Prevalence of Iatrogenesis in the Nigerian Healthcare Delivery System: A Conceptual Analysis

This paper examines the prevalence of social iatrogenesis as an umbrella word subsuming cultural, clinical and technological iatrogeneses in the Nigerian healthcare delivery system. The study takes into consideration the growing cases of perceived unintended or latent consequences among patients and medics while seeking or rendering healthcare services in many Nigerian hospitals. On the one hand, many health seekers have become victims of cultural iatrogenesis, particularly as it bothers on child swapping or baby switch, as well as conflict of faith and therapeutic regimen. On the other hand, many health workers, including medics, have been affected by clinical iatrogenesis measured by negligence, job stress, monetisation of health services, inadequate motivation, medicalization, prognosis and faulty diagnosis, and disregard for ethical standards. In addition to decades of inadequate funding of the Nigerian healthcare system, the prevalence of iatrogenic experiences among medics and patients has further exacerbated the dearth of trust and confidence in the orthodox medical practice among many Nigerians. The theory of unintended consequences by Robert Merton and the attribution theory by Palmieri and Petersons were utilised in providing a theoretical analysis to the prevalence of iatrogenesis. The paper bridged the gap between cultural and clinical iatrogenesis in explaining the importance of consent in therapeutic medicine; attributing the choice of undermining the consent of a patient at any stage in the therapeutic milieu as liable to social iatrogenesis.

本文以尼日利亚医疗服务体系为研究场景，探讨社会医源性（social iatrogenesis）的流行态势——该术语为涵盖文化医源性（cultural iatrogenesis）、临床医源性（clinical iatrogenesis）与技术医源性（technological iatrogenesis）的总括性概念。本研究聚焦尼日利亚多家医院中，患者就医与医护人员行医过程中日益增多的非预期或潜在后果案例。一方面，诸多就医者沦为文化医源性问题的受害者，尤其体现在婴儿调包、信仰与治疗方案冲突等议题上。另一方面，包括医师在内的众多医护人员受到临床医源性问题的影响，其衡量维度包括疏忽职守、工作压力、医疗服务商业化、激励不足、医疗化倾向、预后失误与诊断失当，以及漠视伦理准则。除尼日利亚医疗体系数十年来投入不足之外，医护人员与患者群体中医源性经历的普遍存在，进一步加剧了众多尼日利亚民众对正统医疗实践的信任缺失。本研究援引罗伯特·默顿（Robert Merton）的非预期后果理论，以及帕米耶里与彼得森（Palmieri and Petersons）的归因理论，对医源性问题的流行态势开展理论分析。本文在阐释知情同意在治疗医学中的重要性时，弥合了文化医源性与临床医源性问题之间的研究鸿沟；并提出，在治疗场景的任一阶段漠视患者知情同意权，均易引发社会医源性问题。