Interpretation of the Reasons for Consultation: Manifest and Latent Content. The Initiation of the Diagnostic Process in General Medicine

task of the general practitioner (GP) is to discover the true nature of the health problem. The reason for consultation expressed by the patient is a manifest content. The GP must transform or complete those ideas that are latent or initially hidden. The latent content of the symptom / problem / motive may be incomprehensible at the beginning. When the initial manifest material of the patient is translated by the GP, we have a more understandable expression. This distinction between manifest and latent content makes special sense in two the motives / symptoms / problems that: A) although they pose a coherent material, cause some surprise or cognitive dissonance to the GP, and B) have no explanatory physiopathological meaning, nor are they comprehensible according to the usual theoretical frameworks. These types of visits may be a large part of the patients seen on a normal GP consultation day. In these motives / symptoms / problems the GP, instead of performing the “clinical method of the detective,” uses a “biopsychoanalytical” method or tool, that is the beginning of the diagnostic process, which has at least 3 ways: 1) The GP acts by helping and avoiding disturbances in the patient’s reflexive process; 2) The GP try of knowing the latent material by means of “reading the patient’s manifest signs and symbols”. The messages of our patients contain “facts” and “feelings”, and we must be attentive and understand the emotional messages. The reason for consultation / symptom / manifest problem that the patient initially expresses is a “symbolic representation” (with universal and particular symbols); and 3) In addition, the doctor looks for what seems to be the cause of the patient’s problem in the doctor-patient relationship itself.

Keywords: General practitioner; General Practice; Family medicine; Physician-patient communication; Diagnostic techniques; Physician-patient relations; Symptom assessment; Biopsychosocial; Diseases; Patient-centred medicine care; Framework.