DIFFERENTIATING CLINICAL CARE FROM DISEASE PREVENTION: A PREREQUISITE FOR PRACTICING QUATERNARY PREVENTION
Charles Dalcanale Tesser, Armando Henrique Norman
Cad. Saúde Pública, Rio de Janeiro, 32(10):e00012316, out,
2016
Abstract:This article contends that the
distinction between clinical care (illness) and prevention of future disease is
essential to the practice of quaternary prevention. The authors argue that the
ongoing entanglement of clinical care and prevention transforms healthy into
“sick” people through changes in disease classification criteria and/or cut-off
points for defining high-risk states. This diverts health care resources away
from those in need of care and increases the risk of iatrogenic harm in healthy
people. The distinction in focus is based on: (a) management of uncertainty
(more flexible when caring for ill persons); (b) guarantee of benefit (required
only in prevention); (c) harm tolerance (nil or minimal in prevention). This implies
attitudinal differences in the decision-making process: greater skepticism,
scientism and resistance towards preventive action. These should be based on
high-quality scientific evidence of end-outcomes that displays a net positive
harm/benefit ratio. Leia o artigo.
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