home Audience 1 General information about iatrogenic diseases. Iatrogenesis

General information about iatrogenic diseases. Iatrogenesis

Iatrogenesis- one of the types of psychogenics, that is, mental illness or disorder mental activity caused by emotional shock.

The specificity of iatrogenics is that an emotional shock of this kind can happen to an individual only during his interaction with doctor or another health worker, that is, during those periods of life when he had to seek medical help and become patient.

Iatrogenesis(from the ancient Greek iatros - doctor and genes - generating) is a disease provoked by a doctor.

This concept was first mentioned by a German psychiatrist ABOUT. Bumke also in 1925 year in the work “The Doctor as the Cause of Mental Disorders.” Sometimes in the literature there is a different spelling of the term “iatrogeny”, due to difficulties in translation - “iatrogeny”.

In ICD-10 ( International classification diseases) iatrogenics is interpreted more widely, like any doctor’s mistake that resulted in dysfunction of the body, disability or death of the patient. However, iatrogenics is still often interpreted more narrowly, as a disease that negatively affects specifically psyche sick.

Iatrogenesis happens because of incorrect, inadequate, unqualified actions or words of the doctor performing Not intentional (or maybe intentional) suggestive influence per patient. Roughly speaking, the doctor said or did something wrong, and this made the patient feel much worse.

For example, a doctor may say to a young patient: “You know, people with a disease like yours don’t even live to see forty!” How will the person feel after this? At a minimum - not very good, at a maximum - not much worse. Scientifically, this “can’t be worse” qualifies as a combination of depressive and hypochondriacal states.

Iatrogenic diseases are most often expressed in two forms:

Depression – mental disorder, characterized by low mood, inhibition of mental and physical activity, decreased vital motivations, pessimistic assessments of one’s “I” and life situation, somatoneurological disorders.
Hypochondria– excessive attention to one’s health, fear of incurable diseases, belief in the presence of a disease when it is absent and disbelief in getting rid of a real disease (even not too dangerous).

Iatrogenesis is also called "negative psychotherapy", since the doctor’s duty is to help the patient feel better, more confident, more optimistic, but the opposite happens: only fear, horror, panic, apathy and lack of hope for the future.

Types of iatrogeny

Any careless gesture, look, action or inaction and, of course, the doctor’s word can become a real psychological trauma for the patient, provoke psychosis, neurosis, and cause other harm to the psyche and body.

Recently, the following have begun to stand out separately: types of iatrogeny How:

Identity of doctor and patient

Of course, how strongly the doctor’s words will affect the patient depends on the personality and individual psychological characteristics of each of them, on the type and severity of somatic disease patient and from the moment when the impact was provided.

The situation of an operation during which the patient is under anesthesia. The words spoken by the doctor at this time penetrate directly into the patient’s unconscious, bypassing consciousness.

If during interaction in a state of consciousness the patient can at least somehow resist what was said or any manipulations (perceive critically what was said, apply self-regulation techniques, refuse the procedure), then under anesthesia - not. The state of anesthesia is close to hypnotic sleep. In this case, suggestion is carried out at an unconscious level. Doctors and nurses must monitor not only what they say in front of the patient, but also when they think that the patient cannot hear them.

There are good “hypnotists” doctors, differing:

high self-esteem,
the habit of “getting smart”
harshness and callousness in words and actions,
categoricalness in statements.

Easily people are suggestible:

People in our society for the most part Not trust doctors, but when coming to the hospital, any person hopes that he will come across the most best doctor. People trust, and sometimes even blindly believe, the doctors treating them, hence the all too frequent cases of iatrogenicity. But there are always two sides to a coin!

If a patient believes a doctor, why shouldn’t that doctor give him hope and faith in the best? If “dummy” pills have a placebo effect, then the words of an authoritative doctor can certainly provoke the same placebo effect, but this will no longer be negative (as in iatrogenics), but positive suggestion!

It is impossible to deceive patients, but is it possible not to leave them even hope? The words and actions of a doctor and other medical workers should act not as poison that poisons a person, but as medicine!

Prevention and treatment of iatrogenism

Iatrogenesis is a disease that is one of the most acute problems modern medicine, along with euthanasia, abortion, surrogacy and others. This is not just medical, it's ethical Problems.

The medical profession is one of the most psychologically difficult. Dispassion and composure must be combined with the ability to be friendly, sympathetic, attentive, always ready to help anyone at any moment.

