Communication skills

a bridge between quaternary prevention theory and practice

Abstract

The understanding of the health-disease process changes over time. Nowadays, it is heading towards an increase in pathologizing phenomena previously considered to be natural and paves the way for a scenario of valuing the excesses. Therefore the importance of protecting people from possible damage caused by medical interventions, quaternary prevention (P4) emerged, advocating for a less iatrogenic medicine, avoiding overdiagnosis, overmedicalization, and unnecessary interventions. However, in clinical practice, doctors face several obstacles at the application of P4, so they frequently not use it, even though they are aware of its importance. Among these obstacles, we highlight the difficulty of denying a patient’s demand, dealing with situations of disagreement, poor argumentative skills, and the fear of not making a diagnosis or losing the patient’s confidence. This essay discusses communication skills techniques, taking account the person-centered medicine, aiming to assist doctors in the face of these difficulties. Starting from everyday situations, answers were sought in scientific references, such as books, articles and manuals. Some of the techniques presented are: how to deny a demand, how to understand the personal desire for a medical intervention, how to deal with the divergence of ideas, how to explore the experience of non-agreement, how to undeprescribe medications, and how to do share decision making. It is expected that, after this reading, professionals may feel more prepared and motivated to swim against the hegemonic tide of unnecessary medical interventions. This could help medicine to follow the “first, do no harm” principle and advance in order to promote the best possible care for people.