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See detailImplications éthiques, pédagogiques, socio-politiques et anthropologiques de la prévention quaternaire
Jamoulle, Marc ULiege; Roland, Michel; Bae, Jong-Myon et al

in Revue Médicale de Bruxelles (2018), 39

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the age-old ethical requirement: first, a doctor must do no harm; second ... [more ▼]

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the age-old ethical requirement: first, a doctor must do no harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 10 countries. This collective text deals more specifically with : the ethics of prevention, the importance of teaching Quaternary prevention and Evidence Based Medicine, the social and political implications of the concept of Quaternary prevention, and its anthropological dimensions. [less ▲]

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See detailRound table. Quaternary Prevention(P4) or first do not harm.
Jamoulle, Marc ULiege; Widmer, Daniel; La Valle, Ricardo et al

Conference (2017, September 09)

Quaternary prevention (P4), born from a reflection on the doctor-patient relationship, began as an answer of family doctors facing overmedicalization. It aims to protect the patient or population against ... [more ▼]

Quaternary prevention (P4), born from a reflection on the doctor-patient relationship, began as an answer of family doctors facing overmedicalization. It aims to protect the patient or population against the danger of medicine. Harmful effects can appear with preventive activities (example: prostate cancer screening by PSA) as well as by therapeutic interventions (example: disruptive medicine). P4 promoted by the World Organization of Family Doctors (WONCA) is practiced in different ways around the world through the activity of the WONCA Special Interest Group on Quaternary Prevention and Overmedicalisation (P4&O). There are multiple initiatives and backgrounds of P4. All these multiple initiatives that lead to P4 have their origin in denouncing the inadequacies of the Hegemonic Medical Model and the excesses perpetrated in the pursuit of profit. There are many schools of thought that try to solve this situation, such as "Medicines Based on ..." These contributions are valuable but usually point to a single dimension of the problem so they do not change the situation too much. The P4, however, have understood the centrality of the political and economic dimensions and, that is why, P4 has become a movement. P4 has understood that the root causes far exceed the limits of medicine, have understood that the problem includes ethical, political, economic and epistemological aspects of medicine. It is for this reason that the definition of P4 has shifted to the function of foundational idea since the movement that has been generated around this concept has surpassed this initial definition centered in a, yet complex, but still medical vision. P4 has understood that a new model of medicine and a new pact with society is necessary. P4 is a counter-hegemonic movement with predominant development in peripheral countries. This movement includes many other perspectives developed in the central countries but is the only one that has an ideological position that discusses the current paradigm of medicine that legitimates the same causes that give rise to P4, proposing to think a new way of practice the medicine that includes Ethical values, other forms of knowledge and the return to human medicine for humans with place for uncertainty, compassion, the encounter between people and non-commodified. Justice in health care is a central aspect of this new way of conceiving the medicine that we propose. Remember what Rudolf Virchow said in the nineteenth century "Physicians are the natural advocates of the poor and social problems fall largely under their jurisdiction. Medicine is a social science, and politics is nothing more than medicine in large scale". We must reformulate our contract with society and for this we must be very clear that our loyalty must always be with the sick, the poor and those who are weak. For this new contract we must also take into account the magnitude of the power that has been given to us and to live up to such responsibility. In the Rio manifesto (2016) we propose to “Avoid and denounce the naturalization of: hunger, exclusion, manipulation, inequality, violence, racism, exploitation, which harm health more than "diseases"” . There is a better and fairer world, let's fight to get it! More about P4 on www.ph3c.org/p4 [less ▲]

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See detailSpecial seminar "Quaternary Prevention (P4) or First do not harm "
Jamoulle, Marc ULiege; Widmer, Daniel; Wagner, Hamilton et al

Conference (2015, August 23)

Quaternary prevention (P4), an answer of family doctors facing overmedicalization aims to protect the patient or population against the dangers of medicine. Harmful effects can appear with preventive ... [more ▼]

Quaternary prevention (P4), an answer of family doctors facing overmedicalization aims to protect the patient or population against the dangers of medicine. Harmful effects can appear with preventive activities (example: prostate cancer screening by PSA) such as by therapeutic interventions (example: disruptive medicine). P4 promoted by the Wonca (World Organization of Family Doctors) is practiced in different ways around the world. The seminar should present examples of teaching and application of P4 in different countries. 6 short talks (total 45 min) will be followed by an open roundtable about the philosophical aspects of P4, where the audience can participate. Asking the question: « is acting always justified in medicine? », P4 opens our thinking to a philosophy of action. Questioning the best way to reduce uncertainty, P4 is rooted in a philosophy of knowledge. How to decide action or abstention? How to appreciate the danger of both? How to accompany a patient without harmful effects (primum non nocere)? More about P4 on www.ph3c.org/p4. [less ▲]

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See detailModes de rémunération des médecins généralistes : quelles conséquences ?
Saint-Lary, Olivier; Franc, Carine; Raginel, Thibaud et al

in Exercer (2015), 119

Introduction. The health reform law crystallizes the tensions between the different health system players. Besides the specific issue of third-party payment, which will be addressed in an upcoming article ... [more ▼]

Introduction. The health reform law crystallizes the tensions between the different health system players. Besides the specific issue of third-party payment, which will be addressed in an upcoming article, some professional organizations wish to strengthen fee for servicies while others call for more mixed forms of remuneration. Many economic analyses were conducted to study the benefits and limits of each mode of physician compensation. This article offers a synthesis of the literature about these modes: fee for service, capitation, payment performance and wage labor. Method. Collaborative literature analysis between doctors and health economist. The databases searched were MEDLINE, the Cochrane Library and CAIRN. Results. Each mode has specific benefits and limits for the financer, the physicians and the patients. Fee for services increases physician productivity but may increases health spending. Capitation and salary decrease care supply but might help to control health spending and to develop preventive activities. The effectiveness of pay for performance is now being questioned. The current trend is to promote mixed forms of remuneration, hoping to combine the advantages and limit the share of defects of each modality. The complexity of such systems makes it difficult to compare from one country to another. Discussion. The choice of a mode by the financer must take into account both the possible combinations of different payment methods and the developments or societal aspirations to meet population health needs. [less ▲]

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See detailPrévention quaternaire : agir est-il toujours justifié en médecine de famille ?
Widmer, Daniel; Herzig, Lilly; Jamoulle, Marc ULiege

in Revue Médicale Suisse (2014), 10(430), 1052-6

La prévention quaternaire vise à protéger le patient ou la po- pulation de la surmédicalisation. Elle imprègne toute l’activité du médecin de famille par une interrogation tant sur l’utilité de la ... [more ▼]

La prévention quaternaire vise à protéger le patient ou la po- pulation de la surmédicalisation. Elle imprègne toute l’activité du médecin de famille par une interrogation tant sur l’utilité de la prévention primaire que du diagnostic précoce, ou sur les risques de la création de nouvelles entités pathologiques et d’une médecine maximaliste. Le médecin de famille favorise la prévention quaternaire en se centrant sur les priorités du patient et sur les ressources locales d’un système de soins efficace. [less ▲]

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