Indifference, inattention, and disdainful attitude towards patients only intensify the feelings with which they usually come:

For the prevention of iatrogenic, by and large, all you need is a little - friendly communication, a guarantee of maintaining medical confidentiality and the doctor’s sympathetic attitude towards the patient. Meet the patient with smile– to some extent protect him from possible emotional shock.

To avoid becoming a victim physician errors, it is recommended:

Develop such personality qualities as self-confidence, optimism, criticality and flexibility of thinking, stress resistance. A doctor can be an erudite person, but when listening to him, one must remember to think and reflect on what is said, and not just blindly believe. Abandon the attitudes “The doctor knows best” and “As the doctor says, I’ll do it.” Doctors are people too, they can make mistakes.
Before going to a doctor, you need to find out what kind of specialist he is, find reviews from his patients (at least search on the Internet, on forums). You also need to carefully choose the medical institution where you will be treated, especially if you are expected to stay in a hospital.
Reserve the right to choose a doctor and medical institution. If you don’t like a doctor and you have the opportunity to go to another, you should do it. Don't put up with bad doctors!
When a diagnosis is made by one doctor, it is better to double-check it by visiting one or two more (especially if the diagnosis is serious). Often different doctors give different diagnoses to the same person.
Believe in your recovery! No matter what anyone says, you need to believe in yourself, in your strengths and capabilities! Think and imagine yourself healthy, convince yourself of your complete recovery, continue to enjoy life!

In case of iatrogenic has already arrived, and there is no hope left, no faith in the best and no self-love, you need to turn to help psychotherapist or psychiatrist, these specialists will help you cope with the problem.

If you want to study in more detail such a complex phenomenon as iatrogenics, we recommend the following books:

V. Volkov “Iatrogenic psychoneurosomatic syndromes”
S. Kuznetsov “Compensation for damage to health from improper medical activities”
A. Anastasov “Drug disease (lesions due to the use of pharmacotherapeutic agents in therapeutic doses)”

Have you ever suffered from iatrogenic disease?

Ministry of Health of the Republic of Belarus

EE "Vitebsk State Order of Peoples' Friendship Medical University"

Department of Propaedeutics of Internal Diseases

Essay

on the topic of:

“Types of medical institutions. Structure and organization of work of a typical treatment and preventive organization"

Prepared by: 2nd year student, 11th group

Faculty of Medicine

Radchenko S.G.

Checked by: Izmailov V.E.

Vitebsk, 2014

Introduction

At certain periods in the development of human society, “winged” words appear and acquire a ubiquitous sound, reflecting the anxieties and aspirations of people. Currently, such words have become “danger”, “safety” and “ecology”, and ecology is considered primarily from the standpoint of the danger of the habitat for human health and life.

The danger comes from two groups of factors: natural and anthropogenic. In the process of evolution of the Earth and human society, the range and role of natural risk factors for human health and life gradually decreased, while anthropogenic ones rapidly increased. In the second half of the 20th century, during the era of the modern scientific and technological revolution, this danger increased to a scale threatening the existence of mankind. Among anthropogenic factors, iatrogenics play a special role.

Doctors were among the first to understand the danger of their professional activities for the life and health of people. Already in the 4th century. BC e. The Hippocratic oath contained the doctor's promise: "... I will protect the sick from everything harmful and unsuitable for them." About 2 thousand years ago, this became the principle of treatment: “Primum non nocere” (First of all, do no harm), “Nihil nocere” (Do no harm), which was perceived as the first commandment of the doctor. Subsequently, diseases associated with the provision of medical care, began to be called iatrogenies - diseases of medical origin. iatrogenic disease medical

The detonating factor in the modern doctrine of iatrogenics was the publication in 1925 of O. Bumke’s work “The Doctor as the Cause of Mental Disorders.” In the subsequent period, the term “iatrogeny” was used to refer to diseases caused by the psychogenic influence of medical workers on patients. This interpretation of iatrogenesis can also be found in contemporary works. Currently, the prevailing trend is towards an expanded understanding of iatrogeny, towards the inclusion in iatrogenics of diseases caused by the action of medical factors of a physical, chemical and mechanical nature.

