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.

1. Quaternary
Prevention
Dr. K. Md. Shoyaib
PG, Dept of Community Medicine,
Bangalore Medical College and Research Institute
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2. Quaternary Prevention
• First suggested by Marc Jamoulle in 2015.
• It is the complimentary dimension to the other
three dimensions of prevention.
• Prevention of medicine itself, whose understanding
could help to control the economic and human
costs of healthcare.
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3. Patient Doctor Interaction
Doctors Side
Patients
Side
Disease Absent Disease Present
Feels
ill
Feels
well
Timeline
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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
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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
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6. The Red Arrows
• Miscommunication
• Anxiogenic health education
• Bad public health program
• Personal fear of the patient or caregiver
• Health belief
• Defensive medicine
• Uncontrolled technology
• Specialist based care
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7. Quaternary Prevention: P4
QUATERNARY
PREVENTION
• It forces the doctor to have a critical look on his/her own
activity.
• Need for close monitoring by the doctor himself/herself.
• It is about understanding that medicine is based on a
relationship
• P4 attitude acts as a resistance.
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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
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9. P4: A Scenario
Defensive Medicine
Miscommunication
Anxiogenic Health
Education
Somatoform Disorder
Misunderstanding
Anxiety of the
patient or caregiver
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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
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11. The Black Barriers
Doctor attracts
patient and
Patient attracts
doctor
• Listen to the Patient, Control the Medicine.
• Follow ethically based medicine.
• “Not to do” is not as easy as accepting “to do”.
• A counsel of “not to do” needs trust between patient and
doctor in supporting doubt.
• P4 attitude acts as a response of family doctor facing
overmedicalization, as a resistance.
• P4 is a rallying cry against the lack of humanity of large
sectors of medicine.
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12. QUATERNARY
PREVENTION
Shaping of new Concepts
• Auto control of Preventive and Curative Program.
• Careful analysis of Miscommunication.
• Understanding patient’s anxiety and belief.
• Defensive medicine.
• Accepting to decide in Uncertainty.
• Humility in Diagnostic process and patient relationship.
• Ethically balanced attitudes.
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13. “Quaternary prevention is more than prevention”.
“It’s a style”.
“A way of thinking about our job but also a tool to
control it.”
QUATERNARY
PREVENTION
Conclusion
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14. Reference
• 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.
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15. 16 June 2021 QUATERNARY PREVENTION 15
Thank You