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

Document Type: Commentary

Author

Institut Universitaire de Médecine de Famille, Policlinique Médicale Universitaire, Lausanne, Switzerland

Abstract

The discussion between general practitioners (GPs) and healthcare delivery organizations necessitates a common language. The presentation of the 4 types of GP’s activities, opens dialogue but can lead to possible misunderstandings between the micro- and macro-level of the healthcare system. This commentary takes 4 examples: costs reduction by P4, priority of beneficence or nonmaleficence, role of evidence-based medicine (EBM) and use of a constructivist model.

Keywords

Main Subjects


  1. Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Policy Manag. 2015;4(2):61-64. doi:10.15171/ijhpm.2015.24
  2. Balint M. The Doctor, his Patient and the Illness. Edinburgh: Churchill Livingstone; 2000.
  3. Schön DA. The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books; 1983:374.
  4. Lemon T, Smith R. Consultation content not consultation length improves patient satisfaction. J Family Med Prim Care. 2014;3(4):334. doi:10.4103/2249-4863.148102
  5. Balint E, Norell JS. Six Minutes for the Patient; Interactions in General Practice Consultation. London: Tavistock Publications; 1973:182.
  6. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 4th ed. New York: Oxford University Press; 1994:546.
  7. Hippocrates. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment. Jones WHS, Withington ET, trans. Cambridge, MA: Harvard University Press; 1923.
  8. Hippocrates. Heracleitus On The Universe. Jones WHS, tran. Cambridge, MA: Harvard University Press; 1923.
  9. Gillon R. Philosophical Medical Ethics. Chichester: Wiley; 1986:189.
  10. Pellegrino ED. The Virtues in Medical Practice. New York: Oxford University Press; 1993:205.
  11. Gadamer HG. The Enigma of Health: The Art of Healing in a Scientific Age. Stanford: Stanford University Press; 1996:180.
  12. Steel N. Thresholds for taking antihypertensive drugs in different professional and lay groups: questionnaire survey. BMJ. 2000;320(7247):1446-1447. doi:10.1136/bmj.320.7247.1446
  13. Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine. New York: Churchikk Livingstone; 1997.
  14. Thomas P. General medical practitioners need to be aware of the theories on which our work depend. Ann Fam Med. 2006;4(5):450-454.
  15. Launer J. Narrative-Based Primary Care: A Practical Guide. Abingdon, Oxon, UK: Radcliffe Medical Press; 2002.
  16. May C, Montori VM, Mair FS. We need minimally disruptive medicine. BMJ. 2009;339:b2803. doi:10.1136/bmj.b2803
  17. De Maeseneer J, van Weel C, Egilman D, Demarzo M, Sewankambo N. Tackling NCDs: a different approach is needed – Authors’ reply. Lancet 2012;379(9829):1873-1874. doi:10.1016/s0140-6736(12)60802-2
  18. Starfield B, Hyde J, Gervas J, Heath I. The concept of prevention: a good idea gone astray? J Epidemiol Community Health. 2008;62(7):580-583. doi:10.1136/jech.2007.071027
  19. Harrison MJ, Dusheiko M, Sutton M, Gravelle H, Doran T, Roland M. Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study. BMJ. 2014;349:g6423. doi:10.1136/bmj.g6423
  20. Wertz FJ. Five Ways of doing Qualitative Analysis: Phenomenological Psychology, Grounded Theory, Discourse Analysis, Narrative Research, and Intuitive Inquiry. New York: Guilford Press; 2011.
  21. Grant S, Huby G, Watkins F, et al. The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study. Sociol Health Illn. 2009;31(2):229-245. doi:10.1111/j.1467-9566.2008.01129.x
  22. Checkland K, Harrison S, McDonald R, Grant S, Campbell S, Guthrie B. Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract. Sociol Health Illn. 2008;30(5):788-803. doi:10.1111/j.1467-9566.2008.01081.x