Quaternary prevention: first, do not harm
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Tipo de documento: | Artigo |
Idioma: | eng por |
Título da fonte: | Revista Brasileira de Medicina de Família e Comunidade (Online) |
Texto Completo: | https://www.rbmfc.org.br/rbmfc/article/view/1064 |
Resumo: | Towards patient-doctor relationship based careClinical prevention, under the influence of public health, has been organised in a chronologicalmanner since the middle of the 20th century. A paradigm shift from a chronological to a constructivist relationship-based preventive pattern of care1 offers new insights into the practice of doctors. This paradigm shift brings to light the concept of quaternary prevention, a critical look at medical activities with an emphasis on the need not to harm. 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 family doctors (Figure 1). The shift from time-based prevention towards a relationship-based organisation offers new perspectives into physicians’ work. The physicians observe themselves and question the ethical limits of their activities. In this sense, quaternary prevention is aimed more at the doctor than the patient. Moreover, the four definitions of prevention, published in the Wonca Dictionary of Family Medicine,2 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 overinformation, and overmedicalisation. |
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Quaternary prevention: first, do not harmPrevención cuaternaria: primero no hacer dañoPrevenção quaternária: primeiro não causar danoQuaternary PreventionPhysician-Patient RelationsMedicalizationPrimary Health CareFamily Practice.Quaternary PreventionPhysician-Patient RelationsMedicalizationPrimary Health CareFamily Practice.Prevención cuaternariacuidadoPrevenção QuartenáriaCuidadoRedução de danoTowards patient-doctor relationship based careClinical prevention, under the influence of public health, has been organised in a chronologicalmanner since the middle of the 20th century. A paradigm shift from a chronological to a constructivist relationship-based preventive pattern of care1 offers new insights into the practice of doctors. This paradigm shift brings to light the concept of quaternary prevention, a critical look at medical activities with an emphasis on the need not to harm. 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 family doctors (Figure 1). The shift from time-based prevention towards a relationship-based organisation offers new perspectives into physicians’ work. The physicians observe themselves and question the ethical limits of their activities. In this sense, quaternary prevention is aimed more at the doctor than the patient. Moreover, the four definitions of prevention, published in the Wonca Dictionary of Family Medicine,2 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 overinformation, and overmedicalisation.Em direção a um cuidado alicerçado na relação paciente-médicoA prevenção clínica, sob a influência da saúde pública, foi organizada de forma cronológica, desdemeados do século XX. No entanto, uma mudança de paradigma de uma ordem cronológica paraum padrão construtivista1 fundamentado em uma relação preventiva de atendimento, oferece novasreflexões à prática dos médicos. Essa mudança de paradigma traz à tona o conceito de prevençãoquaternária, um olhar crítico sobre as atividades médicas, com ênfase na necessidade de não causardanos. A prevenção quaternária aborda a questão principal do que se constitui como ‘muita’ ou‘pouca’ medicina. Ela é a quarta forma de prevenção de doenças, e também a quarta etapa de açãodos médicos de família (Figura 1).Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC)2015-06-24info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/otherapplication/pdfapplication/pdfhttps://www.rbmfc.org.br/rbmfc/article/view/106410.5712/rbmfc10(35)1064Revista Brasileira de Medicina de Família e Comunidade; Vol. 10 No. 35 (2015): Abril-Junho "Quaternary Prevention (P4)"; 1-3Revista Brasileira de Medicina de Família e Comunidade; Vol. 10 Núm. 35 (2015): Abril-Junho "Quaternary Prevention (P4)"; 1-3Revista Brasileira de Medicina de Família e Comunidade; v. 10 n. 35 (2015): Abril-Junho "Quaternary Prevention (P4)"; 1-32179-79941809-5909reponame:Revista Brasileira de Medicina de Família e Comunidade (Online)instname:Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC)instacron:SBMFCengporhttps://www.rbmfc.org.br/rbmfc/article/view/1064/696https://www.rbmfc.org.br/rbmfc/article/view/1064/697Copyright (c) 2015 Marc Jamoulleinfo:eu-repo/semantics/openAccessJamoulle, Marc2020-05-21T20:19:12Zoai:ojs.rbmfc.org.br:article/1064Revistahttp://www.rbmfc.org.br/index.php/rbmfchttps://www.rbmfc.org.br/rbmfc/oai||david@sbmfc.org.br2179-79941809-5909opendoar:2020-05-21T20:19:12Revista Brasileira de Medicina de Família e Comunidade (Online) - Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC)false |
