardial infarction to go unnoticed against the background of a severe pathology (gastric cancer), and necessary studies (ECG, troponins) may not be ordered.

Classification of medical personnel actions

Not all adverse outcomes are legally interpreted in the same way. Classically, three categories of actions are distinguished:

In the event of a patient's death, errors are evaluated through the discrepancy between clinical and pathoanatomical diagnoses. In Category I, it was impossible to establish the correct diagnosis. In Category II, the diagnosis could have been made, but it would not have affected the outcome. In Category III, the error directly led to incorrect treatment and a fatal outcome.

The patient's role and the issue of treatment adherence

The patient frequently becomes an unwitting accomplice to iatrogenesis. This can occur at any stage of interaction with the healthcare system:

1. At the diagnostic stage: concealing concomitant pathologies, intentionally false description of symptoms, or inability to adequately assess one's own condition.
2. At the decision-making stage: refusal of additional examinations, endless search for the "best" specialist, or imposing one's own point of view on the physician.
3. At the treatment stage: low compliance (imprecise execution of recommendations), indulgence in self-medication, or complete refusal of medications.

The successes of the inpatient stage are often nullified after discharge. Non-compliance is provoked by the high cost of medications, a psychological reluctance to be treated at home, or iatrogenic-organizational factors — when the physician simply did not have enough time to explain the dosing regimen in detail.

Examples from clinical practice

Iatrogenic factors are specific to each medical discipline:

• Pulmonology and allergology: anticoagulant therapy increases the risk of hemoptysis. In asthma, pharmacological defects are common: delayed prescription of glucocorticoids, toxic overdose of theophylline, or excessive use of short-acting β2-agonists (leading to cardiotoxicity).
• Neurology: incorrect interpretation of instrumental data (Doppler ultrasound, MRI) in migraine leads to false diagnoses (osteochondrosis, vegetative-vascular dystonia). Nootropics prescribed in this case are useless and only contribute to the chronic progression of pain.
• Rheumatology: prolonged intake of systemic hormones causes secondary osteoporosis.
• Gastroenterology: iatrogenic constipation often occurs against the background of taking iron preparations, antidepressants, or calcium channel blockers.
• Cardiology: iatrogenic myocardial infarction can develop as a complication of percutaneous coronary intervention (PCI) or due to thrombosis of a previously placed stent.

Class and exam questions

What else to study on this topic

• Categories of discrepancy between clinical and pathoanatomical diagnoses (I, II, III).
• Pharmacological, diagnostic, and organizational management defects in bronchial asthma.
• Causes of myocardial infarction: atherothrombosis, ischemic imbalance, and specific pathologies.
• Medication-related causes of constipation in gastroenterological practice.
• Rules for maintaining medical documentation for the legal protection of the physician.

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.