Medical or diagnostic errors that can cause harm to the patient

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 harming patients and even applying the appropriate therapy.

Around the year 400 a. c. 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.

It is understood by iatrogeny (“iatro” = doctor; “geno” = produce, and “ia” = quality) to all negative consequence that occurs in the patient as a result of the intervention of a health professionalbe a doctor, psychologist, psychiatrist, nurse, pharmacist, dentist.

A very important concept –and one that differentiates it from malpractice– refers to the fact that the damage occurs even when the professional has applied the treatment adequately, ethically, without negligence, errors or omissions.

Iatrogenicity refers to the negative effects that can arise from proper medical care while malpractice involves negligent, reckless or illegal conduct by the health professional.

In psychiatry it is difficult to establish an exact figure on the frequency of iatrogenesis since its negative effects may vary according to the treatment, the disorder and the individual characteristics of the patientalthough 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 US by M. Makary and M. Daniel determined that medical error was the third leading 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.

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 a psychotherapeutic and not psychopharmacological treatment.

In our setting, the therapeutic capacity of the mental health care system (public or private) is usually limited and rushed diagnoses and treatments are common without critically considering the benefits they can provide or the harm 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.

MS