Healthy Skepticism Library item: 18970

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M
Quaternary prevention: a task of the general practitioner
Primary Care 2010; (18):
http://www.primary-care.ch/pdf_d/2010/2010-18/2010-18-368_ELPS_engl.pdf

Abstract:

Quaternary prevention is the prevention of unnecessary medicine or the prevention of
overmedicalisation. The principle of “primum non nocere” is central to the whole of medicine. The task
to avoid excess medical interventions is particularly mandatory in the field of general practice. We
report on a workshop on this topic held at the 15th Wonca Europe Conference in Basel, in September
2009. In a world of growing obsessions with health matters and rising possibilities of “doing
something”, there is a need for someone to give advice about the appropriateness of medical
procedures. Mainly in the name of prevention, there has been an explosion of new disease labels and
health care measures that warrant a rethinking of the objectives and underlying philosophy of primary
care. Especially in an area of high grades of uncertainty and low prevalence of severe diseases, the
most difficult thing for the physician is the decision not to pursue further action and to protect our
patients from unnecessary medicine. This decision can firmly be grounded on probabilities arising from
clinical studies on the one side and the individual life stories and values of our patients on the other.
We propose to make quaternary prevention more explicitly the task of the general practitioner.
2
Key words: quaternary prevention, general practice, overmedicalisation
T.M., 62 years old and up to now a healthy man, comes to see his general practitioner. In a journal
distributed by the local pharmacy he has learned about the rising number of men his age, diagnosed
with cancer of the prostate gland. He asks for screening for prostate cancer with PSA-testing. As the
test is not covered by his health care insurance, he is willing to accept that he will have to pay for it
himself. He does not have any problem with voiding or his sexual life. There is no history of prostate
cancer in his family. He says: “You know, I was always in good health but I feel I am coming to a
certain age now and my wife said that I should start to do something to stay healthy”.
What should the advice of his doctor be?