Quaternary Prevention, an Answer of Family Doctors to Overmedicalization

In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare

Drogue d'usage, drogue d'abus; le médecin et l'usager de drogue

Un titre provocateur, tant il engrisaille la limite entre l'usage et l'abus, entre le médicament et la drogue, entre l'utilisateur de produits pharmaceutiques et l'usager de drogue. Et pourtant c'est bien des limites de la thérapeutique médicale dont il s'agit quand il faut aborder les marchés détournés des opiacés thérapeutiques (codéine), des barbituriques (Vesparax®), des benzodiazépines (Valium®, Xanax®, Rohypnol®) et bientôt peut-être des sérotoninergiques (Prozac®, Seroxat ®). L’analogie d’usage entre les médicaments prescrits pour la sphère mentale et les drogues de rue est frappante. Les médicaments prescrits par les médecins et détournés de leur usage le sont-ils sans responsabilité aucune des producteurs, prescripteurs, délivreurs et autorités sanitaires

Médico de familia, desviaciones y límites

El análisis del concepto de prevención, de acuerdo a un eje relacional y no a un eje cronológico, ha permitido poner en evidencia la existencia de cuatro tipos de atenciones del médico y en particular, del médico de familia, en respuesta a la demanda del paciente

Séquelles post-aiguës de l'infection à SARS-CoV-2. Suivi d'une cohorte de patients atteints de Long Covid

suivi d'une cohorte de patients Long Covid en médecine de famille. Partage de savoir avec un groupe de médecin

La santé est un état de résistance

editorial reviewedL’exercice de la médecine est difficile, mais cela n’explique ni n’excuse certaines pratiques qui oublient que celui qui souffre est avant tout un humain. Il convient de les identifier, analyser et contrôler en partenariat avec le patient. Patients et médecins vivent, souffrent et résistent ensemble

Post-acute sequelae of SARS-CoV-2 infection or Long Covid

Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don't have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6-8 months, 15 patients were able to return to life and work after 12-18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients' lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine

Long Covid in family medicine. Follow-up of a cohort of patients suffering from Long Covid in a family practice. Updated July 2022

Fifty-two patients who suffered from COVID-19, who were all still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and June 2022. Data extracted from the medical records of the 52 patients (38 women), mean age 43.2 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-one patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort to explore the genetic and immunological basis of their problem, as 20/52 cases don’t have immunological certainty of a COVID-19 infection. There is no known verified treatment. Three categories of patients appeared over time: 16 patients have fully recovered after 6 to 8 months, 15 patients were able to resume life and work after 12 to 18 months with some after-effects, 21 patients are still very ill and unable to resume their life after 18 months. The biopsychosocial consequences on patients’ lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine. Data extracted from the medical records of the 34 patients (26 women, range 12 to 69 years) and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture. Brain single-photon emission computed tomography (SPECT-CT) has been used in fifteen patients with a high severity index and a functional status highly impaired. Vascular encephalopathy has been demonstrated in fourteen of the fifteen patients and supports the hypothesis of a persistent cerebral vascular flow disorder in Long Covid. The patients will benefit from the consortium COVID Human Genetic Effort to explore the genetic and immunological basis of their problem, as 14/34 cases don't have immunological certainty of a Covid infection. It is necessary to test the reproducibility of this description, conducted on a small number of patients. There is no known verified treatment and patients do not receive any specific help from Belgian health authorities. Neurocognitive rehabilitation and physiotherapy are not widely available. The biopsychosocial consequences on patients' lives are severe and family doctors left out in the cold.Cinquante-deux patients post Covid, présentant une fatigue extrême, un épuisement à l'effort, un brouillard cérébral, une anomie, un trouble de la mémoire, une anosmie, une dysgueusie et d'autres problèmes de santé multi-systémiques ont été suivis en médecine familiale entre 2020 et 2022

What is going on here and now when a patient meets a family doctor? A P4 minded cybernetic observation of the consultation process.

