“Iatrogenic” is a word that we doctors don’t like to hear. Pronounced “ai-at-tro-jen-ic,” it means a condition or symptoms caused by something we did.
First do no harm
The reason we don’t like to hear it is because one of the basic tenets of medicine is “First do no harm.” And yet we all know that it happens. All the time. Sometimes they are avoidable and sometimes not. Sometimes they are called adverse events and other times we call them medical errors.
We encourage each other to write them up so we can learn how to improve the system. We have conferences called M&M (which stands for morbidity and mortality) where we try to figure out what went wrong and how to do better. But sometimes the patient is hurt in a way that no one can see, and most people don’t learn about.
As an Integrative Medicine specialist, I often see patients referred by integrative practitioners like naturopaths or osteopaths. Sometimes these colleagues feel compelled to warn me that the patient was very reluctant to see a medical doctor. That it took them a long time to convince the patient to come see me, because the patient was afraid of being hurt.
Iatrogenic PTSD
When I finally see those patients and hear their stories, my heart breaks a little for the profession of medicine. Because it is our birthright as healers to make people feel better, but how did we get to this place where we are seen as villains?
There was the man whose ankle surgery and subsequent revisions went wrong, who became so mistrustful that he undertook to become his own doctor, taking a list of over 20 prescription medicines and at least 30 supplements. So many others have undergone rounds of medicines and painful endoscopies, only to be dismissed because her pain was “all in her head.”
Cure sometimes, treat often, and comfort always
These patients and many more are left with a condition I call “iatrogenic PTSD (post traumatic stress disorder).” In other words they were emotionally traumatized by what happened to them in the course of seeking help.
Treat often and comfort always
Hippocrates is often quoted as saying, “Cure sometimes, treat often, and comfort always.” As doctors, we cannot always cure or treat patients, but we can help by validating their experience and staying with them when they are sick and vulnerable.
I truly believe that most doctors are doing their best and do not intend to cause the degree of trauma that resulted from their words. And unfortunately our healthcare systems are mostly set up for doctors to be maximally efficient in diagnosis and treatment, not to provide comfort.
In fact, even as a doctor, I find it jarring to be asked about my insurance as the first question when I’m calling to make an appointment for care. I understand why the corporate machinery of the Healthcare Industrial Complex runs the way that it does.
But there’s a part of me that wants those in charge of designing it to ask why we are making the experience even more uncomfortable and vulnerable than it already is. As if the “care” was gone from healthcare.
Owning our part
We usually don’t hear about patients who may have been hurt by our words, and we won’t get a second chance to see them again. But we can help our patients by acknowledging the emotional pain they suffered before, and by validating that they shouldn’t have had to experience it.
We don’t have to explain nor vilify the other doctors, we don’t even have to know what actually happened. Our job is to heal the trust between the patient and all doctors, by helping them rebuild back some level of respect and trust over time.
In my experience, patients are seldom angry at the doctor who caused their iatrogenic PTSD - they more often direct their anger at themselves. They blame themselves for not having been more assertive, or for having been too naive by trusting someone they shouldn’t have.
Turns out we have a lot in common, because doctors also more often blame themselves when things don’t turn out the way they had wanted. So we could all use a lot more compassion. For ourselves and for each other.
