IATROGENIC DISEASES

From Big Medical Encyclopedia

IATROGENIC DISEASES (Greek iatros the doctor + gennao to create, make; a synonym of a yatrogeniya) — the psychogenic frustration arising as a result of deontological mistakes of health workers — the wrong, careless statements or actions.

Studying of the monuments of culture reflecting development of ethical standards and rules of conduct of the doctor (see the Deontology medical, Ethics medical), allows to conclude that the disorders of health resulting from unreasoned words and actions of the doctor were known already to physicians of antiquity. However the term «yatrogeniye» was widely adopted only after publication in 1925 of work is mute. psychiatrist Bumke (O. of Page E. Round) «Doctor as reason of mental derangements». From now on the concept of yatrogeniye is actively investigated by specialists different a wedge, profiles. From domestic scientists the essential contribution to its development was made by R. A. Luriya.

Nek-ry clinical physicians (e.g., I. A. Kassirsky) applied the concept «iatrogenic diseases» in a broader sense, carrying to them any pathology which resulted from actions of the doctor — from complications of incorrectly carried out manipulation or the procedure before emergence of a so-called drug disease, i.e. those negative effects of medical interventions, to-rye a number of researchers designate, unlike yatrogeniye, yatropatiya, or somatic yatrogeniye. Extension of the contents of the concept «iatrogenic diseases» is not justified since, on the one hand, nek-ry negative effects of medical interventions are inevitable so far (e.g., the injury caused by an operative measure), and on the other hand, the complications caused by incorrectly conducted examination or treatment of the patient belong to the category of medical errors (see) or even medical offenses (see) also make absolutely special etiological group. Therefore standard is use of the concept «iatrogenic diseases» of its traditional sense, i.e. for designation of the disorders of health caused by the psychoinjuring influence rash, deontological incorrect statements or acts of medics.

M. S. Lebedinsky and V. N. Mya-sishchev (1966) specified that for development I. h. both the behavior of the doctor, and feature of the identity of the patient matter (degree of emotionality, suspiciousness, etc.). Many of sick people suffer not only from a disease, but also from generated by it alarms, fears, fears for an outcome. The special attention of the patient and to words of the doctor, and to his behavior, intonations, a look is explained by it. At the same time depending on type of nervous activity, a warehouse of the personality and features of mentality different patients differently, sometimes opposite, react to certain words and behavior of the medic. Not only unreasoned remarks can have pathogenic value («Your heart attack is the first call»; «... the main vessel of heart passes blood for 30%», etc.) or unclear value of nek-ry words and expressions («a hook-shaped stomach», «dystrophy of a myocardium» etc.), but sometimes even interjections or prolonged silence of the doctor, to-rye can be interpreted by the patient as signs of special difficulty of diagnosis or treatment of his disease, its special weight, hopelessness of the forecast.

Risk of emergence I. h. with other things being equal it is not identical at persons of different age, sex, education. At women probability the yatro-genius is on average higher, than at men. Age groups of the increased risk of development I. h. people of so-called transitional age — teenagers and persons in the period of a climax make (especially women at patol. a climax), and also elderly people, among to-rykh there is much aktsentuirovanny on inevitability at them involute changes and the increased probability of a lethal outcome of the arising disease.

To factors, to-rye can promote emergence I. h., it is necessary to carry and not always justified expansion of volume of the medical information distributed among the population (popular lectures, telecasts and broadcasts) when symptoms of this or that dangerous disease are stated is fixed attention on its early manifestations, frightening perspectives of «the late address» are drawn.

Character I. h. depends on prevalence and efficiency of treatment of these or those diseases. So, at the beginning of 20 century among suffering I. h. the people assuming at themselves tuberculosis or syphilis met more often; in a crust, time cancerophobias and cardiophobias are more widespread.