The consultation is a meeting between two human beings, where one is the patient, playing the part of the sick, while the other plays the therapeutic role. It is also a meeting between knowledge and feeling. The doctor's knowledge/thoughts (true or false) influences the thoughts/knowledge (true or false) of the patient, in a dialectical relationship. In a way, the patient-doctor encounter is a meeting between science and conscience fitted in the symbolic world of human beings. The term science, as it is used here, encompasses the knowledge of the biological, the mental and the social being, as well as the observation of what is going on here and now, a cybernetic observation of the consultation itself, in a manner of speaking. Through his or her training, the doctor inevitably confronts the patient with the disease. It is his or her job to reveal it. He or she will be gratified to have, at least, found the evil, by always pushing the limits of diagnostic exploration. In an attempt to know better about what we are doing, we will go through a recent work on the main themes discussed by GPs during congresses ( www.hetop.eu/Q ) to examine which ones are dealing with the Quaternary prevention concept. We will ask to the participants if and when Quaternary prevention could exert a deep influence throughout their consultation process and their patients care pathway

Les Evidence Based Medical Guidelines® sont-elles adaptées à la médecine defamille?

The author is a family physician and terminologist. He shares his experience of proofreading translations from English to French of the Evidence Based Medical Guidelines (EBMG) published by DUODECIM Ltd and Finnish general practitioners. These EBMGs are available to healthcare personnel in several countries. In Belgium they are disseminated by CEBAM, the Belgian Centre for Evidence Based Medicine, through the ebmpractice.net website on behalf of the national insurer, INAMI. After having corrected a few hundred texts, the author shares his experience. Terminological issues are first addressed. System of corrections, specific difficulties or questions of acronyms are reviewed. Then the author gives a partial presentation of his own critical readings of about a hundred recommendations that he has more particularly studied. The main pitfalls encountered in the field of prevention, clinical pharmacology or mental health which are discussed here in light of the author's experience and vision of family medicine. The exchange of these criticisms with the Finnish authors of the guidelines proved to be particularly interactive and fruitful. Although the concept of evidence is not clear to anyone, the EBMGs are an indispensable tool for understanding and supporting the complexity of family medicine.L'auteur est médecin de famille et terminologue. Il nous fait part de son expérience de relecture des traductions de l'anglais vers le français des Evidence Based Medical Guidelines (EBMG) publiées par DUODECIM Ltd et les médecins généralistes finlandais. Ces EBMG sont disponibles pour le personnel de santé dans plusieurs pays. En Belgique, ils sont diffusés par le CEBAM, le Centre belge pour la médecine factuelle, via le site ebmpractice.net pour le compte de l'assureur national, l'INAMI. Après avoir corrigé quelques centaines de textes, l'auteur partage son expérience. Les questions terminologiques sont abordées en premier lieu. Les systèmes de correction, les difficultés spécifiques ou les questions d'acronymes sont passés en revue. Ensuite, l'auteur présente partiellement ses propres lectures critiques d'une centaine de recommandations qu'il a plus particulièrement étudiées. Ce sont les principaux écueils rencontrés dans le domaine de la prévention, de la pharmacologie clinique ou de la santé mentale qui sont ici discutés à la lumière de l'expérience et de la vision de la médecine de famille de l'auteur. L'échange de ces critiques avec les auteurs finlandais des guidelines s'est révélé particulièrement interactif et fructueux. Bien que le concept d'évidence ne soit clair pour personne, les EBMG sont un outil indispensable pour comprendre et soutenir la complexité de la médecine de famille

La médecine de famille, une connaissance complexe et multi facettes

Dans les conditions difficiles que doit affronter la Tunisie, soit faire face a l'augmentation de la demande en soins de santé, à l'amélioration de la qualité et à la transition démographique et épidémiologique, la Médecine de Famille représente un atout certain. L'image internationale peu flatteuse de la médecine de famille Tunisienne est présentée au travers de sa présence dans les publications scientifiques. Une série de concepts spécifiques de la Médecine de Famille sont exposés ; la complexité, l'extension de la connaissance, l'incertitude, les différents niveaux de l'action. Leur prise en compte permet d'appeler à un autre regard et à un appel à écrire le métier d'une façon différente. Pour en sortir définitivement avec l'image délétère de ce métier exigeant