In the world of medicine, we often focus on doing more: more tests, more treatments, and more technology.
However, Quaternary Prevention is ask, “When is more actually is the too much?”
While most people are familiar with vaccines (primary prevention) or screenings (secondary prevention),
quaternary prevention is a crucial safeguard within healthcare system designed to protect patients from medical overactivity.
Defining Quaternary Prevention
The term was first introduced by Belgian family physician Dr. Marc Jamoulle.
It is defined as:
Action taken to identify a patient at risk of over-medicalization, to protect them from new medical invasion, and to suggest interventions which are ethically acceptable.
In simpler terms, it is art of protecting patients from the medical system itself.
It aims to prevent “iatrogenesis”—harm caused by medical treatment or diagnostic procedures.
The Four Levels of Prevention
| Level | Goal | Example |
| Primary | Prevent a disease from occurring. | Immunizations, exercise, smoking cessation. |
| Secondary | Detect disease early before symptoms appear. | Mammograms, blood pressure checks. |
| Tertiary | Reduce the impact of an existing disease. | Rehabilitation after a stroke, chronic pain management. |
| Quaternary | Prevent over-medicalization and unnecessary harm. | Avoiding redundant scans, refusing “defensive medicine.” |
Why Is It Necessary?
As technology advances, boundary between the “healthy” and “sick” has become blurred very much.
“Incidentaloma”
- With high-resolution imaging (CT scans, MRIs), doctors often find tiny abnormalities that would never have caused patient harm.
- These “incidentalomas” often lead to a cascade of biopsies and surgeries that carry real risks but provide no benefit.
Defensive Medicine
- Doctors sometimes order tests not because the patient needs them, but to protect themselves from potential lawsuits.
- Quaternary prevention encourages evidence-based practice over fear-based practice.
Over-diagnosis and Medicalization
- Normal life transitions—such as menopause, aging, or mild sadness—are increasingly treated as medical “disorders” requiring pharmaceutical intervention.
- Quaternary prevention seeks to re-humanize these experiences without unnecessary labeling.
How Does It Work in Practice?
Quaternary prevention relies heavily on the doctor-patient relationship and principle of Primum non nocere (First, do no harm).
- Watchful Waiting: Instead of immediate surgery or heavy medication, a doctor may suggest monitoring a condition that is likely to resolve on its own.
- Shared Decision Making: Doctors be transparent about the “Number Needed to Treat” (NNT) vs. the “Number Needed to Harm” (NNH) so patients can make informed choices.
- De-prescribing: Systematically reviewing a patient’s medications to remove those that are no longer necessary or are causing adverse side effects.
At its corn philosophy and concept is, quaternary prevention is about integrity.
It acknowledges that while medicine is powerful, it is not infallible.
By resisting the urge to over-test and over-treat, healthcare providers respect the patient’s autonomy and physical well-being, ensuring that the cure never becomes worse than the disease.