Quaternary prevention
Encyclopedia
The quaternary prevention, concept coined by the Belgian general practitioner
Marc Jamoulle , are the action taken to identify patient
at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.
Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the health system
.
Social credit that legitimizes medical intervention may be damaged if doctors do not prevent unnecessary medical activity and its consequences. Quaternary prevention should take precedence over any alternative preventive, diagnostic and therapeutic, as is the practice version primun non nocere.
Main idea: to avoid patient overdiagnosis and overtreatment.
Use: During all the episode of care (preclinical and clinical period).
It's the "actions taken to identify patients at risk of overtreatment, to protect them from new medical procedures and ethically acceptable alternative to suggest". The concept is included in WONCA
's Dictionary of General and Family Medicine.
To do quaternary prevention is to say “no” to many considerably indecent proposals, and to offer prudent and scientific alternatives (“ethics of negation” , “ethics of ignorance sharing”). To do quaternary prevention is to to exchange the fear exploited by healthcare malice for the feeling of knowing that what matters is the quality of life.
The intent of quaternary prevention is not to eliminate but rather to moderate the medicalization of the daily life, since a part of the aforementioned medicalization is not directly related to the medical intervention and has to do with social, cultural and psychologic reasons. Quaternary prevention is only about avoiding or palliating the medical part of the medicalization of the daily life.
To do quaternary prevention in clinical encounters is to comply with the scientific goal of Medicine, which aims for “the maximum quality with the minimum quantity, as close to the patient as possible”.
“To prevent is better than healing, when preventing is less harmful than healing”. To engage into quaternary prevention is to avoid the unnecessary curative and preventive activities. Every doctor-patient encounter should include quaternary prevention in order to avoid/limit the damage caused by the activity of the health system. To do it is to enforce the old motto primum non nocere.
The strongest means to accomplish this is to listen better to our patients. This is what has been termed Narrative based Medicine, which means to adapt the medically possible to the individual needs and wants. What we need is a strong and sustainable relationship with our patients and their trust in our honesty and specific knowledge.
2.- Evidence-based medicine
The other important means is called Evidence based Medicine. The knowledge of the probable predictive values of diagnostic tests and the probabilities of effect sizes of benefit and harm of therapy and preventive measures give us the opportunity to leave out many useless procedures.
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
Marc Jamoulle , are the action taken to identify patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.
Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the health system
Health system
A health system can be defined as the structured and interrelated set of all actors and institutions contributing to health improvement. The health system boundaries could then be referred to the concept of health action, which is "any set of activities whose primary intent is to improve or...
.
Social credit that legitimizes medical intervention may be damaged if doctors do not prevent unnecessary medical activity and its consequences. Quaternary prevention should take precedence over any alternative preventive, diagnostic and therapeutic, as is the practice version primun non nocere.
Concept
| Prevention levels | Doctor’s side | |||||
| Disease | ||||||
| absent | present | |||||
|---|---|---|---|---|---|---|
| Patient’s side |
|Illness | | absent | Primary prevention (illness absent disease absent) |
Secondary prevention (illness absent disease present) |
||
| present | Quaternary prevention Quaternary prevention The quaternary prevention, concept coined by the Belgian general practitioner , are the action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable... (illness present disease absent) |
Tertiary prevention (illness present disease present) |
||||
Main idea: to avoid patient overdiagnosis and overtreatment.
Use: During all the episode of care (preclinical and clinical period).
It's the "actions taken to identify patients at risk of overtreatment, to protect them from new medical procedures and ethically acceptable alternative to suggest". The concept is included in WONCA
World Organization of Family Doctors
The World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians or in short World Organization of Family Doctors is an international organization of national colleges, academies or organizations concerned with the academic aspects of...
's Dictionary of General and Family Medicine.
To do quaternary prevention is to say “no” to many considerably indecent proposals, and to offer prudent and scientific alternatives (“ethics of negation” , “ethics of ignorance sharing”). To do quaternary prevention is to to exchange the fear exploited by healthcare malice for the feeling of knowing that what matters is the quality of life.
The intent of quaternary prevention is not to eliminate but rather to moderate the medicalization of the daily life, since a part of the aforementioned medicalization is not directly related to the medical intervention and has to do with social, cultural and psychologic reasons. Quaternary prevention is only about avoiding or palliating the medical part of the medicalization of the daily life.
To do quaternary prevention in clinical encounters is to comply with the scientific goal of Medicine, which aims for “the maximum quality with the minimum quantity, as close to the patient as possible”.
“To prevent is better than healing, when preventing is less harmful than healing”. To engage into quaternary prevention is to avoid the unnecessary curative and preventive activities. Every doctor-patient encounter should include quaternary prevention in order to avoid/limit the damage caused by the activity of the health system. To do it is to enforce the old motto primum non nocere.