1. Iatrogenesis, classification

Initially, the concept of iatrogenics was expanded to diseases associated with erroneous actions of a doctor, and then to all diseases and injuries associated with any medical interventions. So, I.F. Kalitievsky et al. They offer two definitions of iatrogenesis:

1-any new side disease(including functional), associated with the actions (treatment, diagnostic tests, prevention, behavior, etc.) of medical workers, regardless of whether they were correct or incorrect;

2-complications of the underlying disease caused by erroneous or inadequate actions of the doctor. A.P. Krasilnikov and A.I. Kondrusev, arguing that a significant part of iatrogenic diseases, especially infectious and psychogenic, develops without medical interventions, propose to understand iatrogenics as any diseases that arise in a patient as a result of medical interventions or communication with medical workers, regardless of the place of medical care and the causative factor. However, this definition from modern positions does not fully reflect the phenomenon of iatrogenics, since it does not take into account medical injuries and medical workers, who also often suffer from iatrogenic diseases.

Iatrogenesis is all diseases and injuries that occur in patients and health care workers as a result of providing any type of medical care.

To designate diseases associated with the provision of medical care, the following names were proposed: hospitalism, pathology of treatment and diagnosis, adverse (side) consequences (effects) of diagnosis and treatment.

There are several classifications of iatrogenesis. S. Ya. Doletsky distinguishes iatrogeny of communication and iatrogenic influence. E. S. Belozerov distinguishes among iatrogenics general reactions of the body, damage to individual organs and tissues, drug teratogenesis and oncogenesis, side effect medicines. P. F. Kalitievsky et al. Iatrogenesis is classified into those caused by medicinal, surgical, physical and other methods of treatment. V. L. Kovalenko et al. In the iatrogenic group, diseases associated with diagnostic studies, drug treatment, preventive measures, iatrogenic pseudo-diseases, informational and other iatrogenies are distinguished. E. D. Cherstvoy et al. The classification was based on the type of medical intervention, identifying groups of iatrogenics associated with drug therapy, surgical interventions, diagnostic procedures and preventive measures. M. M. Balyasny distinguishes between jatropsychogeny, jatropharmamacogeny, and yatrophysiogeny.

Recognizing the scientific validity and practical usefulness of these classifications, we note that the main thing in constructing classification schemes of iatrogeny should be causative factor, pathogen. Based on this, iatrogenics should be divided into 5 groups:

psychogenic,

medicinal,

traumatic,

infectious,

mixed.

Psychogenic iatrogenies manifest themselves in the form of neuroses, psychoses, neurasthenia, hysteria, phobias, depression, anxiety, depressive and hypochondriacal disorders. They are caused by careless and misunderstood statements by a medical worker about the patient’s health status, familiarization with one’s own medical history and special medical literature, and listening to public lectures, especially on television. They are also called “diseases of the word.” This group of iatrogenics also develops in cases of ineffective treatment, mistrust of the doctor, fear of diagnostic methods, treatment, abrupt transition from active image life to a passive one, from the usual conditions of family and work collective to a group of people with heightened and altered personal perception (in the words of A.F. Bilibin, “to people with a suffering self”).

The addition of iatrogenesis complicates the course of the underlying disease and increases the likelihood of developing new diseases, for example, hospital-acquired diseases. Unfortunately, psychogenic iatrogenies are not taken into account; we did not find any data from sample studies in the literature. R.A. Luria believes that they occur often and are difficult, and sometimes end tragically. Thus, an article analyzing the causes of suicide, published in the World Health Forum, states that the majority of people who committed suicide had recently visited a doctor general practice or other health care professionals.

Drug iatrogenies. For medicinal skin rashes E.A. Arkin proposed the term “medicinal diseases”. Since the main manifestation of the side effect of drugs is illness, and the cause of the disease is the medicine prescribed by the doctor, the term “drug disease” can be extended to all clinical forms of diseases associated with the direct or indirect damaging effect of certain components of drugs and impurities to them. Objections to this term are based on understandable, but subjective, and, moreover, corporate considerations. Most medicinal diseases are iatrogenic in nature. Only for diseases caused by self-medication and violation of doctor’s instructions, there are no grounds for inclusion in iatrogenics, but they naturally are included in the group of medicinal diseases. Some authors suggest calling them chemical, drug iatrogenies. These names do not seem very successful to us, especially since some drugs, for example, vaccines, immune serums, bacteriophages, lysozyme, and bacterial preparations, are not of a chemical, but of a biological nature.

