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.

a médecin généraliste à Lausanne, Suisse, vice-président de l'UEMO; b médecin généraliste à Angers, France, vice-président de l'UEMO; c avocate-juriste, senior policy officer UEMO Ὁ βίος βραχὺς, ἡ δὲ τέχνη μακρὴ, ὁ δὲ καιρὸς ὀξὺς, ἡ δὲ πεῖρα σφαλερὴ, ἡ δὲ κρίσις χαλεπή. Δεῖ δὲ οὐ μόνον ἑωυτὸν παρέχειν τὰ δέοντα ποιεῦντα, ἀλλὰ καὶ τὸν νοσέοντα, καὶ τοὺς παρεόντας, καὶ τὰ ἔξωθεν. Das Leben ist kurz, die Heilkunst lang, die Gelegenheit flüchtig, die Erfahrung trügerisch, das Urteil schwierig. Denn man muss nicht nur selber (als Arzt) das Richtige tun, sondern auch dafür sorgen, dass der Kranke, seine Umgebung und die gesamten Umstände dabei mithelfen [1].

a médecin généraliste à Lausanne, Suisse, vice-président de l'UEMO; b médecin généraliste à Angers, France, vice-président de l'UEMO; c avocate-juriste, senior policy officer UEMO ὦ τεχνικώτατε Θεύθ, ἄλλος μὲν τεκεῖν δυνατὸς τὰ τέχνης, ἄλλος δὲ κρῖναι τίν᾽ ἔχει μοῖραν βλάβης τε καὶ ὠφελίας τοῖς μέλλουσι χρῆσθαι· Doch der König antwortete: Theuth, du Meister der Künste: einer hat die Fähigkeit, die Produkte der Kunst herzustellen, ein anderer aber kann beurteilen, in welchem Masse sie Schaden bringen und Nutzen für die, die damit umgehen sollen. [1]

Background An interprofessional and cross-cultural pedagogical project in community health for students in nursing, social work, anthropology and medicine at the end of the bachelor’s degree begun in 2014. After a rural context fieldwork in several Santal villages of West Bengal (India), students had to conduct a research project, based on a community-health topic. Aims This paper describes how such a pedagogical project, introducing students to ethnographic research, can initiate new ways of thinking for possible future health interventions in rural communities. Methods An inductive approach based on ethnography was used during the fieldwork, including observations, interviews, focus groups and local documentation. Results Our observations led to the finding that actions in rural health cannot be initiated without: promoting an interprofessional/interdisciplinary perspective and a culture of complexity and reflectivity; considering local populations in transition and not in a fixed homogenous situation; understanding more than imposing; taking into account local disease classification and local pragmatic solutions; considering the dialogue between bio-medicine and therapeutic pluralism; considering local perceptions and practices; considering care itineraries/pathways; and finally being conscious of our apostolic function. Conclusion Our interprofessional pedagogical project promotes a bottom-up approach in dialogue with a global health vision.

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