Mode of Action of Competent General Doctors: The Toolkit Concept

Clinical decision making strategies of general practitioners (GPs) must be made regard to the whole range of problems encountered in everyday work (biopsychosocial). So, GPs must integrate large amount of complex information to obtain a relatively simple result. Further, the limited time allotted for each consultation requires rapid actions. What do GPs use to focus on the breadth of the clinic? How do they manage to find in the vast, varied and complex clinic, without apparent reference points, such concrete and small data? Clinical problems managing puts high demands on GPs that have to using a variety of clinical decision-making strategies. Quality of decision making in modern health care is defined with reference to evidence-based medicine (MBE). But, there is concerns that this approach is insufficient for GPs. Actually, the GP uses many more techniques more frequently (qualitative strategies) than MBE, and many of them are specific to him: this is the GP ‘toolkit: 1) Contextualization; 2) Continuity of Care; 3) Doctor-patient relationship; 4) Strategic planning; 5) Use of patient and doctor resources and strengths; 6) The self-esteem, self-capacity, and self-efficacy of patient and doctor; 7) The emotion; 8) The intuition; 9) Ethics; 10) Participation of patients and communities; 11) Ecological and network relationships; 12) Focus on the process instead of the result; 13) The clinical interview and the narration; and 14) The family. The lack of understanding of the non-clinical variables can cause a suboptimal approach in the care of the patients. A true EBM cannot be carried out without the recognition and incorporation of these qualitative variables (the general doctor’ toolkit), that modify clinical decision making in general medicine. As the GP of novel “Anna Karenina“, by Leo Tolstoy, “with a subtle smile” says: “you know, there are always moral, spiritual causes at the back in these cases.”

Keywords: General Practice; Clinical practice; Health Care; Diagnosis; Clinical reasoning; Medical Decision-Making; Medical Expertise; Doctor-Patient Communication; Workplace Learning; Evidence-Based Medicine; Continuity of Patient Care; Ethical Decision-Making.