Family medicine and quaternary prevention
a long history
DOI:
https://doi.org/10.5712/rbmfc16(43)2502Keywords:
Medicalization, Quaternary Prevention, Evidence-Based Medicine, Family Practice, Primary Health Care.Abstract
This article revisits the constitution of family and community medicine (FCM) as a medical specialty and its roots, which favoured the birth of the concept of quaternary prevention (P4). It shows that the bedside medicine tradition, the FCM gatekeeper function - strengthened by national health systems organised through primary health care (PHC) - and Balint’s biographical approach have facilitated the process of protecting patients’ health. Since its beginnings, FCM was linked to a holistic, humanistic and integral approach to the person, consistent with P4. However, two historic moments have strained the FCM approach. The first was the structuring of specialised biomedicine in hospitals, which centred the approach on diseases seen as bodily injuries. The second was the birth of evidence-based medicine (EBM) in the 1990’s, which refined the biomedical model by amplifying the degree of abstraction of biomedical interventions, linking them to measures of impact on collective of patients. Hospital medicine and EBM have brought important advances in care but have expanded their iatrogenic potential as well. EBM has built a hierarchy of evidences of such importance in the medical-scientific community that has been applied uncritically via protocols. This process has steered FCMs away from holistic and individualised approach to patients’ care, multiplying the potential for iatrogenic harm and medicalisation. There is an increased need for P4 to be informed by EBM and simultaneously applied to EBM itself. Thus, P4 requires a critical gaze by the FCM on the modus operandi of biomedicine, in order to make possible a humanised and demedicalising practice in PHC.
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