Iatrogenic

[lawrocket 3]

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I can't seem to find the overall number for it from JAMA

That's because it's difficult to tally an overall number for it. What is and is not an iatrogenic illness or death is subject to a great deal of debate. For example, is weight loss among those kids being treated with stimulants for ADHD an iatrogenic condition? What about allergic reactions to medications?

Death due to malpractice are iatrogenic. But, so are deaths due to a known and unmanageable complication that ihappens with some procedures. A person rejects a transplanted kidney? That's iatrogenic. A person loses her hair during chemo? Iatrogenic.

It's just such a broad category that compiling stats is difficult. Only 195k deaths per year seems small when one thinks of the possibilities.

My wife is hotter than your wife.

[riddler 0]

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Iatrogenic illnesses are something that we don't have the technology to fully prevent.

Here is yet another problem. How do you define iatrogenic? There is actually an organization called the American Iatrogenic Association, although they're based in Dallas, so I don't have the same fraternal bonds . Here's a quote from them:

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it is essential for any use of iatrogenic to include clear directions as what the user intends. That way we can distinguish between a person who is dying from an infection obtained from a physician's contaminated hands and a person who sues his doctor for not informing him that skydiving is a dangerous hobby.

Can I sue my doctor for that? But I think the lack of clarity over the definition makes it important to look at the underlying data. A lot of focus of this thread has been about the septic deaths. What about the other types? What about the fact that

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One in every four Medicare patients who were hospitalized from 2000 to 2002 and experienced a patient-safety incident died.

Could it be that we are not providing extra care to the elderly that they need? Or is it just that they're old and ready to die anyway? How do you look at it?

I've said it before - why are there NO numbers from JAMA? Even if you cut out 80% of the HealthGrades number, you still have enough to show up in the top six. JAMA shows nothing about it. Nada. The sixth leading cause is drug use (17,000/year). Even if you cut 80% out, the number of iatrogenic deaths is twice that. And yet there is no mention of it. Why? The sheer magnitude of the problem is difficult to ignore.

Trapped on the surface of a sphere. XKCD

[billvon 3,114]

>This is a story about a culture that deceives others about it's actions
>and also tries to convince itself that it did nothing wrong.

We have that sort of culture too. We have some students who die, yet most of the time we claim that their death is their fault, because they screwed up. Maybe they cut away at 100 feet. Maybe they pulled a toggle down all the way at 200 feet. Maybe they disregarded the radio and flew straight into a power line

Now, a whuffo might claim "skydiving instructors are killing students, and no one cares!" You might reply that it was the student's fault - in which case the whuffo would claim that you are trying to cover up the incident and pretend your friends did nothing wrong. Again, the problem would be that the whuffo simply doesn't understand the sport, and is coming to erroneous conclusions.

[riddler 0]

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We have some students who die, yet most of the time we claim that their death is their fault, because they screwed up. Maybe they cut away at 100 feet. Maybe they pulled a toggle down all the way at 200 feet.

I agree with that. And I think the analogy is good, because I think that a skydiving instructor would feel a sense of responsibility when a student goes in (I would, I think). I also think that doctors feel some responsibility when patients die due to hospital errors. But the USPA doesn't take accountability for the deaths of students - we point the fingers at students. And I believe the AMA doesn't want to take responsibility for deaths that happen due to improper care.

I do think there's a difference that requires a moral duty on the part of the AMA. Skydivers participate in a sport, and they are informed of the risk (I hope). I also hope that skydivers take the responsibility that they may die doing what they do. But patients have a different view of doctors and medicine. People go to hospitals and they trust doctors - they expect to get better. No one goes in thinking that a doctor/practitioner error could kill them - they may think that they are sick and may not recover, but I don't think people realize that they could die without good cause due to poor treatment. That's why it's important for the AMA to fess up. Let people know that if they are hospitalized, or even treated by a doctor, that there is risk. And depending on the numbers you choose to believe, it may be a serious risk.

I'm still searching around JAMA for any overall numbers. Still can't find any.

Trapped on the surface of a sphere. XKCD

[lawrocket 3]

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No one goes in thinking that a doctor/practitioner error could kill them - they may think that they are sick and may not recover, but I don't think people realize that they could die without good cause due to poor treatment.

Plenty of people go in to a doctor knowing that they may not make it through the procedure. Much like skydiving, the risks associated with open-heart surgery are so in-your-face apparent that to NOT be aware of the possibility of death is stunning.

