Prevenzione quaternaria, primum non nocere

When presented in Durham during the 1995 WICC workshop, the concept of quaternary prevention, born in 1986, has attracted the consensus of the whole audience. In 2003 it has been discretely published in the Wonca dictionary of general practice.
Since this time, medicine has changed. The diffusion of knowledge and the sagacity of some researchers has shown that medicine could become dangerous for health. The concepts of overinformation, overdiagnosis, overtreatment and overscreening are now the bread and butter of numerous medical journals and the themes of numerous books and disputes throughout the world.
Quaternary prevention encompasses all those domains and supersedes them by putting the relationships between patient and doctor at the center of the ethical reflection.
WICC has been instrumental in the genesis and dissemination of the concept of quaternary prevention. This concept is now known and distributed worldwide under the acronym P4. Family physicians form interlinked P4 groups in various countries. It is the theme of many congresses and was propelled to the forefront of the recent Wonca Europe Congress. This concept could induce profound changes in the role of the family physician in health care. Moreover, the combination of the four definitions of prevention provided an amazing view of the activity of family physicians and could renew basic job description in GP / FM.