restricted access 4. Iatrogenicity from the Patient’s Perspective
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“The golden rule of medicine is ­ simple but usually not easy: Put yourself in your patient’s place.” Richard B. Gunderman, MD, PhD(1) Physicians have an ethical duty to their patients, who trust them and rely on them for their well-­ being. Prior experiences related to adverse outcomes color the physician-­ patient interaction. Patient characteristics such as age, gender, education, use of the Internet, and frailty are key ­ factors influencing the occurrence and perception of­ actual or potential iatrogenic adverse consequences. In the past, patients (especially older ones) did not question their doctors’ recommendations or treatments, but younger patients want to be involved in their own care (2). The Internet has made it easy for them to research symptoms, treatments, and potential side effects of treatments . It can also be a source of fear, for example, when an individual makes a self-­ diagnosis that may result in avoidance of medical care. This chapter specifically addresses the issues of physician-­ patient communication, confidentiality, and adverse drug reactions. PHYSICIAN-­PATIENT COMMUNICATION An impor­ tant prob­ lem under­ lying the current increase in malpractice cases and higher malpractice premiums is the lack of appropriate physician-­ patient communication . Patients complain that physicians do not listen, do not talk openly, and do not warn them about short-­and long-­ term risks, especially for infants. More to the point, some patients state that physicians attempt to mislead them and ­ others have the impression that doctors desert them or, more often, are unavailable. Compounding this prob­ lem is the common perception that physicians do not understand the patient’s perspective. The above concerns underscore that good communication is a cornerstone of the physician-­ patient relationship. Studies have shown that the four main reasons prompting patients to file malpractice lawsuits are (a) a desire to prevent similar adverse events from happening to other ­ people; (b) a desire for financial compensation for costs incurred as well as for pain and suffering; (c) a desire for an explanation from the physician on how the complication happened; and (d) a wish to CHAPTER 4 Iatrogenicity from the Patient’s Perspective Jeanne M. Dobrzynski Confidentiality / 29 prolonged distress that may include the development of post-­ traumatic stress disorder. In other instances, the financial losses are catastrophic. Many professional codes,from that of Hippocrates to ­ those of the American Medical Association and the Center for Medicare and Medicaid, emphasize the ethical responsibility of physicians and the obligation to have a defined greivance pro­ cess (3,4). With the current emphasis on patient satisfaction and marketing of physician practices and healthcare facilities, addressing iatrogenic injuries in addition to other quality-­ of-­ life issues such as parking and meals has become impor­ tant. As stated earlier, open and early disclosure of all adverse events is crucial for resolving disagreements, decreasing the possibility of litigation, and maintaining the physician-­ patient relationship. Ways in which the current situation may be improved include consideration of humanistic perspective and compassion in the se­ lection of applicants to medical schools and residency programs ; emphasis on compassion and dedication in healthcare education programs at all levels; and fostering of more person-­ to-­ person interaction with patients in the healthcare system (1). CONFIDENTIALITY Patients understand that recording accurate medical information, including past history as well as information pertaining to their current visit, is essential for good patient care. This came to the forefront with the approval by the Governing Board of the National Research Council of the Institute of Medicine report in 1999 that was published in 2000. (5). In an anonymous survey of 1,126 internists and internal medicine subspecialists , 59% noted questionable reporting of patient information and documentation in the medical rec­ord (6). More than 80 countries have comprehensive laws for health data protection. All data collected should be for a stated purpose and an individual ’s data should not be disclosed to other individuals or organ­ izations ­ unless authorized. Rec­ ords should be accurate and deleted when they are not needed for the purpose they ­ were collected , and some data should not be collected. In the United States, the Health Insurance Portability and Accountability Act (HIPAA), enacted by make the physician accountable for his or her­mistake. Frank communication between physician and patient prior to treatment and admission of errors may go a long way in decreasing enmity and the number of malpractice suits. Physicians who show empathy and re­ spect, answer all questions , and are sensitive to the individual patient’s circumstances are more successful. Aligning...