I'll reiterate - a doctor can kill someone but it does NOT necessarily mean that the doctor did anything wrong. A doctor can kill someone but it does NOT necessarily mean that the doctor did anything wrong. A doctor can kill someone but it does NOT necessarily mean that the doctor did anything wrong.

This is why there is the "informed consent" documentation that is necessary. There are not many informed consents that do not list risk of death with any procedure.

My wife is hotter than your wife.

[kallend 2,147]

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No one goes in thinking that a doctor/practitioner error could kill them - they may think that they are sick and may not recover, but I don't think people realize that they could die without good cause due to poor treatment.

Plenty of people go in to a doctor knowing that they may not make it through the procedure. Much like skydiving, the risks associated with open-heart surgery are so in-your-face apparent that to NOT be aware of the possibility of death is stunning.

I'll reiterate - a doctor can kill someone but it does NOT necessarily mean that the doctor did anything wrong. A doctor can kill someone but it does NOT necessarily mean that the doctor did anything wrong. A doctor can kill someone but it does NOT necessarily mean that the doctor did anything wrong.

This is why there is the "informed consent" documentation that is necessary. There are not many informed consents that do not list risk of death with any procedure.

So you're saying the argument that physicians kill more Americans than guns so physicians should be banned before guns is, in fact, a piss poor analogy.

...

The only sure way to survive a canopy collision is not to have one.

[billvon 3,114]

>No one goes in thinking that a doctor/practitioner error could kill
>them - they may think that they are sick and may not recover, but I
> don't think people realize that they could die without good cause
> due to poor treatment.

Skydivers have waivers, surgical patients have consent forms that do much the same thing. That's one of the reasons they _have_ consent forms, so that no one thinks that medical procedures are without risk.

>That's why it's important for the AMA to fess up. Let people know
>that if they are hospitalized, or even treated by a doctor, that there
> is risk.

?? Again, that's a function of the doctor/hospital policy when it comes to consenting patients. I honestly don't think that there are a lot of patients who believe their surgery will be risk-free.

[peregrinerose 0]

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I do think there's a difference that requires a moral duty on the part of the AMA. Skydivers participate in a sport, and they are informed of the risk (I hope). I also hope that skydivers take the responsibility that they may die doing what they do. But patients have a different view of doctors and medicine. People go to hospitals and they trust doctors - they expect to get better. No one goes in thinking that a doctor/practitioner error could kill them - they may think that they are sick and may not recover, but I don't think people realize that they could die without good cause due to poor treatment. That's why it's important for the AMA to fess up. Let people know that if they are hospitalized, or even treated by a doctor, that there is risk. And depending on the numbers you choose to believe, it may be a serious risk.

Every patient is informed of risk prior to every surgical procedure, and that is documented in the patient's chart. Even when I dilate eyes, I educate the patient regarding the effects of dilation and document in the chart. Surgeons all have consent forms that the patient must read and sign spelling out possible risks of any procedure. When medications are prescribed, they all come with brochures spelling out the potential side effects.

There is no lack of information to patients regarding what can happen.

I think that the biggest issue here is that you believe that an iatrogenic issue means liability or fault or error or poor treatment. Fortunately, for a vast majority, that probably is not the case, there is nothing to 'fess up' to. When there is true malpractice, doctors end up paying large malpractice fees and often lose their license priviledges depending on the problem.

Jen

Do or do not, there is no try -Yoda

[riddler 0]

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Plenty of people go in to a doctor knowing that they may not make it through the procedure.

Right - it was a subtle point I was making before. Let me make it more clear. Plenty of people understand that they may not make it through a surgical procedure. But MOST people don't assume that they may die from an ERROR that that the staff or doctor makes, or due to incompetence, indifference, lack of equipment or preparation, etc.

This goes back to the earlier point of what constitutes iatrogenic. Does it mean medical error/pathos/incompetence, or does it get applied to anyone who dies in a hospital? You have to read the source of the statistics to find out.

And I personally am just looking for the AMA to admit that there are a number of deaths due to these problems, and publish their numbers on the matter.

Trapped on the surface of a sphere. XKCD

[riddler 0]

I posted this originally a few years ago, and the only reason I'm bumping it is because there's an interesting article about a friend of mine that died a few years ago, the day after my daughter was born. His original injuries were skydiving related, but he was well on his way to a full recovery. Then a bacteria he acquired from the hospital killed him. Iatrogenic.

http://www.cnn.com/2008/HEALTH/05/01/ep.avoiding.infection/index.html

Blue Skies, Josh.

Trapped on the surface of a sphere. XKCD