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Quaternary prevention

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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 Dr. K. Md. Shoyaib PG, Dept of Community Medicine, Bangalore Medical College and Research Institute 16 June 2021 QUATERNARY PREVENTION 1

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Quaternary Prevention โ€ข First suggested by Marc Jamoulle in 2015. โ€ข It is the complimentary dimension to the other three dimensions of prevention. โ€ข Prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare. 16 June 2021 QUATERNARY PREVENTION 2

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Patient Doctor Interaction Doctors Side Patients Side Disease Absent Disease Present Feels ill Feels well Timeline 16 June 2021 QUATERNARY PREVENTION 3

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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

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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

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The Red Arrows โ€ข Miscommunication โ€ข Anxiogenic health education โ€ข Bad public health program โ€ข Personal fear of the patient or caregiver โ€ข Health belief โ€ข Defensive medicine โ€ข Uncontrolled technology โ€ข Specialist based care 16 June 2021 QUATERNARY PREVENTION 6

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Quaternary Prevention: P4 QUATERNARY PREVENTION โ€ข It forces the doctor to have a critical look on his/her own activity. โ€ข Need for close monitoring by the doctor himself/herself. โ€ข It is about understanding that medicine is based on a relationship โ€ข P4 attitude acts as a resistance. 16 June 2021 QUATERNARY PREVENTION 7

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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

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P4: A Scenario Defensive Medicine Miscommunication Anxiogenic Health Education Somatoform Disorder Misunderstanding Anxiety of the patient or caregiver 16 June 2021 QUATERNARY PREVENTION 9

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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

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The Black Barriers Doctor attracts patient and Patient attracts doctor โ€ข Listen to the Patient, Control the Medicine. โ€ข Follow ethically based medicine. โ€ข โ€œNot to doโ€ is not as easy as accepting โ€œto doโ€. โ€ข A counsel of โ€œnot to doโ€ needs trust between patient and doctor in supporting doubt. โ€ข P4 attitude acts as a response of family doctor facing overmedicalization, as a resistance. โ€ข P4 is a rallying cry against the lack of humanity of large sectors of medicine. 16 June 2021 QUATERNARY PREVENTION 11

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QUATERNARY PREVENTION Shaping of new Concepts โ€ข Auto control of Preventive and Curative Program. โ€ข Careful analysis of Miscommunication. โ€ข Understanding patientโ€™s anxiety and belief. โ€ข Defensive medicine. โ€ข Accepting to decide in Uncertainty. โ€ข Humility in Diagnostic process and patient relationship. โ€ข Ethically balanced attitudes. 16 June 2021 QUATERNARY PREVENTION 12

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โ€œQuaternary prevention is more than preventionโ€. โ€œItโ€™s a styleโ€. โ€œA way of thinking about our job but also a tool to control it.โ€ QUATERNARY PREVENTION Conclusion 16 June 2021 QUATERNARY PREVENTION 13

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Reference โ€ข 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

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16 June 2021 QUATERNARY PREVENTION 15 Thank You

More Related Content

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 โ€ข First suggested by Marc Jamoulle in 2015. โ€ข It is the complimentary dimension to the other three dimensions of prevention. โ€ข 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 โ€ข Miscommunication โ€ข Anxiogenic health education โ€ข Bad public health program โ€ข Personal fear of the patient or caregiver โ€ข Health belief โ€ข Defensive medicine โ€ข Uncontrolled technology โ€ข Specialist based care 16 June 2021 QUATERNARY PREVENTION 6
  • 7. Quaternary Prevention: P4 QUATERNARY PREVENTION โ€ข It forces the doctor to have a critical look on his/her own activity. โ€ข Need for close monitoring by the doctor himself/herself. โ€ข It is about understanding that medicine is based on a relationship โ€ข 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 โ€ข Listen to the Patient, Control the Medicine. โ€ข Follow ethically based medicine. โ€ข โ€œNot to doโ€ is not as easy as accepting โ€œto doโ€. โ€ข A counsel of โ€œnot to doโ€ needs trust between patient and doctor in supporting doubt. โ€ข P4 attitude acts as a response of family doctor facing overmedicalization, as a resistance. โ€ข 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 โ€ข Auto control of Preventive and Curative Program. โ€ข Careful analysis of Miscommunication. โ€ข Understanding patientโ€™s anxiety and belief. โ€ข Defensive medicine. โ€ข Accepting to decide in Uncertainty. โ€ข Humility in Diagnostic process and patient relationship. โ€ข Ethically balanced attitudes. 16 June 2021 QUATERNARY PREVENTION 12
  • 13. โ€œQuaternary prevention is more than preventionโ€. โ€œItโ€™s a styleโ€. โ€œA 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 โ€ข 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
  • 15. 16 June 2021 QUATERNARY PREVENTION 15 Thank You

Editor's Notes

  1. 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.