Iatrogenic Disease

Overview

Iatrogenic disease has been cited as a widespread national problem. In 2000, the national Institute of Medicine (IOM) released a report titled To Err Is Human: Building a Safer Health System. This landmark report estimated that between 44,000 and 98,000 deaths occur each year in the nation's hospitals from medical errors. An earlier report about medical errors in New York hospitals spurred the Joint Commission to create a sentinel event-reporting system. After the IOM report, the Joint Commission created a set of national patient safety goals that were incorporated into the accreditation process to reduce medical errors.

The most obvious example of iatrogenic disease is medical errors. Common medical errors include performing an operation on the wrong body part or dispensing the wrong medicine due to negligence; however, this is only a small part of iatrogenic disease. The greatest amount of iatrogenic disease is caused by the unintended side effects or adverse effects caused by drug interactions. These adverse effects may range from mild disease states, such as impaired sleep or indigestion, to severe consequences, such as heart failure, stroke, and death. Sometimes, the adverse effects are known and accepted by the patient because the positive effects of the treatment outweigh the adverse effects. In these cases, while the resulting disease state is in fact iatrogenic, the term is often not applied because iatrogenic disease is generally used pejoratively.

Iatrogenic disease may also result in hospitalized patients acquiring nosocomial infections. For example, hospital staff may unintentionally transmit microbes during the routine patient encounter because of improperly sterilized medical equipment and through the use of unclean or ungloved hands.

Another example of iatrogenic disease derives from interventions that are done or not done as a result of financial incentives. For example, when a healthcare provider decides to use a certain medication because of its association with a [Page 624]pharmaceutical company, any disease state that results from choosing the particular medicine over a more effective alternative is considered to be an iatrogenic disease. Thus, the referral for an intervention for the purpose of profit rather than for the best interest of the patient also results in iatrogenic disease. Many studies of physician behavior have documented that financial incentives change practice patterns.

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