I. h. hl are shown. obr. neurotic reactions in the form of various options of vegetative dysfunction. Their development is promoted by the increased emotionality and suggestibility. Depending on the nature of a psychoinjury and premorbidal features of the personality vegetative frustration can have generalized character or are expressed by preferential dysfunction cardiovascular (arrhythmia of heart, change of the ABP, etc.), digestive (heartburn, vomiting, frustration of a chair) or other systems in combination with senesthopathias, a negative affective background.

Establishment of interrelation between I. h. and neurosises (see Neurosises) presents certain difficulties. According to B. D. Karvasarsky (1980), yatrogeniya come to light approximately at 1/3 patients with neurosises. However in the nomenclature of neurosises as one of their independent forms Ya. h. do not enter.

Main method of treatment I. h. — the psychotherapy (see) supplemented if necessary by a symptomatic treatment — use of tranquilizers, antidepressants and other psychopharmacological means (see). It is inadmissible to tell the patient that the disease at it is absent and it is not necessary to be treated. Doctors shall remember that it is about the disease demanding careful studying of features of the identity of the patient, knowledge of his social environment. The psychotherapy demands the establishment of features given I. h. and the factors promoting its emergence. The big psychotherapeutic effect can render the convincing conclusion of an authoritative consultation or the highly qualified specialist which is brought to the attention of the patient. At a heavy current I. h. the help of the psychotherapist or psychiatrist is required.

Forecast I. h. in most cases favorable, at timely and correct therapy recovery occurs in several weeks or months. Late recognition I. h. promotes its long current and worsens the forecast.

Prevention I. h. begins with deep assimilation by future doctors of the principles of medical ethics and a deontology, to-rykh the sensitive relation, compassion to the patient, and also from highly moral, humanistic education of medics in the course of their training and activity are the cornerstone (see the Deontology medical, Ethics medical). Important factor of prevention I. h. knowledge is a doctor of fundamentals of psychology (see).

The existing premises to growth of frequency of neurosises, and also the progressing increase in number of people of the senior age groups increase risk of emergence the yatro-genius. On this background responsibility of doctors for «a verbal asepsis», need of constant control of the behavior (intonations, views, gestures) increases, a cut it can be misinterpreted by the patient. In a crust, time when not one, as a rule, communicates with the patient, and several doctors, average and junior medics, registrars, possibility I. h. increases. Therefore for the prevention I. h. it is necessary to carry out systematic educational work with all personnel communicating with patients. Thought over shall be the contents of the medical documentation issued to patients. Extra care should be shown at assistance to medics, at to-rykh I. h. are rather frequent, and their treatment presents difficulties in connection with quite often raised refrakternostyo medics to psychotherapy.

The system of medical education of the population shall exclude the superficial amateurish training in self-diagnostics promoting distribution of iatrogenic diseases.

Legal aspects I. h. are not developed; they shall be referred to the medical right, problems to-rogo in the conditions of scientific техниче-GKoro of progress of steel especially urgent.

Bibliography: Karvasarsky B. D * Neurosises, M., 1980; Kassirsky I. And „About doctoring, Problems and thoughts, M., 1970; Lakosina N. D. and At sh joint stock company about in G. K. The manual on medical psychology, M., 1976; JI e e d and N-skiym. Page imyasishchevv. H. Introduction to medical psychology, JI., 1966; JI at r and I am R. A. Internal picture of diseases and iatrogenny diseases, M., 1977; E lstein N. V. All-medical problems of therapeutic practice, Tallinn, 1983; Bernades P. Conditions de survenue des gastropathies iatrogfcnes, Rev. franQ. Gastroent., No. 178, p. 21, 1982;

B u m k e O. Der Arzt an Is Ursache seelischer Storungen, Dtsch. med. Wschr., S. 3, 1925; Nelson R. L., A b with a r i-a n H. P of s a d M. L. Iatrogenic perforation of the colon and rectum, Dis. Colon Rect., y. 25, p. 305, 1982; S with h i p-kowensky N. Iatrogenie oder befreien-de Psychotherapie, Lpz., 1965.

H. V. Elstein.

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