This paper draws on qualitative research using focus groups involving 38 general practitioners (GPs). It explores their attitudes and feelings about (over-)medicalisation. Our main findings were that GPs had a complex representation of (over-)medicalisation, composed of many professional, social, technological, economic and relational issues. This representation led GPs to feel uncomfortable. They felt pressure from all sides, which led them to question their social roles and responsibilities. We identified four main GP-driven proposals to deal with (over-)medicalisation: (1) focusing on the communication in doctor-patient relationships; (2) grounding practices in evidence-based medicine; (3) relying on clinical skills, experience and intuition; and (4) promoting training, leadership bodies and social movements. Drawing on these proposals, we identify and discuss five paradigms that underpin GPs' attitudes toward (over-)medicalisation: underlying social factors, preventing medicalisation, managing uncertainties, sharing medical decision-making and thinking about care as a rationale. We suggest that these paradigms constitute a defensive posture against GPs' uncomfortable feelings. All five defensive paradigms were identified in our focus groups, echoing contemporary political debates on public health. This non-exhaustive framework forms the outline of what we call ordinary defensive medicine. GPs' uncomfortable feelings are the origin of their defensive solutions and the manifestation of their vulnerability. This professional vulnerability can be shared with the patient's vulnerability. In our view, this creates an opportunity to rediscover patient-doctor relationships and examine patients' and doctors' vulnerabilities together."There are many cases in which-though the signs of a confusion of tongues between the patient and his doctor are painfully present-there is apparently no open controversy. Some of these cases demonstrate the working of two other, often interlinked, factors. One is the patient's increasing anxiety and despair, resulting in more and more fervently clamouring demands for help. Often the doctor's response is guilt feelings and despair that his most conscientious, most carefully devised examinations do not seem to throw real light on the patient's "illness", that his most erudite, most modern, most circumspect therapy does not bring real relief." (Balint M. The Doctor, His Patient and the Illness. New York: International Universities; 2005. [1957].)"Theories about care put an unprecedented emphasis on vulnerability-taking up that challenge to transform what really counts in today's hospitals implies letting colleagues inside previously closely guarded professional boundaries" (2, our translation).

Background: An interprofessional and cross-cultural pedagogical project in community health for students in nursing, social work, anthropology and medicine at the end of the bachelor's degree begun in 2014. After a rural context fieldwork in several Santal villages of West Bengal (India), students had to conduct a research project, based on a community-health topic. Aims: This paper describes how such a pedagogical project, introducing students to ethnographic research, can initiate new ways of thinking for possible future health interventions in rural communities. Methods: An inductive approach based on ethnography was used during the fieldwork, including observations, interviews, focus groups and local documentation. Results: Our observations led to the finding that actions in rural health cannot be initiated without: promoting an interprofessional/interdisciplinary perspective and a culture of complexity and reflectivity; considering local populations in transition and not in a fixed homogenous situation; understanding more than imposing; taking into account local disease classification and local pragmatic solutions; considering the dialogue between bio-medicine and therapeutic pluralism; considering local perceptions and practices; considering care itineraries/pathways; and finally being conscious of our apostolic function. Conclusion: Our interprofessional pedagogical project promotes a bottom-up approach in dialogue with a global health vision.

L’Union Europeenne des medecins generalistes/medecins de famille (UEMO) se doit d’etre attentive aux evenements politiques europeens qui peuvent concerner le medecin de famille.

Die European Union of General Practitioners/Family Doctors (UEMO) sieht es als ihre Aufgabe an, die politischen Entwicklungen auf europaischer Ebene, welche die Hausarztinnen und -arzte betreffen konnten, aufmerksam zu verfolgen.

L’UEMO présidé depuis 2 ans le groupe des professionnels de santé (Health Care Professionnals Pillar) du réseau d’intérêt sur l’évaluation des technologies de la santé et participé à de nombreuses séances avec la Commission Européenne et avec le réseau EUnetHTA.

Seit zwei Jahren hat die UEMO den Vorsitz in der Gruppe der Gesundheitsdienstleister (Health Care Professionnals Pillar) innerhalb des Interessenträgernetzes für die Bewertung von Gesundheitstechnologien inne und nimmt an zahlreichen Sitzungen mit der Europäischen Kommission und dem EUnetHTA teil.

