Workshop, Addressing the limits of medical practice. Wonca 2013


Workshop # 298

Quaternary prevention, addressing the limits of medical practice


DAY: Wednesday June 26, 2013
SESSION: WORKSHOP: 2.15. Ethics and law
SESSION TIME: from 10:30 to 12:00


Marc Jamoulle, GP , researcher in Primary care , IRSS-UCL, Belgium

Gene Tsoi, Immediate Past President, Hong Kong College of Family Physicians, China

Iona Heath, past-president of the Royal College of General Practitioners, United Kingdom

Dee Mangin, Director, General Practice Research Group, Associate Professor, Otago university, New Zealand

Mohamad Pezeshki, Associate Professor, Department of Community Medicine, Tabriz Medical School, Iran

Miguel Pizzanelli Báez, head of the Primary care network, Florida, Uruguay


As stated in Wonca dictionary of family Medicine (Bentzen, 2003), quaternary prevention definition is “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.” 

Quaternary prevention, first coined at Wonca world Hong Kong 1995 by M. Jamoulle& M.Roland, describes the protection of patients from diagnostic tests, interventions and treatments that offer no benefit for overall morbidity or mortality for the individual, and may cause physical or psychological harm.


The P4 concept pulls together all reflexive moves on the problems resulting from an excess of medical care, such as overscreening, overinvestigation, overprescription, and overtreatment.


Since the first workshop in Wonca Basel 2009, the P4 concept has spread throughout the world, and has provoked an intense exchange of ideas. The speakers gathered here from around the world intend to show how front line family physicians could analyze, understand, appropriate and use the P4 concept to examine, analyze and modify their practice.


The audience will be stimulated to share their concern about the limits of medicine exchange critical comments on the concept of P4.

At the end of the workshop attendees will be able to able to use and apply Quaternary prevention to improve both the health of individual patients and public policy.


More on rubric Quaternary prevention



Marc Jamoulle : From Illitch to Moynihan , medicine can be dangerous for your health

Gene Tsoi ; Doctor-Patient Relationship - sharing of experience with a GP from Hong Kong

Iona Heath ; The ethical implications of excessive prevention

Dee Mangin : Mutimorbidity, ageing, and Quaternary Prevention

Mohammad Zakaria Pezeshki: Clinical Epidemiology and Quaternary Prevention

Miguel Pizanelli, Jorge Bernstein & André L. Silva: A South American move; the “Comision de Prevencion Cuaternaria”



Created 13/07/2013 - Last modified 27/11/2015