Preventing over-medicalization by listening and sharing
Over-medicalization and Quaternary Prevention
The Lecce Conference has been successful and has seen the participation of Italian and foreign guests, who have analyzed the problem of over-diagnosis and over-medicalization, suggesting pathways to reduce their risk to the benefit of patient health. Ernesto Mola, President of the Italian WONCA Network, focused on the conference theme during his initial speech: “The progress of medical technology and knowledge has greatly improved care, but has also produced over-diagnosis and over-medicalization. These are not only due to inadequacy but also to the consequences inherent in some diagnostic or therapeutic practices, so it appears to be necessary to promote awareness of the problem and to correctly inform patients, trying to prevent the risk of over-medicalization that causes the patients more harm than advantages.” Furthermore, the General Director of ASL in Lecce Silvana Melli in her greeting speech explained the reasons for the presence of the local health authority as the sole sponsor of the event: “It is not just a problem of costs generated by the over-diagnosis, which could be better used to improve other aspects of care, but of the harm that patients may suffer from excessive or inappropriate care.” On the first day, the interventions showed scientific evidence of some non-tumoral and tumoral pathologies, for which the over-diagnosis was quantified in significant numbers. Marc Jamoulle on one hand, illustrated the concept of Quaternary Prevention, of which he is considered the creator, and that is defined as the action taken to protect people/patients from medical interventions likely to cause more harm than good health and well-being. A positive action that is the result of the interaction between the physician and the individual in a communicative relationship between scientific and human experiences that can lead to conscious sharing of diagnostic and therapeutic choices. Anna Stavdal, President of WONCA Europe, after explaining the aims of the International Medical Care Organization bringing together 131 countries and associating 500,000 family physicians around the world, announced that WONCA Europe, of which she is the President, is producing a position paper on the subject of over-diagnosis, in order to help doctors acknowledge the problem and face it in the exclusive benefit of patients. Johann August Sigurdsson, professor of General Medicine in Norway and Iceland, presented the analogous initiative of a public position on the over-diagnosis shared by the scientific societies of Scandinavian Countries. Roberto Satolli, GP and journalist, has presented recurrent examples of increased health costs in relation to media pressures in healthcare industry. For example, the risk thresholds progressive lowering in recent years has meant to recruit more and more patients to drug treatments. At the end of day one Alessandro Mereu and Nicola Pecora of Giotto Movement have openly and problematically tackled the theme of training needs for trainee GPs. How to get to know the problem of overmedicalization and how to acquire the right skills to cope with it. The second day was opened with a report by Patrizia Elli of the Pediatric Cultural Association, which illustrated the basic concepts of narrative medicine as a method of approach to the patient in support of Quaternary Prevention. Furthermore, an interesting training course based on the simulated patient technique by Norma Sartori and Fabrizio Valcanover from the General Medicine school in Trento, in front of an amused and surprised audience, have presented recurring situations in a common family medicine practice. An original and effective way to offer reflections and behavioral ideas for doctors who are planning to prevent the risk of over-medicalization of the disorders complained of by their patients. The intervention of Maria del Rosario Perez, of the World Health Organization, preceded the round table attended by several speakers of the conference. “There is a lot of concern in the World Health Organization – said Perez – about the indiscriminate use of ionizing radiation in medical diagnostics, whose use should be justified by a clear suspect diagnosis. Today, however, there is an increasing use of radiological examinations for assessing health in the asymptomatic patient, for a false idea of prevention or for defending against legal litigation. WHO pays much attention to the exponential growth of over-diagnosis, which pushes the patient to unnecessary and traumatic treatments and examinations that do not increase his life expectancy.” At the Round Table, presented by Giorgio Visentin (Center for Studies and Research in General Medicine) it was emphasized the importance of the conference, not only to make the doctors and the common people more aware of the risk of over-diagnosis and over-medication, but also as a contribution to the drafting of WONCA’s position paper, which is directed by doctors and patients. “Only by sharing between the physician and the patient of the diagnostic and therapeutic pathway, listening to and accepting the patient’s expectations and communicating scientific knowledge, it is possible to cope with the risk of over-medicalization. The best choices are the result of a meeting between two experts: the physician who is the expert in scientific evidence and the patient who is the best expert in his health and psycho-physical well-being.” They also offered their interesting contributions: Anna Maria Falasconi: “Do better with less”; Rosario Falanga: “Reconciliation of drug therapy and deprescribing in multi-treated patients: the experience of the GPs of the AS5 West Friuli”; Paolo Longoni: “Survey: The perception of Italian physicians about the problem of over-medicalization”; Giorgio Visentin: “Experiences in the international arena”; Giuseppe Febbo, Giulia Berloffa, Ernesto Mola, Andrea Moser, Fabrizio Quarta proposed: Communications on evidence of over medicalization, followed by a discussion involving Fernando Parente (Condultant and Director at the Internal Medicine division of “Vito Fazzi” Lecce Hospital) and Claudia Felici (ASSIMEFAC).