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 Table of Contents 
COMMENTARY
Year : 2015  |  Volume : 6  |  Issue : 2  |  Page : 51-52  

First do not harm


Department of General Practice, University of Liege, Liege, Belgium

Date of Web Publication17-Jun-2015

Correspondence Address:
Marc Jamoulle
Department of General Practice, University of Liege, Liege
Belgium
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Source of Support: None, Conflict of Interest: None


PMID: 26167053

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How to cite this article:
Jamoulle M. First do not harm. J Mid-life Health 2015;6:51-2

How to cite this URL:
Jamoulle M. First do not harm. J Mid-life Health [serial online] 2015 [cited 2023 Jan 29];6:51-2. Available from: https://www.jmidlifehealth.org/text.asp?2015/6/2/51/158940

In their paper Bharti Kalra and Sonia Malik are addressing the issue of the transformation of menopause, a usual asymptomatic problem in a so-called treatable disease. [1]

They argue that menopause and androgenic natural deficiency have been "branded" by unscrupulous marketers. To highlight this unusual position, they are referring to the concept of quaternary prevention.

I would say I am grateful to those authors to refer to my work endorsed by the Wonca International Classification Committee (WICC) and I am pretty proud to contribute to the general reflection about the patient doctor relationship and its consequences for the organization of health care. I have been amazed to read, soon after, two other Indian publications dealing with quaternary prevention in anesthesiology and thyroidology. [2],[3]

Quaternary prevention is born by introducing patient and doctor instead of a test in a chi square draw. It highlights four fields of the patient-doctor encounter based on relationships. The doctor looks for diseases. The patient could feel ill. Timeline is obliquely oriented from left to right, from alpha to omega, from birth to death. Anyone will become sick and die, doctors as well as patients. The fourth field influences the 3 others [Figure 1]. [4]
Figure 1: Four fields of the patient-doctor encounter based on relationships. The doctor looks for diseases. The patient could feel ill. Timeline is obliquely oriented from left to right, from alpha to omega, from birth to death. Anyone will become sick and die, doctors as well as patients. The fourth field influences the 3 others (Jamoulle 1986)

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This represents a paradigmatic shift from a chronological to a constructivist relationship-based preventive pattern of care and offers new insight into the practice of doctors and a critical look at medical activities with an emphasis on the need not to harm, perfectly in line with the current discussion about overmedicalization. Quaternary prevention addresses the fundamental question of what constitutes too much or too little medicine. It is the fourth form of disease prevention, but also the fourth frame of action for doctors.

The four definitions of prevention published in the Wonca Dictionary of Family Medicine [5] offer a structured way to discuss the activities of family doctors, including ethical considerations on the patient-doctor encounter. Quaternary prevention, also known as P4, is a new term for an old concept: First, do not harm. This concept enforces disciplines and attitudes such as evidence-based medicine, quality assurance, defensive medicine, avoiding abusive nosographic diagnoses and ethical issues including those linked to a heartsink patient.

The P4 network has now members worldwide expressing through websites, Facebook and Twitter. P4 is now widely accepted by Wonca and a poster has been translated in French, Spanish, Portuguese, Vietnamese, Thai and Chinese. [6] For information about quaternary prevention-related events, links, bibliography and slides, have a look at the Quaternary Prevention rubric of WICC website (www.ph3c.org/p4)

 
   References Top

1.
Kalra B, Malik S. Quaternary prevention and menopause. J Midlife Health 2014;5:53-4.  Back to cited text no. 1
    
2.
Bajwa SJ, Kalra S, Takrouri MS. Quaternary prevention in anesthesiology: Enhancing the socio-clinical standards. Anesth Essays Res 2014;8:125-6.  Back to cited text no. 2
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3.
Kalra S, Sahay R, Baruah M. Quaternary prevention in thyroidology. Thyroid Res Pract 2014;11:43.  Back to cited text no. 3
    
4.
Jamoulle M. Computer and computerisation in general practice. Les informa-g-iciens. Belgium: Presses Universitaires de Namur; 1986. p. 193-209.  Back to cited text no. 4
    
5.
Bentzen N. Wonca dictionary of general/family practice. Copenhagen: Laegeforeningers Forlag; 2003. http://www.ph3c.org/PH3C/docs/27/000092/0000052.pdf [Last accessed on 2015 June 6].  Back to cited text no. 5
    
6.
Jamoulle M, Roland M. Quaternary prevention. From Wonca world Hong Kong 1995 to Wonca world Prague 2013. In Wonca world conference Prague 2013 (Poster). Retrieved from: http://www.ph3c.org/PH3C/docs/27/000284/0000439.pdf [Last accessed on 2015 Jun 6].  Back to cited text no. 6
    


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