Disease is an Alteration of the Patient's Relationships Matrix: Implications for the Diagnosis in Family Practice

This paper investigates and reflects on the biopsychosocial concept of disease from the point of view of the general practitioner. What is the disease? The disease is a relational concept. The disease appears between the person and their relationships with the contexts; there are not isolated contexts. The disease depends on individual contexts and in turn produces consequences in contexts: social, cultural, economic, environmental and political in which it occurs. The disease (not only the mental) is impossible to be located and framed in the purely individual. The degradation of a living system (i.e., disease, aging, etc.) that occurs over time is primarily the result of a breakdown or reduction or dysfunction in the interconnections of its network of relations. Individual health is an expression of sick relationships or connections. Patient is the spokesperson of a sick relational structure (family conflict, social conflict, etc.). Therefore, to make the diagnosis in general medicine is to consider: which relationships are broken or distorted? In whom this situation occurs? At what time, with what sense, in what structure of the personality, what is the function of the symptomatology, in what context, and with what actors? And in this way, the units of analysis of the consultation in general medicine should be the relationships, connections, or “links” between actors. Health problems (bio-psycho-social) can be conceived as a result of the blockage in relational processes (structural, strategic, narrative and construction of the meaning of experience). The treatment is based on the re-learning of patient communication with itself and with others, of an adjustment of significant relationships.

Keywords: General Practice; Family Practice; Framework; Sanitary Attention; Diagnostic Techniques; Symptom Assessment; Biopsychosocial; Ecosystem.