Quaternary prevention: a task of the general practitioner.

Quaternary prevention is the prevention of unnecessary medicine or the prevention of overmedicalisation. The principle of “primum non nocere” is central to the whole of medicine. The task to avoid excess medical interventions is particularly mandatory in the field of general practice. We report on a workshop on this topic held at the 15th Wonca Europe Conference in Basel, in September 2009. In a world of growing obsessions with health matters and rising possibilities of “doing something”, there is a need for someone to give advice about the appropriateness of medical procedures. Mainly in the name of prevention, there has been an explosion of new disease labels and health care measures that warrant a rethinking of the objectives and underlying philosophy of primary care. Especially in an area of high grades of uncertainty and low prevalence of severe diseases, the most difficult thing for the physician is the decision not to pursue further action and to protect our patients from unnecessary medicine. This decision can firmly be grounded on probabilities arising from clinical studies on the one side and the individual life stories and values of our patients on the other. We propose to make quaternary prevention more explicitly the task of the general practitioner.