Medical or diagnostic errors that can cause harm to the patient

2023-03-06T10:42:14.543Z

The negative effects that can arise from the correct medical attention are called iatrogenic. Why is it different from malpractice?

Question: I was in psychiatric treatment for 4 years for panic attacks with very little success until another psychiatrist found out that I actually had mitral valve prolapse in my heart.

Is it possible that such mistakes can be made today?

Juana Z. Rafetti.

CABA

Since the beginning of Medicine, it has been proven that doctors can

inadvertently cause harm to patients

and even applying the appropriate therapy.

Around the year 400 a.

Hippocrates already recommended as fundamental the basic principle of "help or, at least, do no harm".

Time later, it would become "primum non nocere", "first not to harm", which is attributed to Galen.

Iatrogenicity is understood (“iatro” = doctor; “geno” = produce, and “ia” = quality) as any

negative consequence that occurs in the patient as a result of the intervention of a health professional

, be it a doctor, psychologist, psychiatrist , nurse, pharmacist, dentist.

Iatrogenicity refers to the negative effects that can arise from proper medical care.

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A very important concept –and that differentiates it from malpractice– refers to the fact that

the damage occurs even when the professional has applied the treatment in an adequate, ethical manner, without negligence, errors or omissions.

Iatrogenicity refers to the negative effects that may arise from proper medical care, while

malpractice implies negligent, reckless, or illegal conduct

on the part of the health professional.

In psychiatry it is difficult to establish an exact figure on the frequency of iatrogenicity since

its negative effects can vary according to the treatment, the disorder and the individual characteristics of the patient

, although there is a presumption that it affects many.

Diagnostic errors, lack of adequate follow-up and poor communication between the professional and the patient can play a role.

An investigation carried out in the USA by M. Makary and M. Daniel determined that medical error was the third cause of death in that country in 2016.

Norberto Abdala, psychiatrist

What are the most frequent causes:

1) Indication of a treatment that does not correspond.

For example, when treating healthy people, with normal mood problems without involving a disease (due to bereavement, lack of work, relationship problems, economic).

Some investigations have estimated that almost a quarter of the patients who attend a mental health center do not present any mental disorder and even so receive psychopharmacological medication, medicalizing normal aspects of their lives.

In psychiatry it is difficult to establish an exact figure on the frequency of iatrogenesis.

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2) Excessive use in time and quantity due to high doses of psychotropic drugs.

3) Technically inadequate treatments

such as unjustified combinations of medications, inadequate prescription, improperly made suspensions.

4) Insufficient complementary studies.

5) Divorce of the psychiatrist's knowledge in matters of internal medicine and confusing, for example, hypothyroidism with depression.

6) Tendency to an exaggerated organic approach

without weighing possible psychological factors that warrant psychotherapeutic and non-psychopharmacological treatment.

Hasty diagnosis and treatment is common.

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In our environment, the therapeutic capacity of the mental health care system (public or private) is usually limited and

hasty diagnoses and treatments are frequently carried out

without critically considering the benefits they can provide or the damage they can cause.

As an example,

an investigation carried out in the USA by M. Makary and M. Daniel determined that medical error was the third cause of death in that country in 2016.

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