Drug iatrogenies are diverse in their manifestations, and their classifications are numerous. We present only one etiopathogenetic classification, which is the result of a generalization of the works of many researchers. According to this classification, the following groups of medicinal diseases are distinguished:

1-pharmacologically negative effects (for example, hypoglycemic shock after insulin administration);

2-drug intoxications, including toxic, mutagenic, oncogenic, teratogenic, embryotoxic, immunosuppressive effects;

3-drug allergy;

4-drug intolerance of pseudo-allergic nature;

5-drug dependence;

6-drug psychoses;

7-exacerbation reactions, for example bacterial (endotoxic) shock;

8-complications of the underlying disease caused by physicochemical, pharmacodynamic and pharmacokinetic incompatibility of simultaneously administered drugs;

9-post-vaccination reactions and complications.

There are many other, less complete classifications of medicinal diseases. For example, Anderson distinguishes among medicinal diseases (in his terminology - drug reactions) organ-specific reactions (skin, blood, liver, head); generalized reactions (systemic anaphylaxis, anaphylactoid reactions, generalized urticaria, angioedema, drug fever, autoimmune reactions, drug-induced vasculitis, serum sickness-like reactions); pseudoallergic reactions.

There is no mandatory registration of medicinal diseases. Data presented in the literature are based on voluntary reports from treating physicians or best case scenario on sample studies. The general conclusion from acquaintance with even such obviously incomplete data in comparison with the scale of drug therapy is this: drug-induced infections are extremely common. According to G. Mazhdrakov and I. Popkhristov, adverse reactions develop in 7%, according to A.S. Lopatin, I.M. Stankovskaya - in 10-12%, according to B.M. Pukhlik - in 15-40% of people taking medications. In the USA, 1-2 million cases of side effects of drugs are registered annually, 2-5% of the total number of hospitalizations are due to this pathology. About 30% of hospitalized patients acquire a drug-induced disease during treatment. The incidence of adverse reactions to antimicrobial therapy ranges from 1 to 50%. Allergic reactions after taking medications develop in 0.5 - 60% of people.

Traumatic iatrogeny. For diseases caused by the action of medical damaging factors of a physical and mechanical nature, the term “medical injuries and their consequences” (adverse consequences of surgical treatment methods) is usually used. The epithet “medical”, not as clearly as “iatrogenic”, indicates the connection of injuries with the provision of medical care. Based on this, as well as the need to combine them into one group with psychogenic, medicinal and infectious iatrogenies, it is more logical to call them traumatic iatrogenies.

This group includes surgical, manipulation and accidental medical injuries, burns (radiation, thermal, chemical) and consequences of injuries. The consequences and complications of surgical and manipulation injuries and burns are especially serious and numerous. Here is an incomplete list of them: surgical, bacterial, blood transfusion and anaphylactic shock, surgical collapse, acute cardiovascular failure, adhesive disease, post-resection syndrome, post-cholecystectomy syndrome, short bowel syndrome, operated lung disease, massive transfusion syndrome, air embolism, vascular thrombosis, pulmonary atelectasis, hemothorax, hydrothorax, bronchospasm, pulmonary edema, cerebral edema, cholestasis, emphysema subcutaneous tissue, bleeding, asphyxia, intestinal atony, infertility after removal of the uterus, radiation sickness and other less severe lesions.

This group of iatrogenics can also conditionally include the consequences of excessive intervention, intervention without indications (the so-called surgical aggression) and, conversely, leaving the patient without medical care and care.

Infectious iatrogenies (iatrogenic infections). These include all cases of infectious diseases contracted during the provision of any type of medical care. They are more often (more sparingly for the conscience and honor of the doctor) called nosocomial (hospital, nosocomial) infections, which does not fully reflect the essence of the phenomenon, since, firstly, these diseases also arise during the provision of medical care in outpatient clinics and at home, secondly, they do not include diseases contracted outside the hospital. The term "iatrogenic" directly indicates the connection of a disease or complication with the provision of medical care, which prompts the doctor to look for ways to prevent similar phenomena in your practice. The term "nosocomial" may be reserved for iatrogenic infections that develop in hospitals.

Iatrogenic infections arose simultaneously with the opening of the first hospitals. As it expands inpatient care the number of iatrogenic infections increased, and in the 18th -19th centuries. they have become widespread. By the end of the 19th century. After the establishment of the microbial etiology of infectious diseases, the development and implementation of antiseptics, sterilization, disinfection, chemotherapy, asepsis, and isolation, the incidence of iatrogenic infections decreased sharply. A new period of growth and widespread spread of such infections began in the second half of the 20th century. and continues to this day, but not everywhere and not at the same pace as before. The average incidence of iatrogenic infections is currently estimated at 5-9% of the total number of hospital discharges. In 4-5% of those who die in hospital, the only cause of death is iatrogenic infections. In certain categories of patients and in some hospitals, morbidity and mortality rates are several times higher.

