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Curriculum reconceived
Published in Alan Bleakley, Medical Education, Politics and Social Justice, 2020
Pressures on medical schools for curriculum reconceptualization come from Consumers through changing patient demographics. This includes a growing number of elderly patients with multiple chronic conditions, requiring complex cross-specialty care in the community; a growing number of mental health-related issues such as treatments for anxiety and depression; and a changing profile of disease manifestations such as a sharp rise in cardiac conditions.Royal Colleges promoting specialties interests, based partly on perceived future needs and partly on vested interests (for example, medical schools may have successful research interests in particular specialties, raising significant income and affording prestige).Iatrogenesis – a recognition that a significant number of patient deaths occur through avoidable errors – has led to interest in providing patient safety input to the curriculum, especially around quality of intra- and inter-team communication.
The wisdom hierarchy
Published in Paul Bowie, Carl de Wet, Aneez Esmail, Philip Cachia, Safety and Improvement in Primary Care: The Essential Guide, 2020
Illich18 was one of the early writers on the harm caused by medicine - iatrogenesis - in the 1970s. He described three types of iatrogenesis: (1) clinical iatrogenesis, which includes harm to individuals such as adverse drug events and hospital-acquired infections and harm to society such as drug resistance; (2) social iatrogenesis, which is about the medicalisation of life, where every deviation becomes a medical problem, rendering people anxious and dependent on healthcare; and (3) cultural iatrogenesis, which is about the war against suffering that undermines patients’ ability to face their reality and accept pain and inevitable decline.18 The current patient safety debate is largely confined to what Illich called clinical iatrogenesis - specifically, the harm to individuals - but in primary care, social and cultural iatrogenesis may be the greater problem. Some groups of individuals may be at greater risk of clinical, social and cultural iatrogenesis - such as women, because they take more drugs,19 have more cosmetic surgery,20 participate more in cancer screening and experience more over-diagnosis.21
Practical Considerations for Interpreting Change Following Brain Injury
Published in Mark R. Lovell, Ruben J. Echemendia, Jeffrey T. Barth, Michael W. Collins, Traumatic Brain Injury in Sports, 2020
Grant L. Iverson, Michael Gaetz
Although it can be argued that the term impairment simply refers to a negative change in function, for most people the term carries much more serious connotations. This is a particularly important issue when working with athletes, or others, who have sustained concussions. As a profession, we must guard against iatrogenesis (i.e., health care providers making the problem worse). It is quite possible that by over-pathologizing an injury, the health care provider can inadvertently make the athlete worse. Focusing, dwelling, and worrying about symptoms of concussion, and “brain damage”, can magnify them and protract the recovery period. Having stated this, it is important to accurately detect change that has occurred, and to determine whether this is a statistically and/or clinically meaningful change. Detection of clinically meaningful change is important because athletes function in an environment where subsequent injuries can occur, making it necessary to address the issue of cumulative effects. The need to detect subtle changes when they occur, without over-pathologizing these changes, adds to the complexity of assessing athletes.
High utilisers of emergency departments: the profile and journey of patients with mental health issues
Published in International Journal of Psychiatry in Clinical Practice, 2021
Melissa Casey, Dinali Perera, Joanne Enticott, Hung Vo, Stana Cubra, Ashlee Gravell, Moana Waerea, George Habib
It has been further documented that those who present and receive too many services may also be vulnerable to iatrogenic injury or unintentional harm (Batavia and Batavia 2004). Iatrogenesis can be broadly defined as unintended or unnecessary harm arising from any aspect of health care management; and can be due to preventable human error or system failure (Runciman and Moller 2001). High utilisers may be at risk for errors resulting from poor transitional care, multiple handoffs (Lim and Warning 2016), and vulnerable to overtreatment, misdiagnosis, inappropriate pharmacologic therapy (Boltz 2013), and adverse events (Batavia and Batavia 2004). Research exploring experiences of adverse events, errors and multiple handoffs specifically for high utilisers with mental health conditions is however limited.
Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter
Published in Disability and Rehabilitation, 2019
Keith J. Geraghty, Charlotte Blease
While the etiology of ME/CFS remains unclear, the ‘first do no harm’ principle of medicine should continue to guide practice. Doctors should respect the patient narrative, rather than seek to impose illness models and interventions in a top-down fashion. The simple act of acknowledging patients’ concerns and involving patients in decision making, may avoid the distress, isolation, and iatrogenic harm many ME/CFS sufferers report [139]. Nassir Ghaemi [33] suggests that Karl Jasper’s ‘method-based medicine,’ or William Olsen’s ‘medical humanist model, offer more patient-centred and pragmatic approaches with few of the weaknesses of the biopsychosocial model. The need for a concordant model of practice is well established [140]. A pragmatic patient-centred approach encourages physicians to be open about the limitations of medical science whilst maintaining a traditional therapeutic role [139]. Harm is an empirical reality of medicine and is potentially measurable, and doctors and researchers should seek to better understand iatrogenesis, with a view towards minimization. Findings from this review should be employed to raise awareness among health care professionals about the potential for iatrogenesis using biopsychosocial approaches, particularly in ME/CFS, but also in other illness domains. Medical educators should include teaching on ME/CFS in training programs, particularly for front-line primary care doctors. Researchers should also investigate alternative models and interventions that better meet the needs of patients with ME/CFS.
Person-centered versus disease-centered narratives among mental health providers in Kuwait: A critical and qualitative analysis of iatrogenesis and .global medical discourse in action
Published in International Journal of Mental Health, 2018
Several participants in this study felt that Kuwait is an overmedicated society, due to the overdiagnosis of mental disorders, such as anxiety, depression, and ADHD, for which the first course of action once a patient enters public healthcare facilities is a prescription. These prescriptions can sometimes lead to iatrogenically propagated drug-dependence, similar to North America (Frances, 2013; Greenberg, 2013). The only study fully addressing iatrogenic drug dependence in Kuwait was carried out in 1989 by A. M. Bilal, a psychiatrist in Kuwait, who pointed out, that after intravenous fluids and vitamins, the primary drugs given at a local psychiatric facility were benzodiazapines and neuroleptics (e.g., haloperidol and thioridazine) for the detoxification of patients who were already suffering from addictions (Bilal, 1989). According to his analysis, there was a shift between the use of illicit substances—which even today are primarily alcohol, heroin, hashish, and amphetamines—to benzodiazapines (Bilal, 1989). Several of the clinicians interviewed in this study provided similar narratives, suggesting that iatrogenesis persists in Kuwait and requires more attention from healthcare providers.