General Practice as a high context discipline
by Francesco Carelli
Which are the essential features that influence all skills, attitudes, and knowledge acquisition in general practice education? They are not taught and learned as separate competencies, in fact the way in which these essential features are an integral part of the discipline differentiates this discipline from most of the other medical specialty branches. This defines the specific role of family medicine within medical care.
General Practice/Family Medicine, as a patient centred discipline, is a “high context discipline”1, accepting the subjective world of patient health beliefs, and family and cultural influences. Most other specialties in medicine develop as “low context discipline”, decision making to objective facts, measurable quantitative information and visual diagnostic techniques.
Patient centred clinical care includes as a consequence a scenario whereby the doctor involves him/herself as a person in this relation with the patient, not merely as a medical provider. Education should learn to promote attitudes, strengths and weaknesses, values and beliefs in a partnership relation with the individual patient.
Although a high-context and very individually focused discipline, General Practice/Family Medicine should be as much as possible based on scientific evidence. Combining and balancing both approaches in the development of practice guidelines provides an authority based approach which complements the support from the scientific community. Education should provide the competence to search, collect, understand and interpret scientific research critically. Using evidence as much as possible, and implementing authority based guidelines should become a family doctor’s attitude that would and should be maintained over the entire professional career. Knowing and using with flexibility the principles of lifelong learning and quality improvement should be considered as an essential competence.
1. Helman CG. The role of context in Primary Care. J Coll Gen Pract 1984; 34:547-50.
Francesco Carelli is a General Practitioner and Professor of Family Medicine at the University of Milan. He is the Italian representative on EURACT’s Council and Director of Communications and Chairman of the Basic Medical Education Committee within EURACT.