Iatrogenic infections are diverse in their manifestations. A.P. Krasilnikov and A.I. Condrusev divide them into bacterial, fungal, viral, protozoal and metazoal; hospital, outpatient, home and industrial; endogenous, exogenous; metastatic and autoinfections; sick, medical workers, healthy patients; local, systemic, generalized; acute, primary-chronic and acute-chronic; related and not related to medical interventions. They are also divided according to the location of the pathological process: blood infections; surgical wound infections; infections urinary tract; bone and joint infections; infections of the cardiovascular system; central infections nervous system; pneumonia; lower respiratory tract infections; infections of the eyes, ear, throat, nose, mouth; digestive system infections; infections of the reproductive organs; skin and soft tissue infections; systemic infections.

Iatrogenic infections are caused by more than 200 species of bacteria, fungi, viruses, protozoa, and multicellular invertebrates. The leading position is occupied by conditionally pathogenic microbes that cause opportunistic diseases, i.e. diseases of persons with reduced function of natural and acquired immunity. Causative agents of iatrogenic infections are characterized by a wider range of properties and higher rates of their changes. The most dangerous direction in the evolution of this group of microbes is the continuous formation in hospitals of hospital strains and ecovars of leading pathogens, primarily staphylococci, pseudomonads, and enterobacteria. Hospital ecovars differ from community-acquired ones by higher virulence, multiple resistance to antibiotics, increased resistance to antiseptics and disinfectants, physical factors, and population polymorphism. They are well adapted to the hospital environment and are difficult to suppress. They are mainly associated with the most severe cases of the disease and group morbidity. IN last years Severe large outbreaks of iatrogenic infections caused by methicillin-resistant variants of staphylococci are being reported in many countries. Registration of infectious iatrogeny, which is better compared to other forms of iatrogeny (although cases of intentional or unintentional concealment are very frequent), as well as the introduction of epidemiological surveillance of medical institutions and a system of sanitary, preventive and anti-epidemic measures based on it, sharply reduce the incidence of iatrogenic infections .

Iatrogenic diseases(Greek iatros doctor + gennaō create, produce; synonym of iatrogeny) - psychogenic disorders, arising as a result of deontological errors of medical workers - incorrect, careless statements or actions.

Health disorders that arise as a result of the influence of a doctor’s words and actions on a patient were already known to ancient physicians. However, the term “iatrogenics” became widespread only after the publication in 1925 of the work of the German psychiatrist Bumke (O.S.E. Bumke) “The Doctor as the Cause of Mental Disorders.” Since that time, the concept of iatrogenics has been actively studied by specialists of various clinical profiles. There is a steady trend of broad interpretation iatrogenic diseases. Many experts, especially abroad, attribute to them pathology that arises as a result of not only deontological errors (see. Medical deontology), but also any actions of the doctor (from complications of an incorrectly performed manipulation or procedure to the occurrence of the so-called medicinal disease), i.e. any negative consequences of medical intervention. Some researchers designate such conditions as iatropathies, or somatic iatrogenies.

For development iatrogenic diseases(in the traditional interpretation) both the doctor’s behavior and the patient’s personality traits (degree of emotionality, suspiciousness, etc.) matter. Many of the sick people suffer not only from the disease, but also from the anxiety, fears, and concerns about the outcome it generates. This explains the patient’s special attention to both the doctor’s words and his behavior, intonation, and facial expression. Moreover, depending on the type of nervous activity, personality type and mental characteristics, different patients react differently, sometimes in the opposite way, to certain words and behavior of the health worker. Not only ill-considered remarks (“Your heart attack is the first call”; “... the main vessel of the heart allows 30% of blood through”, etc.) or the unclear meaning of some words and expressions (“hook-shaped stomach” can have a pathogenic meaning , “myocardial dystrophy,” etc.), but sometimes even interjections or prolonged silence from the doctor, which can be interpreted by the patient as signs of the particular difficulty of diagnosing or treating his illness, its particular severity, and the hopelessness of the prognosis.

