Iatrotropism and Related Neologisms

Iatrotropism, or the degree to which individuals are inclined to seek medical attention, is quite obviously one of the most important determinants of outcome in patients with treatable medical problems.

The word, like the existing word iatrotropic, comes from the Greek iatros [doctor], and from trope [turn]. (See, Summerton, 2007).

A dysiatrotropic patient is someone who seeks medical attention inappropriately. Hyperiatrotropic patients have a low threshold for presenting for medical attention. These patients are sometimes called  “frequent flyers” or superutilizers. I don’t like either term. The term “frequent flyer” is rather dismissive, while the term superutilizer is problematic for several reasons. First, it suggests that the main problem is one of inappropriate allocation of resources on a societal level when, to me, the problem is best-conceptualized as one involving the effectuation of interventions which may be harmful to the patient in front of me right now – and regardless of cost. Hyperiatrotropic patients are at increased risk of suffering from the consequences of overtesting, overdiagnosis, and overtreatment and are simultaneously at risk of being underdiagnosed and undertreated because of the Gambler’s Fallacy. (There was no myocardial infarction diagnosed at the previous twelve presentations for chest pain, therefore there is no myocardial infarction now either..) Second, the main issue isn’t necessarily one of “super” (better? more?) utilization, but rather of frequent, inappropriate, and often-harmful medical attention. Third, the term places undue emphasis, and perhaps blame, on the patient. (Is the patient being a superutelizer or are the physicians being superproviders?)

The hypoiatrotropic patient is similarly at risk of underdiagnosis and undertreatment because patient cannot receive appropriate and timely care without coming to medical attention in an appropriate and timely manner. Therefore, one of our major goals as doctors should be to help our patients become as euiatrotropic as possible.

Reference

• Summerton, Nicholas (2007). Patient-Centred Diagnosis. (p. 41)