Book Review

Medical Harm: Historical, conceptual, and ethical dimensions of iatrogenic illness

N Engl J Med 1998; 339:930-931September 24, 1998

Article

Medical Harm: Historical, conceptual, and ethical dimensions of iatrogenic illness
By Virginia A. Sharpe and Alan I. Faden. 280 pp. New York, Cambridge University Press, 1998. $27.95. ISBN: 0-521-57133-2

The authors have chosen to use the term “medical harm” rather than “iatrogenic disease,” principally because they are referring to incidents that occur during or as a result of treatment given not only by physicians but also by medical personnel of all types. They report that medical harm is experienced by almost 4 percent of hospitalized patients in the United States, a surprising and undoubtedly important number. In addition, they claim that more than two thirds of these harmful events are preventable. Given the scope of the problem, this book is an important one for medical professionals.

The book has three main parts. The first is a discussion of the authority of the medical profession as opposed to “the patient's rights.” The second deals with the fine line between providing “due care” as a professional duty and simply “doing no harm.” Appropriately, in the third part, the authors close the work with recommendations for limiting such harm.

The book is nicely written and makes for easy reading. Throughout, the authors use well-documented, specific cases to illustrate particular points. Some of these cases are well known, having been reported in newspapers nationwide — for example, the case of the man in Florida, Willie King, who had gangrene of one leg and was mistakenly subjected to amputation of the other. Incidentally, the authors inadvertently include that story twice, once at the beginning of the book and again near the middle. However, that minor oversight does not detract at all from the value of the book as a whole.

The appendix comprises six excellent tables. The first, for example, provides the details of certain iatrogenic events that have occurred in hospital settings; the third is devoted to adverse effects of drugs in outpatients. There are numerous references at the end of every chapter, in addition to a 22-page bibliography with almost 500 references at the back of the book. The index is an asset, especially since it includes listings of the figures and tables.

Marie Valdés-Dapena, M.D.
University of Miami School of Medicine, Miami, FL 33101