Iatrogenesis - Harm from Healthcare
By: Eric Bricker, MD
Iatrogenesis is harm caused by healthcare. The word comes from the Greek root Iatros, which means physicians, and genesis, which means origin.
According to a study by Dr. Marty Makary, Iatrogenesis is responsible for 250,000 deaths per year in the US and is the 3rd leading cause of death.
Iatrogenesis also causes suffering from effects such as diarrhea after taking antibiotics and difficulty swallowing after esophagus surgery.
To make patients aware of possible iatrogenesis, doctors need to perform informed consent.
Informed consent involves discussing with a patient 1) the condition being treated, 2) the nature of the treatment, 3) anticipated results of the treatment, 4) alternatives to the treatment, including non-treatment, and 5) risks, complications, and benefits of the treatment.
In practice, informed consent is not always performed correctly.
Finally, iatrogenesis contributes to high healthcare costs. Iatrogenesis costs employers approximately $44.50 per employee per month… as much as the ASO fee to administer their entire employee health plan!
What Employers Can Do About Iatrogenesis
There are differences in the degree of iatrogenesis by some doctors versus others. This variance in iatrogenesis can be measured in wide-ranging clinical areas as such as surgical complication rates and non-adherence to scientifically proven treatments for heart disease.
Data for this variance in iatrogenesis comes from Medicare, commercial insurance claims data, and quality organizations such as the National Committee for Quality Assurance (NCQA).
A typical employee does not have the expertise to sift through this data to find the information that is most relevant to them.
However, the employee health plan itself can guide plan members away from doctors with higher levels of iatrogenesis.
A difference in copay costs—with higher copays assigned to doctors with higher levels of iatrogenesis and LOWER copays assigned to doctors with lower levels of iatrogenesis—is an understandable way to direct employees to higher-quality doctors with lower degrees of iatrogenesis.
Those copays can be built into the plan design and the explanation for WHY those copay differentials exist can be communicated to the employees.
There is a path forward for those who want to make a difference and help health plan members avoid harm.