Daniel Widmera, Patrick Ouvrardb, Blaise Guinchardc, Kumkum Bhattacharyad, Ranjit Bhattacharyae, Carla Vaucherf, Madeleine Baumanng, Ilario Rossih, Jacques Gaumei, Jean-Bernard Daeppenj a General practitioner, University Institute of Family Medicine, University of Lausanne, Member of IMCO board, Switzerland; b General practitioner, Société de Formation Thérapeutique du Généraliste SFTG, Continuing General Practitioner’s Education Society, Paris, France; c Nurse, La Source, School of Nursing Sciences, University of Applied Sciences of Western Switzerland HESSO; d Psychologist, Department of Social Work, Visva-Bharati University, Santiniketan, India; e Anthropologist, former director of Anthropological Survey of India; f PhD candidate in Medical Anthropology, Social Sciences and Politics Faculty SSP, University of Lausanne, Switzerland; g Nurse, La Source, School of Nursing Sciences, University of Applied Sciences of Western Switzerland HESSO. Member of IMCO board; h Medical Anthropologist, Social Sciences and Politics Faculty SSP, University of Lausanne, Switzerland;i PhD, IMCO coordinator; j Professor, CHUV, alcoology service. IMCO director.

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the age-old ethical requirement: first, a doctor must do no harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 10 countries. This collective text deals more specifically with: the bioethics of prevention, the importance of teaching Quaternary prevention and factual medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions.

General practice/ Family Medicine (GP/FM) and Primary Health Care (PHC) Knowledge Management (KM) - High complexity by intertwined human and technical approaches - Content not harmonized. No uniform table of content for both disciplines - Classification system available only for clinical purposes (ICPC 1987- ongoing) - No existing contextual features classification Methods: - Qualitative analysis of 2300 abstracts of GP congresses - Elaboration of a taxonomy called Q-Codes about contextual information (ie not clinical), - Complementary to the International Classification of Primary care (ICPC-2) - Using online HeTOP semantic base (OWL-2) to develop terminological records - Linking concept to existing terminologies and knowledge repositories (PubMed- DBpedia-Babelnet) - Multilingual translation by dedicated GPs worldwide (10 languages – more ongoing) - Experimental use of Q-Codes in various KM situations Results: • GP/FM & PHC evolutionary knowledge base on www.hetop.eu/Q (exportable in Excel and OWL-2) • 182 Q-Codes Uniform Resource Identifier (URI) in 10 languages: ex : Korean Shared Decision Making in Korean • Experiments are ongoing and presented on http://3cgp.docpatient.net/(abstracts indexing, pedagogy, master thesis indexing, discussion indexing, automatic annotators, e-learning application) Conclusion: Indexing of the GP/FM literature (congress abstracts, master's and doctoral thesis, group discussions) enhance the accessibility of research results and promote the emergence of networks of researchers. The work is ongoing and will be maintained by the Q-Code working group into the WONCA International Classification Committee.

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the age-old ethical requirement: first, a doctor must do no harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 10 countries. This collective text deals more specifically with: the bioethics of prevention, the importance of teaching Quaternary prevention and factual medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions.

En 2016, nous avons pu accompagner à Santiniketan six étudiants de Lausanne, Ils ont pu mener deux projets de recherche en lien avec la santé communautaire dont vous trouverez le compte-rendu dans ce numéro.

2016 konnten wir sechs Studierende aus Lausanne nach Santiniketan begleiten, Sie führten zwei Forschungsprojekte zum Thema «Community Health» durch. Die Berichterstattung zu diesen beiden Projekten finden Sie in dieser Ausgabe.

"Quaternary Prevention (P4) or First do not harm " Marc Jamoulle, MD, Family doctor, Department of general Practice, Liège University. Belgium. Hamilton Wagner, MD, Family doctor, Professor of Family medicine, Curutiba, Brazil. Patrick Ouvrard, MD, Family doctor, Société de formation thérapeutique du généraliste, France. Daniel Widmer, MD, Family doctor, chargé de cours, Institut Universitaire de Médecine Générale, Lausanne, Switzerland.