Means
1.- Narrative based MedicineThe strongest means to accomplish this is to listen better to our patients. This is what has been termed Narrative based Medicine, which means to adapt the medically possible to the individual needs and wants. What we need is a strong and sustainable relationship with our patients and their trust in our honesty and specific knowledge.
2.- Evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
The other important means is called Evidence based Medicine. The knowledge of the probable predictive values of diagnostic tests and the probabilities of effect sizes of benefit and harm of therapy and preventive measures give us the opportunity to leave out many useless procedures.
Intervention types
Healthcare professionals must be aware of the consequences of their decisions, and include quaternary prevention interventions in their daily clinical practice with each patient.- To prevent the cascade effect:
- - To prevent the diagnostic cascade
- - To prevent the therapeutical cascade
- To prevent disease promotion
- To prevent medicalization
Activities
- Do not mistake risk factor with disease. ,
- To avoid check ups or unnecessary exams.,
- To avoid technical interventionism in healthcare.
- To avoid scoliosis.
- To avoid the pharmacological treatment of hypercholesterolemiaHypercholesterolemiaHypercholesterolemia is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement that can be caused by many diseases, notably cardiovascular disease...
in primary prevention. - To avoid hormone replacement therapy during menopause
- To avoid the indiscriminate use of antibiotics (very often unnecessary, with the subsequent unjustified increase of bacterial resistances)
- To avoid unnecessary diagnosis of genetic disorders (for example: the promotion of the haemocromatosis screeningScreeningOne meaning of screening is the investigation of a great number of something looking for those with a particular problem or feature....
, of doubtful scientific value, but of undoubted effect in terms of the medicalization of society. - To avoid the overdiagnosisOverdiagnosisOverdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. Overdiagnosis is the least familiar side effect of testing for early forms of disease – and, arguably, the most important...
and overtreatment of the attention deficit hyperactivity disorder (ADHD). - To elaborate validated diagnostic and therapeutic protocols that are effective in the prevention of the renal injury in the minority of patients with “complicated” pielic ectasia, and that avoid the excessive amount of intervention in the majority of the patients with “simple” pielic ectasia.
Further reading
- Gofrit ON, Shemer J, Leibovici D, Modan B, Shapira SC. Quaternary prevention: a new look at an old challenge. Isr Med Assoc J. 2000;2(7):498-500.
- Ortún V. Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Barcelona: Elsevier/Masson; 2003. p.245
- UEMO, European Union of General Practitioners / Family Physicians, Santiago LM. Quaternary prevention. Document 2008/040, October 2008.
- Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-99.
- PubMed: Quaternary Prevention
See also
- BioethicsBioethicsBioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....
- Cascade effectCascade effectA Cascade Effect is an unforeseen chain of events due to an act affecting a system. If there is a possibility that the cascade effect will have a negative impact on the system, it is possible to analyze the effects with a consequence/impact analysis...
- Disease mongeringDisease mongering]Disease mongering is a pejorative term for the practice of widening the diagnostic boundaries of illnesses, and promoting public awareness of such, in order to expand the markets for those who sell and deliver treatments, which may include pharmaceutical companies, physicians, and other...
- IatrogenesisIatrogenesisIatrogenesis, or an iatrogenic artifact is an inadvertent adverse effect or complication resulting from medical treatment or advice, including that of psychologists, therapists, pharmacists, nurses, physicians and dentists...
- Inverse benefit lawInverse benefit lawThe Inverse Benefit Law states that the ratio of benefits to harms among patients taking new drugs tends to vary inversely with how extensively a drug is marketed...
- Ivan IllichIvan IllichIvan Illich was an Austrian philosopher, Roman Catholic priest, and "maverick social critic" of the institutions of contemporary western culture and their effects on the provenance and practice of education, medicine, work, energy use, transportation, and economic development.- Personal life...
- Juan GérvasJuan GérvasJuan Javier Gérvas Camacho born in Lorca in 1948, is a general practitioner, teacher and researcher in primary care and public health.- Personal :...
- Medical ethicsMedical ethicsMedical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
- MedicalizationMedicalizationMedicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat...
- MedicineMedicineMedicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
- Patient safetyPatient safetyPatient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
- Preventive medicinePreventive medicinePreventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
- SchooliosisSchooliosisSchooliosis, a pun on "school" and "scoliosis", is a term for a type of medical misdiagnosis. The word was coined by Petr Skrabanek and James McCormick....
- World Organization of Family DoctorsWorld Organization of Family DoctorsThe World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians or in short World Organization of Family Doctors is an international organization of national colleges, academies or organizations concerned with the academic aspects of...