Iatrogenic Effects

Iatrogenic, according to several standard dictionaries, means induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures. (The first root of iatrogenic is iatros, which is Greek for “physician.”) The patient or the service provider recognizes that there was an inadvertent and adverse effect or complication resulting from a treatment or advice. This includes all health care providers as well as those who are licensed to practice in the areas of mental health, drug abuse counseling, physical therapy, and marital and family therapy.

Iatrogenic effects, therefore, apply to most service providers, regardless of their credentials. Those professionals who are especially at risk of iatrogenic effects of their services are those who do not follow a standard of care recognized by the relevant practicing profession.

Thus, iatrogenic effects are the unwanted and unintended consequences of ineffective assessment or treatment by a practitioner. In this entry, the focus is the untoward or unexpected medical or behavioral problem resulting directly from errors of omission or commission by a practitioner or some other explanation that is part of the treatment provided.

It is important to appreciate the psychosocial consequences of such effects, though relatively little is written about this phenomenon. First, there is some attention to the patient or client who is seeking trauma-informed professional services and expecting to feel better soon as a result but instead feels worse. Expectations that are too high for quick results are often dashed by the reality of the time required to mitigate the trauma effects. Second, some attention is paid in the professional literature to practitioners who caused the negative (rather than positive) outcomes. In this context, the focus is on the practitioner's competence and state of mind that contributed to the iatrogenic effects.

As noted in the introduction to this encyclopedia, trauma is defined as “a sudden, potentially deadly experience, often leaving lasting, troubling memories.” Moreover, trauma and its individual impacts have systemic implications. Thus, a negative reaction to being treated for a problem caused by a trauma will dampen resilience and lead to a cascade of issues that go well beyond the individual. Trauma and posttraumatic stress must be managed effectively or the individual may develop mental disorders that are more difficult to treat once chronic posttraumatic stress disorder (PTSD) sets in.

All practitioners who work with the traumatized must be especially careful of the iatrogenic effects. To address this important issue and ensure a standard of care, the Green Cross Academy of Traumatology guidelines were established in the 1998. Green Cross was the first to recognize the iatrogenic effects problem and developed the first standards of practice with the traumatized. These standards were established to avoid ineffective work with the traumatized both as researchers and as practitioners. The reader should visit the Green Cross website (http://green-cross.org) to review these standards. The stated purpose of the guidelines (Section I) is to build “a [Page 322]common foundation across disciplines/professions for the humane treatment of persons who have been traumatized.”

Because traumatized individuals may feel a deep sense of vulnerability, dehumanization, and betrayal, as well as cognitive and emotional disequilibrium, increased care is called for in providing a healing environment that conveys respect for the client's experience and dignity.

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