PrimaryCare PrimaryProfession Presentationofthe SFTG The SFTG (Société de FormationThérapeutique du Généraliste) is one of the most important French CME/CPD organisations for GPs.ThisN ational Level Scientific Society was created in 1977.I ti s composed of 30 localgroups of GPs and morethan 2500 members.Valuesand aimsofSFTG aredefined in acharter: independence, humanism, scientific rigour.T he society works in four maina reas: Continuing Medical Education, Continuing Professional Development, Social and Human Sciences, Research. Presentationofthe work of GGRAM (General Practitioners' Medical Anthropology Research Group)Agroup of about 20 doctors played the role of an anthropologist to learn about health practices in various countries (Senegal, Benin, Southern India [Tamil-Nadu and Karnataka] and the Himalayas [Sikkim, Nepal and Tibet]).They regularlyshared, withinpairs, their experiences from during their voyages.They then evaluated the changes brought about in their GP practices under the supervision of aprofessionalanthropologist.

Background: Drug iatrogeny is important but could be decreased if contraindications, cautions for use, drug interactions and adverse effects of drugs described in drug monographs were taken into account. However, the physician's time is limited during consultations, and this information is often not consulted. We describe here the design of "Mister VCM", a graphical interface based on the VCM graphical language, facilitating access to drug monographs. We also provide an assessment of the usability of this interface.Methods: The "Mister VCM" interface was designed by dividing the screen into two parts: a graphical interactive one including VCM icons and synthetizing drug properties, a textual one presenting on demand drug monograph excerpts. The interface was evaluated over 11 volunteer general practitioners, trained in the use of "Mister VCM". They were asked to answer clinical questions related to fictitious randomly generated drug monographs, using a textual interface or "Mister VCM". When answering the questions, correctness of the responses and response time were recorded.Results: "Mister VCM" is an interactive interface that displays VCM icons organized around an anatomical diagram of the human body with additional mental, etiological and physiological areas. Textual excerpts of the drug monograph can be displayed by clicking on the VCM icons. The interface can explicitly represent information implicit in the drug monograph, such as the absence of a given contraindication. Physicians made fewer errors with "Mister VCM" than with text (factor of 1.7; p = 0.034) and responded to questions 2.2 times faster (p < 0.001). The time gain with "Mister VCM" was greater for long monographs and questions with implicit replies.Conclusion: "Mister VCM" seems to be a promising interface for accessing drug monographs. Similar interfaces could be developed for other medical domains, such as electronic patient records.

Background Many medication errors are encountered in drug prescriptions, which would not occur if practitioners could remember the drug properties. They can refer to drug monographs to find these properties, however drug monographs are long and tedious to read during consultation. We propose a two-step approach for facilitating access to drug monographs. The first step, presented here, is the design of a graphical language, called VCM. Methods The VCM graphical language was designed using a small number of graphical primitives and combinatory rules. VCM was evaluated over 11 volunteer general practitioners to assess if the language is easy to learn, to understand and to use. Evaluators were asked to register their VCM training time, to indicate the meaning of VCM icons and sentences, and to answer clinical questions related to randomly generated drug monograph-like documents, supplied in text or VCM format. Results VCM can represent the various signs, diseases, physiological states, life habits, drugs and tests described in drug monographs. Grammatical rules make it possible to generate many icons by combining a small number of primitives and reusing simple icons to build more complex ones. Icons can be organized into simple sentences to express drug recommendations. Evaluation showed that VCM was learnt in 2 to 7 hours, that physicians understood 89% of the tested VCM icons, and that they answered correctly to 94% of questions using VCM (versus 88% using text, p = 0.003) and 1.8 times faster ( p < 0.001). Conclusion VCM can be learnt in a few hours and appears to be easy to read. It can now be used in a second step: the design of graphical interfaces facilitating access to drug monographs. It could also be used for broader applications, including the design of interfaces for consulting other types of medical document or medical data, or, very simply, to enrich medical texts.