The adage about teaching an “old dog” and “new tricks” took an unexpected twist in Denver during the annual meeting of the American Association of Dermatologists. Turning 68 in May, this “old dog” didn’t learn a new trick; he learned a new word: iatrogenic. As published in The Road Less Traveled… (April 15, 2014, page 11)
What makes this new word so interesting is that it actually defined what happened to me between two major milestones:
✽ The first appearance of a dime-sized rash on my forehead on August 8, 2012
✽ My official PRP diagnosis 108 days later on November 28, 2012
First, the story…
By the time I was able to schedule an appointment with my dermatologist it was early September. The dime was now a quarter. She thought it was seborrheic dermatitis, gave me some meds and said to come back in two weeks.
Two weeks later the quarter was a bar the size of a dollar bill. I was clearly the victim of inflation.
Over the next four weeks I began a series of inconclusive biopsies, an ever-increasing regimen of prednisone, and the predictable mantra: “Come back in two weeks.”
The red skin continued to march down my body like General Sherman to the sea. A few days before the Marine Corps Birthday (November 10) the prednisone dosage in the evening was increased to 60 mg. On the second night my sleep was rudely interrupted by a parade of brightly colored tropical fish and a yellow rubber duck of biblical proportions.
I woke up my wife and told her it was time for the ER and, by the way, we might need a truck for the duck.
I was admitted to the Medical Center of Plano and spent a week that included another inconclusive biopsy and an infection that required some “heavy-duty” antibiotics.” I left the hospital without a diagnosis.
Two weeks later I had a follow-up appointment with the dermatologist who had been called in when I was hospitalized. By now I was in full bloom from head to toe. I must have reached some equivalent of PRP Critical Mass. He instructed the dermatopathologist to consider PRP. He did and I finally got my PRP diagnosis.
Now, the word….
So, what does the word Iatrogenic actually mean?
Iatrogenic is an adjective that fits comfortably before the word “effect”. In my case the iatrogenic effect was the impact that the excessive use of prednisone had on the PRP patient who hallucinated and required hospitalization. It wasn’t PRP that put me in the hospital; it was the 60 mg. of prednisone that did.
Use of the term iatrogenic refers to any adverse condition in a patient resulting from treatment by a physician, nurse, or allied health professional. Iatrogenic does not apply to a disease that is running it’s course—no matter how devastating that course might be. The physical agony we experience waiting for a PRP diagnosis is not iatrogenic.
During a Saturday Forum, Dr. Eliot N. Mostow, (Akron, OH) offered his opinion on ways to prevent “iatrogenic” errors.
✽ Avoid shortcut thinking that doesn’t consider multiple possibilities
✽ Don’t latch onto a single diagnosis too quickly and too firmly
✽ Don’t depend on confirmation. You may see only the landmarks you expect to see and neglect those that contradict what you do not see.
✽ Don’t judge the likelihood of an event by the ease with which relevant examples come to mind.
How likely is it that PRP will “come to mind”. This it the reason we need to enlighten dermatologists and dermatopathologists.