What is general clinical competence? Facing the theoretical challenge to general practice

Abstract

If general practice keeps on resorting almost totally to pragmatism, official features of the profession, such as comprehensiveness, will invite a limitless agenda. This lack of specificity also makes general practice seem replaceable, especially in countries where its traditional position is weak, as in Sweden. Still the majority of practitioners regard the contribution of their profession as specific. This situation offers a theoretical challenge, which if successfully answered could lead to the identification of crucial items of the clinical encounter and to the clarification of the position of general practice in medicine.

The challenge lies in understanding and identifying that general clinical competence which mediates between the individual patient and biomedicine and which contributes to the competence of the skilful clinician irrespective of specialisation. The general practitioner is better placed than anybody else to refine that competence, as no distinct professional focus continuously distracts him from the general features of clinical medicine.

After having analysed the relevance for "general clinical competence" of clinical epidemiology, of the "patient-centred clinical method ", of different problem-solving strategies and of communication respectively, this paper traces "general clinical competence" to a rather restricted but crucial area of clinical practice, which deals with the understanding of the symptom presentation. Usually this presentation is neither a clear-cut nor a direct offspring of disease but a personal communication of a change within the experience of the own body, "the lived-body". This understanding of the "lived-body" of the patient, which is here called bodily empathy, is often necessary to grasp the character of a symptom, and it is suggested that it is a major constituent of general clinical competence. It is also suggested that bodily empathy constitutes the basis of general practice as a discipline.