Care and Do Not Harm: Possible Misunderstandings With Quaternary Prevention (P4) Comment on "Quaternary Prevention, an Answer of Family Doctors to Over Medicalization"

Widmer, Daniel

doi:10.15171/ijhpm.2015.99

Cited by 5 publications

(11 citation statements)

References 12 publications

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“…In more recent publications, Marc Jamoulle himself states that quaternary prevention affects the other three levels of preventive activities [ 25–27 ]. Another relevant point is the growing consensus among different authors about the close relation among the concept of quaternary prevention and the non-maleficence principle of medical ethics usually mentioned as primum non nocere (first, do no harm) [ 15 , 25 , 28–30 ]. Wagner H states ‘The concept of quaternary prevention is nothing more than the systematization of the concept of “primum non nocere” in our modern medical practice, an ethical approach to practice better clinical care and to protect people of excess of medicine’ [ 30 ].…”

Section: Quaternary Prevention: the Need Of A New Definitionmentioning

confidence: 99%

Quaternary prevention: reviewing the concept

Martins

Godycki-Cwirko

Heleno

et al. 2018

European Journal of General Practice

115

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Background: According to the Wonca International Dictionary for General/Family Practice Quaternary Prevention is defined as: ‘Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.’ The concept of quaternary prevention was initially proposed by Marc Jamoulle and the targets were mainly patients with illness but without a disease. Objectives: The purpose of this opinion article is to open the debate around a new possible definition and a new conceptual model of quaternary prevention based on the belief that quaternary prevention should be present in physicians’ minds for every intervention they suggest to a patient. Discussion: The debate around quaternary prevention is vital in the context of contemporary medicine and has expanded worldwide. The human being may suffer harm from medical interventions from conception, during their childhood, during their entire healthy lifetime as well as during a self-limited disease, a chronic disease, or a terminal disease. The current definition of quaternary prevention has limitations because it excludes patients and medical interventions where a quaternary prevention perspective would be needed and useful to protect patients from harm. In this context, a new definition and conceptual model of quaternary prevention is proposed. Conclusion: In this new proposal, quaternary prevention is defined as an ‘action taken to protect individuals (persons/patients) from medical interventions that are likely to cause more harm than good.’

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Section: Quaternary Prevention: the Need Of A New Definitionmentioning

confidence: 99%

Quaternary prevention: reviewing the concept

Martins

Godycki-Cwirko

Heleno

et al. 2018

European Journal of General Practice

115

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“…32 Especially, SDM would make patients empower, which is a goal of QP, 43 because Charles et al described SDM as 'a two-way exchanges of information between the parties concerned with the medical decision'. 44 Accordingly, Widmer 45 suggested QP as 'relationship based medicine'. In addition, SDM could overcome a defensive medicine caused by the non-avoidable uncertainty in process of decision making, 46,47 so that over-diagnosis and over-treatment by medical futility decision could be prevented.…”

Section: Quaternary Prevention and Medical Ethicsmentioning

confidence: 99%

“…to prevent overmedication in QP is following not only the principle of non-maleficence but also the obligation of justice because it could reduce to waste the resources. 45 In order to avoid in-efficiency of medical services, appropriateness of patients' care should be maintained in individual level. 50 And the process of setting priorities in health care reflected a social value in population level would be helpful, too.…”

Section: Quaternary Prevention and Medical Ethicsmentioning

confidence: 99%

Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention

Jamoulle

Roland

Bae

et al. 2018

Rev Bras Med Fam Comunidade

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The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the age-old ethical requirement: first, a doctor must do no harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 10 countries. This collective text deals more specifically with: the bioethics of prevention, the importance of teaching Quaternary prevention and factual medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions.

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“…Structural health system factors (eg, lack of primary care system, silos) 2 16 17 19 20 22 23 27 30 31…”

Section: Introductionmentioning

confidence: 99%

“…Financial measures including those that increase time for patient–physician encounters 2 6 18 19 22 27 30…”

Section: Introductionmentioning

confidence: 99%

Enablers and barriers to a quaternary prevention approach: a qualitative study of field experts

Otte,

Llargués Pou

2024

BMJ Open

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ObjectiveThere is a growing concern about the sustainability of healthcare and the impacts of ‘overuse’ on patients and systems. Quaternary prevention (P4), a concept promoting the protection of patients from medical interventions in which harms outweigh benefits, is well positioned to stimulate reflection and inspire solutions, yet has not been widely adopted. We sought to identify enablers and barriers to a P4 approach, according to field experts and advocates in one health system.DesignQualitative methodology, using semistructured interviews and a grounded theory approach facilitated thematic analysis and development of a conceptual model.SettingVirtual interviews, conducted in British Columbia, Canada.Participants12 field experts, recruited based on their interest and work related to P4 and related concepts.ResultsFour factors were seen as promoting or hindering P4 efforts depending on context: relationship between patient and clinician, education of clinicians and the public, health system design and influencers. We extracted four broad enablers of P4: evidence-based medicine, personal experiences and questioning attitude, public P4 campaigns and experience in resource-poor contexts. There were six barriers: peer pressure between clinicians, awareness and screening campaigns, cognitive biases, cultural factors, complexity of the problem and industry influence.ConclusionsElicited facilitators and impediments to the application of P4 were similar to those seen in existing literature but framed uniquely; our findings place increased emphasis on the clinician–patient relationship as central to decision-making and position other drivers as influencing this relationship. A transition to a model of care that explicitly integrates conscious protection of patients by reducing overtesting, overdiagnosis and overtreatment will require changes across health systems and society.

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Care and Do Not Harm: Possible Misunderstandings With Quaternary Prevention (P4) Comment on "Quaternary Prevention, an Answer of Family Doctors to Over Medicalization"

Cited by 5 publications

References 12 publications

Quaternary prevention: reviewing the concept

Quaternary prevention: reviewing the concept

Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention

Enablers and barriers to a quaternary prevention approach: a qualitative study of field experts

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