Quaternary prevention, a GP/FM construct based on doctor-patient relationships. From Wonca world Hong Kong 1995 to Wonca APR Taipei 2015

Aims
Encounter in General Practice/Family Medicine is a meeting point between illness and disease. Looking at patients and doctors beliefs and attitudes, one can define four fields of activity describing the major working areas in GP/FM. Considering clinical prevention as the management of processes over a length of time through the lens of the patient doctor relationships, one can define four main prevention domains.
Methods
Using a double entry table, we show how the definitions already published in the Wonca Glossary of general practice fit perfectly to the fields I, II and III of prevention and how the fourth definition was developed and edited.
Results
The story of the construction of the Quaternary prevention is presented as well as its spread worldwide, through new media, as a core value for many young general practitioners.
“Action taken to identify a patient or a population at risk of overmedicalisation, to protect them from invasive medical interventions and provide for them care procedures which are scientifically and medically acceptable ”
Born in 1986, presented for the first time in Wonca Hong Kong 1995, developed in Durham USA in 1999 the concept has been edited in 2003 in the Wonca dictionary of general practice . Quaternary prevention has now reached the international community of GPs and is considered as a core value by many Wonca representatives
Discussion
This approach enables us to clarify the concepts of Primary, Secondary and Tertiary prevention while defining a new one: Quaternary prevention.The latter encompasses the consequences of the encounter between the anxiety of the patient and the uncertainty of the doctor and gives insight into the propensity of this kind of meeting to distil sickness, thus creating false positive with its cohort of avoidable human, social and economic costs and suffering. Quaternary prevention (P4), an answer of family doctors facing overmedicalization aims to protect the patient or population against the danger of medicine. See www.ph3c.org/P4. (Poster in Chinese and English)