I wanted to be a Doctor when I was young. Then I grew up and realized that I don’t deal so well with the gory side of medical residency. Also, I realized that you don’t always get to save people’s lives. The reason “Do No Harm” is part of the Hippocratic oath is because Doctors mostly walk a tightrope between harm and more harm, short term pain and long term pain. Sometimes they can’t cheat death; they can just negotiate the timetables. Hospital personnel go home nearly every day knowing that they have caused another person a measure of distress. It’s part of the job. We don’t make mailmen take an oath to do no harm because it doesn’t come with the territory, but it does for Doctors.
I enjoyed reading the book, “Do No Harm,” by Henry Marsh, an English brain surgeon. To sum up, I’ll just quote one of the blurbs here:
“If you believe that brain surgery is a precise and exquisite craft, practiced by calm and detached surgeons, this gripping, brutally honest account will make you think again. With astonishing compassion and candor, Marsh reveals the fierce joy of operating, the profoundly moving triumphs, the harrowing disasters, the haunting regrets, and the moments of black humor that characterize a brain surgeon’s life.”
If you believe that any surgery, for that matter, is a precise and exquisite craft practiced by calm and detached surgeons… If you think that doctors are not humans affected by their own perception, prejudice, character flaws, fatigue, and what they ate (or drank) that day… you can think again.
Any complication, disease or condition caused by a Doctor or other members of the medical team is termed “iatrogenesis.” This term would cover iatrogenic effects that are easily recognized and defined, like complications after surgery. Less obvious ones would be complicated drug interactions, medication errors, and other errors in hospitals. Negative effects of drugs (non- error side effects), unnecessary surgery, and nosocomial infections in hospitals are also covered by the term.
Sometimes, intrinsic (though adverse) effects of certain medical treatments are considered “iatrogenic.” For example, hair loss, anemia, vomiting, nausea, brain damage, infertility, lymphedema- those would be considered iatrogenic effects of radiation therapy and chemotherapy. They are caused by the doctor/medical treatment and not by the disease itself. So, the incidence of iatrogenesis is a bit misleading here. Prodedures that cause effects or deaths that are considered iatrogenic may still be a better bet than 100% chance of death without the procedure/treatment. (surgery for ruptured aortic aneurysm would be one example for this.)
It is estimated that globally,142,000 people died in 2013 from adverse effects of medical treatment (up from 94,000 in 1990.)
In the United States these estimated deaths per year would include:
• 12,000 due to unnecessary surgery
• 7,000 due to medication errors in hospitals
• 20,000 due to other errors in hospitals
• 80,000 due to nosocomial infections in hospitals
• 106,000 due to non-error, negative effects of drugs
Based on these figures, iatrogenesis may cause 225,000 deaths per year in the United States.
Nosocomial infections (or HAI- Hospital Acquired Infections) are infections that are contracted by the patient or medical staff in the hospital itself. In the United States, the CDC- Centers for Disease Control and Prevention- estimated roughly 1.7 million hospital-associated infections, from all types of bacteria combined. These cause or contribute to 99,000 deaths each year.
The most frequent type of infections contracted in hospitals are urinary tract infections, bloodstream infections, surgical site infections, and pneumonia. Often, nosocomial infections are difficult to attack because the bacteria have built up antibiotic resistance during their stay at the hospital.
Hospitals, and other settings associated with healthcare, tend to have protocols in place to prevent infection. Protocols usually include equipment sterilization, uniforms, isolation protocols, and hand washing/alchohol rubs, which are the most effective way to prevent nosocomial infections. Also, preventing contamination by using proper medical waste disposal protocols.
One-third of nosocomial infections are considered preventable. I’ve gotten into the business of saving some lives after all by providing easy, convenient and affordable medical waste disposal to health facilities.
On a side note, when you “catch” your Doctor or Nurse or other medical staff appropriately disposing of their used parapharnelia, masks, aprons or gloves, consider saying “Thank You.” With all this harm going on around them, medical personnel don’t hear those words as often as they deserve to. Let them know you notice and appreciate their dedication to reduce the number of nosocomial infections and follow the medical waste disposal process.