Risk of occurrence iatrogenic diseases ceteris paribus is not the same among individuals of different ages, gender, education. Women are, on average, more likely to have iatrogenic disease than men. Age groups at increased risk of development iatrogenic diseases are the people of the so-called transitional ages- adolescents and people in menopause (especially women with pathological menopause), as well as elderly people, among whom there are many who emphasize the inevitability of involutive changes in them and the increased likelihood of death of the emerging disease.

Factors that may contribute to the emergence iatrogenic diseases, we should also include the not always justified expansion of volume medical information, distributed among the population (popular lectures, television and radio broadcasts), when the symptoms of a particular dangerous disease, attention is focused on its early manifestations, and frightening prospects for “late conversion” are drawn.

Iatrogenic diseases manifest themselves mainly neurotic reactions in the form of phobias (cancerophobia, cardiophobia) and various types of autonomic dysfunction. Their development is facilitated by increased emotionality and suggestibility. Depending on the nature of the psychotrauma and premorbid personality characteristics, autonomic disorders may be generalized or expressed by predominant dysfunction of the cardiovascular (heart arrhythmia, changes in blood pressure, etc.), digestive (heartburn, vomiting, bowel disorders) or other systems in combination with senestopathies, negative effective background.

Treatment iatrogenic diseases coincides with the treatment of neuroses. The main method is psychotherapy, supplemented, if necessary, with symptomatic treatment depending on the nature of the manifestations of autonomic dysfunction. It is preferable for treatment to be carried out by a psychotherapist or psychiatrist. It is unacceptable to inform the patient that he does not have the disease and does not need treatment. Doctors should remember that we're talking about about a disease that requires a thorough study of the patient’s personality characteristics, knowledge of his social environment. Psychotherapy requires establishing the characteristics of this iatrogenic disease and the factors that contributed to its occurrence. A great psychotherapeutic effect can be achieved by a convincing conclusion from an authoritative council or a highly qualified specialist, brought to the attention of the patient

Forecast Ya. z. in most cases favorable, with timely and proper therapy recovery occurs within a few weeks or months. Late recognition iatrogenic disease contributes to its protracted course and worsens the prognosis.

The existing prerequisites for an increase in the frequency of neuroses, as well as a progressive increase in the number of people in older age groups, increase the risk of iatrogenic events. Against this background, the responsibility of doctors for “verbal asepsis” increases, the need to constantly monitor their behavior (intonation, glances, gestures), which can be misinterpreted by the patient. IN modern conditions, when, as a rule, not one, but several doctors, as well as middle and junior health workers, communicate with the patient, the possibility of iatrogenic disease increases. Therefore, as a warning iatrogenic disease It is necessary to carry out systematic work with all personnel communicating with patients. The content of medical documentation issued to patients must be thoughtful. Particular care should be taken when providing assistance to health care workers who have iatrogenic diseases are relatively frequent, and their treatment is difficult due to the often increased refractoriness of health workers to psychotherapy.

Let’s try to figure out how this is possible and what iatrogenic diseases are. Diseases resulting from incorrect diagnosis.

We live in a time when various diseases may occur not only against the background of problems in the functioning of the body, but are also a consequence of direct or indirect impact medical workers. When we turn to doctors, we sometimes don’t even suspect that in addition to existing illnesses we may still develop problems. The concept of iatrogenic diseases includes those conditions and diseases that were provoked by medical intervention or influence.

Iatrogenic pathology.

What is interesting is that iatrogenics includes all diseases and injuries that can occur not only in patients, but also medical personnel during the provision of medical care. Despite the fact that many claim that there is no problem as such - medical error, iatrogenic diseases suggest the opposite.

IN modern society We especially often have to deal with the callousness and shamelessness of our doctors. According to the etiology of the disease. Iatrogenesis that occurred after surgical intervention or as a result surgical disease. Iatrogenesis provoked by drug treatment.

The Kalitievsky classification differs in that each class of the disease is further divided into subclasses. 1. Iatrogenesis associated with treatment. Diseases that are caused by the risk of using a diagnostic method or means. Diseases caused by erroneous prevention. 5. Pseudodiseases, that is, those iatrogenies that arose as a result of an incorrect diagnosis.

Diseases caused by an unexpected reaction of the body to medications and other therapies. Iatrogenesis caused by erroneous diagnosis and treatment. Iatrogenesis, which in the pathogenesis of the disease is superimposed on the main disease or concomitant one.

