Quaternary prevention is the fourth dimension of prevention that aims to avoid unnecessary medical actions. It was first suggested in 2015 as a way to control the economic and human costs of healthcare by preventing overmedicalization. Quaternary prevention encourages doctors to critically examine their own practices and consider "not doing" certain interventions to avoid potential harms of misdiagnosis, missed diagnosis, defensive medicine, or inducing unnecessary anxiety in patients. It promotes an ethically balanced approach that respects the patient-doctor relationship through open communication and understanding each patient's perspective.
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Quaternary prevention
1. Quaternary
Prevention
Dr. K. Md. Shoyaib
PG, Dept of Community Medicine,
Bangalore Medical College and Research Institute
16 June 2021 QUATERNARY PREVENTION 1
2. Quaternary Prevention
โข First suggested by Marc Jamoulle in 2015.
โข It is the complimentary dimension to the other
three dimensions of prevention.
โข Prevention of medicine itself, whose understanding
could help to control the economic and human
costs of healthcare.
16 June 2021 QUATERNARY PREVENTION 2
3. Patient Doctor Interaction
Doctors Side
Patients
Side
Disease Absent Disease Present
Feels
ill
Feels
well
Timeline
16 June 2021 QUATERNARY PREVENTION 3
4. Doctors Side
Patients
Side
Disease Absent Disease Present
Feels
ill
Feels
well
Timeline
Dimensions of Prevention
Intervention
before disease
Avoiding falsely
negative
Avoiding falsely
positive
Cure and
Preventing
Complications
16 June 2021 QUATERNARY PREVENTION 4
PRIMARY
PREVENTION
SECONDARY
PREVENTION
TERTIARY
PREVENTION
QUATERNARY
PREVENTION
5. Falling into 4th Quadrant
Doctors Side
Patients
Side
Disease Absent Disease Present
Feels
ill
Feels
well
Health Information
and Education
Immunization
Therapy
Incidentaloma
Missed Diagnosis
Doctor attracts
patient and
Patient attracts
doctor
Screening
Early
Diagnosis
16 June 2021 QUATERNARY PREVENTION 5
6. The Red Arrows
โข Miscommunication
โข Anxiogenic health education
โข Bad public health program
โข Personal fear of the patient or caregiver
โข Health belief
โข Defensive medicine
โข Uncontrolled technology
โข Specialist based care
16 June 2021 QUATERNARY PREVENTION 6
7. Quaternary Prevention: P4
QUATERNARY
PREVENTION
โข It forces the doctor to have a critical look on his/her own
activity.
โข Need for close monitoring by the doctor himself/herself.
โข It is about understanding that medicine is based on a
relationship
โข P4 attitude acts as a resistance.
16 June 2021 QUATERNARY PREVENTION 7
8. P4: A Scenario
FAMILY
DOCTOR
C/O WORKPLACE STRESS SINCE 3 DAYS
H/O HAVING A PUFF OF SMOKE WITH COLLEAGUE YESTERDAY
K/C/O T2DM FOR FOLLOW UP
FAMILY HISTORY: POSITIVE FOR BREAST CANCER
PATIENT
C/O HEADACHE SINCE 1 WEEK ON AND OFF
16 June 2021 QUATERNARY PREVENTION 8
9. P4: A Scenario
Defensive Medicine
Miscommunication
Anxiogenic Health
Education
Somatoform Disorder
Misunderstanding
Anxiety of the
patient or caregiver
16 June 2021 QUATERNARY PREVENTION 9
10. Doctors Side
Patients
Side
Disease Absent Disease Present
Feels
ill
Feels
well
Health Information
and Education
Immunization
Screening
Early
Diagnosis
Therapy
Incidentaloma
Missed Diagnosis
Preventing fall into 4th
Quadrant
Doctor attracts
patient and
Patient attracts
doctor
16 June 2021 QUATERNARY PREVENTION 10
11. The Black Barriers
Doctor attracts
patient and
Patient attracts
doctor
โข Listen to the Patient, Control the Medicine.
โข Follow ethically based medicine.
โข โNot to doโ is not as easy as accepting โto doโ.
โข A counsel of โnot to doโ needs trust between patient and
doctor in supporting doubt.
โข P4 attitude acts as a response of family doctor facing
overmedicalization, as a resistance.
โข P4 is a rallying cry against the lack of humanity of large
sectors of medicine.
16 June 2021 QUATERNARY PREVENTION 11
12. QUATERNARY
PREVENTION
Shaping of new Concepts
โข Auto control of Preventive and Curative Program.
โข Careful analysis of Miscommunication.
โข Understanding patientโs anxiety and belief.
โข Defensive medicine.
โข Accepting to decide in Uncertainty.
โข Humility in Diagnostic process and patient relationship.
โข Ethically balanced attitudes.
16 June 2021 QUATERNARY PREVENTION 12
13. โQuaternary prevention is more than preventionโ.
โItโs a styleโ.
โA way of thinking about our job but also a tool to
control it.โ
QUATERNARY
PREVENTION
Conclusion
16 June 2021 QUATERNARY PREVENTION 13
14. Reference
โข Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J
Health Policy Manag. 2015 Feb 4;4(2):61-4. doi: 10.15171/ijhpm.2015.24. PMID: 25674569;
PMCID: PMC4322627.
16 June 2021 QUATERNARY PREVENTION 14
and to question the ethical limits of his/her activities.
, a sort of permanent quality control.
, and that this relation must remain truly therapeutic by respecting the autonomy of patients and doctors.
lack of humanity of whole sectors of medicine and their institutional corruption.