Iatrogenic Disorders
When a patient, unfamiliar with the intricacies of medicine, walks into a clinic complaining of random weakness, only to be diagnosed with low blood pressure based on a fleeting glance at a blood pressure reading, the medical fraternity needs introspection. This isn’t the science or art of medicine but rather the commerce of medicine, leaving patients living under the constant fear of life-threatening disorders.
Iatrogenic disorders, also known as iatrogenic illness or iatrogenesis, refer to adverse health effects resulting from medical treatment or interventions. They are the unintended consequences, the diseases gifted knowingly or unknowingly by the medical fraternity. Ranging from mild side effects to severe complications, these disorders arise from procedures, medications, or therapies.
Examples of Iatrogenic Disorders
A-Medication-related problems, such as adverse drug reactions, medication errors, and drug interactions.
1- Thalidomide was initially marketed as a sedative and antiemetic for pregnant women. In the 1950–1960s, thousands of infants were born with severe deformities due to Thalidomide exposure during pregnancy.
2- DES (Diethylstilbestrol), a synthetic estrogen, prescribed for miscarriages in 1940–1970, produced reproductive tract abnormalities, infertility, and a rare form of vaginal cancer.
3- Isotretinoin, prescribed for acne, has been associated with a high risk of birth defects, particularly affecting the central nervous system, face, and heart
4- In the year 2000, some batches of Heparin caused a severe allergic reaction, leading to a life-threatening drop in platelet count.
5- In 1990–2004, Vioxx, a cox-2 inhibitor, used for pain relief, increased the risk of heart attacks and strokes associated with long-term use.
6- Fenfluramine and Phentermine, the drugs used for weight loss, led to Primary pulmonary hypertension and cardiac valvular abnormalities in the 1990s.
7- Some antibiotics and painkillers cause SJS (Stevens-Johnson syndrome), a life-threatening disorder, leading to severe ulcers in the mucous membrane and skin infection.
8- Some antibiotics, antipsychotics, and antiarrhythmics cause prolongation of QT interval in the electrical system of the heart, causing heart attacks.
9- Most of the painkillers are nephrotoxic. There are documented evidences of kidney failure after ingestion of non-steroid anti-inflammatory drugs.
10- Acetaminophane, commonly known as Paracetamol is hepatotoxic in large doses.
11- Penicillin and sulpha group of drugs are notorious for allergic reaction. The first dose should be taken under the supervision of a medical professional.
All allopathy medicines have their fixed doses depending on age and weight. Higher doses lead to unwanted toxicity.
B-Healthcare-associated infections are another facet, occurring due to improper sterilization or poor hygiene in healthcare settings. Nosocomial infections can result from surgical procedures, invasive medical devices, and exposure to drug-resistant bacteria.
C-Surgical complications, like those arising from diagnostic errors, can lead to severe consequences.
There were instances when wrong-sided hernial repairs were done due to faulty history-taking or faulty notes.
D-Radiation exposure during imaging tests and psychological effects from treatments can also cause adverse effects, emphasizing the need for awareness and preventive measures.
Radiation increases the risk of skin cancer and leukemia.
E) Miscommunication among health professionals, the last but certainly not the least important issue, can have serious consequences.
Consider the following example: during a routine ward round, a consultant prescribes Tab Diamol to a patient for abdominal bloating. Unfortunately, the resident doctor’s illegible handwriting leads to confusion, and the nurse misinterprets it as Tab Daonil, a potent hypoglycaemic medication that lowers blood sugar levels. Consequently, the patient becomes unconscious, prompting a call to the doctor half an hour later. Improper history taking, poor handwriting, and overburdened doctors are common factors contributing to such miscommunications.
The field of medicine, a marvel of human achievement, is not without imperfections. Iatrogenic disorders serve as a reminder- that while medicine has the power to heal, it is not infallible. Understanding iatrogenic disorders is not about instilling fear or mistrust in the healthcare system but about being informed and proactive.
Awareness is crucial in preventing errors. When patients and healthcare professionals are aligned in understanding potential iatrogenic risks, healthcare quality improves, and medical errors decrease. In a world where healthcare is paramount, knowledge is power. By raising awareness about iatrogenic disorders, we empower ourselves to make informed healthcare choices and become advocates for patient safety.
In our engagement with healthcare professionals, let us be proactive, informed, and collaborative, ensuring the best possible outcomes for our health.
Nandkishor Shingne