Iatrogenic diseases of psychogenic origin in children

This is such a multifaceted classification, which just shows that the problem of iatrogenic diseases is not weakening, but, on the contrary, is becoming more acute every year. Iatrogenic diseases do not have strictly and clearly defined symptoms. If it's iatrogenic psychological nature, then it can manifest itself complete refusal from treatment by a given doctor or by these methods.

Iatrogenic diseases are most often treated with psychotherapy if it is associated with mental problems. If, as a result of medical intervention, incorrect diagnosis and therapy, the patient develops another disease, then treatment is reduced to eliminating the symptoms of the disease. When prescribing treatment for iatrogenic diseases, the doctor must take into account psychological characteristics the patient's body, his social environment.

Chapter 18 of iatrogenic pathology and its MEDICAL AND LEGAL SIGNIFICANCE

Depending on the type of disease, the duration of therapy can take from several weeks to several months. Prevention of physical iatrogenies should consist of the judicious use of diagnostic methods and indications for surgical intervention. If doctors become a little psychologists and treat not the disease, but the person, then the prevention of iatrogenic diseases will not be required.

Iatrogenesis and safety of medical care

Iatrogenic diseases of psychogenic origin in pediatric practice in pure form are less common than in adults and have their own characteristics in different age groups. It is manifested, in particular, by a profound change in the child’s psyche, which is also reflected in the somatic status.

This primarily applies to children who have a history of neurotic reactions to injections; obsessive fears and sharply negative reactions (breakdowns) before the procedure.

We know, for example, cases where complaints of “heart pain,” “palpitations,” etc. appeared after the doctor paid too close attention to functional changes in the heart.

Iatrogenic effects on parents, in our opinion, play an important and often even greater role compared to the impact on the child himself. In a broader sense, the sanitary culture of parents (i.e., the level of sanitary knowledge, attitude towards this knowledge and use of it in practice) largely determines the health of the child.

The common task of the doctor and nurse communicating with parents are objective information about the health of their child and recommendations for creating optimal conditions for its development. Any advice that does not comply with this provision can be a source of iatrogenic harm. We do not stop at giving parents incorrect advice or recommendations that may be misinterpreted; in these cases, the wrong actions medical worker obvious.

Iatrogenic harm mediated by parents is especially common during a child’s illness. 2. Iatrogenic diseases include diseases that manifested themselves as complications of the underlying disease; they were caused by incorrect or erroneous actions of the doctor and nurses.

Iatrogenic diseases are manifested mainly by neurotic reactions, including various options autonomic dysfunction. Depending on the nature of the psychotrauma and personality characteristics autonomic disorders may be generalized in nature or expressed by predominant dysfunction of the cardiovascular (cardiac arrhythmia, changes in blood pressure, etc.), digestive (heartburn, vomiting, stool disorders) and other systems in combination with various pathol. feelings and depression.

The main method of treating iatrogenism is psychotherapy, supplemented if necessary symptomatic treatment- use of tranquilizers, antidepressants and other psychotropic drugs. It is unacceptable to inform the patient that he does not have the disease and does not need treatment. Health care workers must remember that iatrogeny is a disease that requires a careful study of the patient’s personality characteristics and knowledge of his social environment. In case of severe iatrogenic diseases, the help of a psychotherapist or psychiatrist is required.

The prognosis of iatrogenic disease is favorable in most cases; with timely and correct therapy, recovery occurs within a few weeks or months. Late recognition of iatrogenic diseases contributes to its protracted course and worsens the prognosis.

Prevention begins with the highly moral, humanistic education of physicians in the process of their training and work, with the deep assimilation by future medical workers of the principles of medicine. deontology, which is based on sensitive attitude and compassion for the patient. Health care workers must be aware of the responsibility for “verbal asepsis”, the need to constantly monitor their behavior (intonation, glances, gestures), which can be misinterpreted by the patient. The content of the honey given to patients must be carefully considered. documentation. Particular caution should be exercised when providing medical care to the health workers themselves, in whom iatrogenies are relatively frequent, and their treatment is difficult due to often increased resistance to psychotherapy. To prevent iatrogenic diseases, it is necessary to carry out systematic educational work with all personnel communicating with patients. Medical system education of the population should exclude superficial, amateurish training in self-diagnosis, which contributes to the spread of iatrogenic diseases.

Several rules for preventing iatrogenic diseases