Quaternary prevention, an answer of family doctors to overmedicalization

Abstract

In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare.

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

“…"Not to do is not as easy as accepting to do. " 1 It requires more time and more competencies. Time and competencies have a price.…”

Prevenção quaternária: um olhar sobre a medicalização na prática dos médicos de família

“…45 Professionals justify the excessive intervention by the lack of time to address the causes of problems, the inability to intervene in psychosocial causal problems, and also by the imperative to respond to peoples' expectations. 1,12 Indeed, the challenges are great in responding to health needs and demands since: 30 The inability of health professionals (even those working in PHC) in dealing with disease complexity is evident, and even more challenging to dialogue with people and their illnesses in contexts of great socio-economic and cultural vulnerability. This requires skills and competencies from doctors and other health professionals that have not been necessarily taught-learned during their professional training.…”

“…[8][9][10] Family and Community Medicine (FCM), in particular, has proposed some theoretical models and methods that look for ways to face this process in clinical practice, among which stands out the quaternary prevention. 11,12 This article aims to discuss the concept of medicalization and some aspects of this phenomenon in primary health care in Brazilian context. Provides a brief analysis of how quaternary prevention perceives the phenomenon and makes some reflections for the transformation of the scenario in the clinical field.…”

Nothing is certain... A comment on uncertainty, objectivity and scientism

“…10,11 This concept challenges the positivistic ideals of modern times which maintain that science and social progress are constant and always beneficial. This reminds us of Michael Foucault's positive iatrogenesis when he noted that medicine acquired the ability to damage based on its correct practice, not only due to negligence or ignorance.…”