Iatrosedation by Dr Nathan Friedman

Components of the Iatrosedative Process

Iatrosedation has two components:

  1. An iatrosedative interview
  2. The iatrosedative clinical encounter

1. The Iatrosedative Interview:

The first meeting of doctor and patient is an interview in the literal sense of the word; that is, a view between two people. If in the course of this interchange the patient indicates either verbally or nonverbally that he/she is anxious, the doctor responds by initiating an iatrosedative interview. The procedure is designed to identify the fear problem, make a diagnosis and initiate treatment. The fear level will drop as the interview progresses so that a substantive decrease will be achieved at its completion. Usually, the interview does not complete the relearning process in which the fear is eliminated or maximally reduced. This occurs during the second phase of the iatrosedative process, the iatrosedative clinical encounters.

2. The Iatrosedative Clinical Encounters:

The first clinical encounter is crucial. This is the “firing line.” The patient and the doctor are going to face together what the patient perceives as dangerous. The doctor’s behavioral technique must be structured to blend with his clinical techniques to provide the maximum feeling of safety for the patient. Often this first clinical interaction will result in a successful learning experience, eliminating the fear entirely; that is, dropping the level to what is considered within the normal anxiety range. If this does not occur, subsequent clinical encounters will continue to decrease the fear until the maximum effect of iatrosedation is achieved.

There are instances where the iatrosedative interview does not drop the fear level sufficiently and the patient requires some pharmacosedation to face the first clinical encounter. The choice of modality is worked out together, based on the patient’s previous experiences and feelings about the use of drugs and the methods of administering them. Many people have anxieties about inhalation sedation because of imagined threat to breathing, some about intravenous sedation based on a feeling of loss of control, while others object to the use of drugs in any form.