dc.title.none.fl_str_mv |
Quaternary prevention: first, do not harm Prevención cuaternaria: primero no hacer daño Prevenção quaternária: primeiro não causar dano |
title |
Quaternary prevention: first, do not harm |
spellingShingle |
Quaternary prevention: first, do not harm Jamoulle, Marc Quaternary Prevention Physician-Patient Relations Medicalization Primary Health Care Family Practice. Quaternary Prevention Physician-Patient Relations Medicalization Primary Health Care Family Practice. Prevención cuaternaria cuidado Prevenção Quartenária Cuidado Redução de dano |
title_short |
Quaternary prevention: first, do not harm |
title_full |
Quaternary prevention: first, do not harm |
title_fullStr |
Quaternary prevention: first, do not harm |
title_full_unstemmed |
Quaternary prevention: first, do not harm |
title_sort |
Quaternary prevention: first, do not harm |
author |
Jamoulle, Marc |
author_facet |
Jamoulle, Marc |
author_role |
author |
dc.contributor.author.fl_str_mv |
Jamoulle, Marc |
dc.subject.por.fl_str_mv |
Quaternary Prevention Physician-Patient Relations Medicalization Primary Health Care Family Practice. Quaternary Prevention Physician-Patient Relations Medicalization Primary Health Care Family Practice. Prevención cuaternaria cuidado Prevenção Quartenária Cuidado Redução de dano |
topic |
Quaternary Prevention Physician-Patient Relations Medicalization Primary Health Care Family Practice. Quaternary Prevention Physician-Patient Relations Medicalization Primary Health Care Family Practice. Prevención cuaternaria cuidado Prevenção Quartenária Cuidado Redução de dano |
description |
Towards patient-doctor relationship based careClinical prevention, under the influence of public health, has been organised in a chronologicalmanner since the middle of the 20th century. A paradigm shift from a chronological to a constructivist relationship-based preventive pattern of care1 offers new insights into the practice of doctors. This paradigm shift brings to light the concept of quaternary prevention, a critical look at medical activities with an emphasis on the need not to harm. 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 family doctors (Figure 1). The shift from time-based prevention towards a relationship-based organisation offers new perspectives into physicians’ work. The physicians observe themselves and question the ethical limits of their activities. In this sense, quaternary prevention is aimed more at the doctor than the patient. Moreover, the four definitions of prevention, published in the Wonca Dictionary of Family Medicine,2 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 overinformation, and overmedicalisation. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-06-24 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/other |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.rbmfc.org.br/rbmfc/article/view/1064 10.5712/rbmfc10(35)1064 |
url |
https://www.rbmfc.org.br/rbmfc/article/view/1064 |
identifier_str_mv |
10.5712/rbmfc10(35)1064 |
dc.language.iso.fl_str_mv |
eng por |
language |
eng por |
dc.relation.none.fl_str_mv |
https://www.rbmfc.org.br/rbmfc/article/view/1064/696 https://www.rbmfc.org.br/rbmfc/article/view/1064/697 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2015 Marc Jamoulle info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2015 Marc Jamoulle |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC) |
publisher.none.fl_str_mv |
Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC) |
dc.source.none.fl_str_mv |
Revista Brasileira de Medicina de Família e Comunidade; Vol. 10 No. 35 (2015): Abril-Junho "Quaternary Prevention (P4)"; 1-3 Revista Brasileira de Medicina de Família e Comunidade; Vol. 10 Núm. 35 (2015): Abril-Junho "Quaternary Prevention (P4)"; 1-3 Revista Brasileira de Medicina de Família e Comunidade; v. 10 n. 35 (2015): Abril-Junho "Quaternary Prevention (P4)"; 1-3 2179-7994 1809-5909 reponame:Revista Brasileira de Medicina de Família e Comunidade (Online) instname:Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC) instacron:SBMFC |
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Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC) |
instacron_str |
SBMFC |
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SBMFC |
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Revista Brasileira de Medicina de Família e Comunidade (Online) |
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Revista Brasileira de Medicina de Família e Comunidade (Online) |
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Revista Brasileira de Medicina de Família e Comunidade (Online) - Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC) |
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