About quarternary prevention

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About quarternary prevention
Workshop at the 15th Wonca Europe
Conference Basel 2009
Our medical world as a social construction and
the tasks of the GP

• Thomas Kuehlein,
• ,
• Department of general practice and health
  services research, University of Heidelberg,
  Germany

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Points of view and discussion

• The most difficult thing for doctors and their
  patients is the decision not to pursue further
  diagnostics and therapy
• Our medical world is a social construction and by
  thus changeable
• Quarternary prevention the prevention of
  unnecessary medicine is the task of the GP

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The most difficult thing for doctors and their
patients is the decision not to pursue further
diagnostics and therapy
risk
You never get thanked, honoured or paid for
having done nothing
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Our medical world is a social construction and by
thus changeable
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Illness problems are the principal difficulties
that symptoms and disability create in our lives
Disease, however, is what the practitioner
creates in the recasting of illness in terms of
theories of disorder. Disease is what
practitioners have been trained to see through
the theoretical lenses of their particular form
of practice. That is to say, the practitioner
reconfigures the patients and familys illness
problems as narrow technical issue
Arthur Kleinman, The Illness Narratives
Suffering, Healing and the Human Condition, Basic
Books 1988
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The whole is more than the sum of its pieces
Ludwig van Beethoven, Für Elise,
Ursus Wehrli, Noch mehr Kunst aufräumen, Kein
Aber Verlag 2006
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1 very good example 7 very bad example, or
nor example at all
Cited from Taylor JR Linguistic Categorization,
Oxford University Press, Oxford 2003
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If we confuse disease and illness and if we
confuse diagnosis and risk factor we are in
danger to miss the needs of our patients
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Quarternary prevention means to prevent
overmedicalization
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In danger of overmedicalization

1. The worried well
2. Patients with somatoform or medically unexplained
   symptoms
3. All the rest of our patients

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overmedicalization is not inevitable
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