When considering iatrogenesis, don’t overlook structural drivers


Iatrogenesis is traditionally thought of as harm resulting from the actions or negligence of health professionals, but structural biases and inequities also contribute to medically induced harm. The health of patients who have been historically marginalized due to gender, race, class, ethnicity or comorbidities may hinge on a better understanding of the ethical, clinical, legal and social relationships between iatrogenic harm and health inequity.

Achieving optimal health for all

The AMA is confronting inequity at the system and community level to bring health equity to marginalized and minoritized communities in the U.S.

The August issue of AMA Journal of Ethics® (@JournalofEthics) examines how iatrogenic harm exacerbates inequity and how the different kinds of inequity exacerbate iatrogenesis.

The issue includes the following articles.

  1. How Should Clinicians Respond to Race-Based Algorithms as Sources of Iatrogenic Harm?

    1. Algorithms use race as an epidemiological shorthand, but clinically influential historical, social and cultural determinants of health are still sources of variability.
  2. When Is Iatrogenic Harm Negligent?

    1. All harm resulting from negligence is iatrogenic, but not all iatrogenic injury is negligent.

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  3. When Experiencing Inequitable Health Care Is a Patient’s Norm, How Should Iatrogenic Harm Be Considered?

    1. Inequitable care and outcomes experienced by patients with mental illness have long been exacerbated by stigma expressed by clinicians.
  4. How Cisgender Clinicians Can Help Prevent Harm During Encounters With Transgender Patients.”

    1. Transgender people commonly experience discrimination from clinicians, which directly contributes to worse mental and physical health outcomes.

The journal’s August “Ethics Talk” podcast features a discussion with Helen Chapple, PhD, RN, MSN, a professor in the Department of Interdisciplinary Studies at Creighton University, in Omaha, Nebraska, about the harms of poor end-of-life care and how to avoid them.

The August issue also features eight author-interview podcasts. Listen to previous episodes of the “Ethics Talk” podcast or subscribe in Apple Podcasts or other services.

Also, CME modules drawn from this month’s issue are collected at the AMA Ed Hub™ AMA Journal of Ethics webpage.

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Upcoming issues of the journal will focus on what is owed to low-wage heath care workers, health care waste, and price transparency and economic decision-making in health care. Sign up to receive email alerts when new issues are published.

Table of Contents

  1. Listen and learn
  2. A look ahead