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How can medical errors outpace accidents and strokes as the third leading cause of death in the U.S.? With over 250,000 annual deaths, iatrogenesis — harm from medical care — is a critical issue. Understanding and mitigating iatrogenesis is essential for improving patient safety and overall healthcare quality.

adverse drug reactions (ADRs)

According to a study published in the Journal of the American Medical Association (JAMA), ADRs are among the leading causes of morbidity and mortality in hospitalized patients – for about 2 million hospitalizations and contribute to over 100,000 deaths each year in the U.S.- contributing significantly to healthcare costs and patient suffering. These reactions can occur due to incorrect dosages, drug interactions, or individual patient sensitivities, highlighting the complexities and risks inherent in pharmacotherapy.

Implementing pharmacogenetics in clinical practice offers a promising solution to adverse drug reactions (ADRs). By understanding how genetic variations affect drug metabolism and response, pharmacogenetics enables more precise prescribing. This personalized approach can minimize harmful side effects, improve drug efficacy, and lower healthcare costs associated with ADRs.

Several healthcare institutions, such as the Mayo Clinic and St. Jude Children’s Research Hospital, are already using pharmacogenetics to guide treatment decisions. The growth of this field has been facilitated by advances in technologies like next-generation sequencing and bioinformatics, which allow for comprehensive genetic analysis and the integration of genetic data into clinical workflows. These technologies have made it feasible to tailor medications to individual genetic profiles, paving the way for safer and more effective treatments.

hospital-acquired infections (HAIs)

The Centers for Disease Control and Prevention (CDC) estimates that HAIs affect approximately 1 in 31 hospital patients on any given day. These infections, often caused by bacteria resistant to antibiotics, can lead to prolonged hospital stays, increased healthcare costs, and higher mortality rates. Measures such as strict hand hygiene protocols, proper sterilization techniques, and prudent antibiotic use are crucial in preventing HAIs.

surgery

Surgical complications represent another critical aspect of iatrogenesis. Errors during surgery, ranging from wrong-site surgery to postoperative infections, can have devastating consequences for patients. The implementation of standardized surgical checklists (thanks Atul Gawande!), as promoted by the World Health Organization (WHO), has been shown to reduce surgical complications and improve patient outcomes. These checklists ensure that critical steps are not overlooked, thus enhancing surgical safety.

diagnostic errors

Misdiagnosis or delayed diagnosis can lead to inappropriate or delayed treatments, resulting in worsened patient outcomes. The National Academy of Medicine reports that diagnostic errors affect 12 million Americans each year, with 40,000 to 80,000 deaths annually attributed to misdiagnosis.

A different flavor of diagnostic error is overdiagnosis and overtreatment. Both are critical issues in modern healthcare, often leading to unnecessary interventions and associated harms. For example, a study in the British Medical Journal found that over 30% of breast cancer cases diagnosed through screening mammography were overdiagnosed, leading to unnecessary treatments and psychological distress. So, a continuing emphasis should be placed on improving treatment decision tools to prevent potential overtreatment.

psychological

The mental health impact of medical interventions, such as the stress and anxiety associated with chronic illness management or invasive procedures, can be profound. Patient-centered care approaches that include psychological support and clear communication can help mitigate these adverse effects.

In a recent episode of Conversations with Coleman, Coleman Hughes speaks with Abigail Shrier, who introduces iatrogenesis as a key negative outcome prevelant in therapy with children. Children cannot adequatly push back or contextualize certain things, which leads to the creation of something that wasn’t there previously.

Coleman shares a therapist’s casual (mis)diagnosis of his having PTSD. Such diagnoses (however casual) can alter a person’s self-conception and lead to long-term negative effects. Abigail Shrier emphasizes that children and adolescents are particularly vulnerable to these labels, which can limit their self-identity and lead to dependency on therapy.

Additionally, therapy often encourages patients to focus on and rehash their negative experiences and feelings. This can lead to rumination, which is a predictor of depression. Encouraging constant reflection on negative emotions can exacerbate mental health issues rather than alleviate them.

treatment prevalence paradox

Despite increased access to therapy and psychiatric medications, rates of depression and anxiety have not decreased (yes, some of this is due to COVID, but this trend was happening prior). This paradox suggests that more therapy does not necessarily lead to better mental health outcomes. Instead, it can sometimes perpetuate or even exacerbate the issues it aims to resolve.

Plus, long-term therapy can lead to treatment dependency, where individuals feel they cannot handle their problems without professional help. This dependency can undermine a person’s ability to develop self-reliance and resilience.

Shrier advocates for the importance of parental authority and stable relationships over therapeutic interventions. She suggests that strong family support and authoritative parenting can often provide the stability and guidance children need, reducing the need for external therapeutic interventions.

going forward

To address iatrogenesis, healthcare systems must prioritize patient safety and quality improvement initiatives. This includes fostering a culture of transparency and accountability, where medical errors are openly reported and analyzed to prevent future occurrences. Continuous education and training for healthcare professionals on best practices and emerging risks are also vital.

Moreover, patients themselves play a crucial role in minimizing iatrogenesis. Engaging patients in their own care, encouraging them to ask questions, and providing them with clear information about their treatments and potential risks can empower them to make informed decisions and participate actively in preventing adverse outcomes.

Iatrogenesis remains a significant challenge in modern healthcare. Estimates suggest that medical errors cost the U.S. healthcare system between $17 billion and $29 billion annually, considering direct costs like additional medical treatments and indirect costs such as lost productivity and legal expenses. By recognizing its various forms and implementing multifaceted strategies to prevent and manage medical harm, the healthcare community can enhance patient safety, improve outcomes, and build a more resilient and trustworthy healthcare system.