Le competenze distintive metodologiche e relazionali del medico di medicina generale nelle cure primarie

In this article, we examine three out of the seven distinctive values of General practice/family medicine (Gpfm), as proposed by World Organization of Family Doctors (Wonca) and recently translated into Italian: patient-centered care, continuity of care, and evidence-based care. We believe that these values can contribute to the ongoing debate on the reorganization of the primary care model and the reform of the core curriculum of Italian Gpfm. These three values are the basis of the distinctive methodological and relational competencies of Gpfm. In this contribution, we analyze them through the lens of epistemology of complexity, aiming to highlight the unique aspects of this method and relationship, thus identifying the necessary competencies for Gpfm. The thought and method of care - the first and third values - are analyzed considering that the framework in which Gpfm operates leads to significant modifications of the clinical method. While it certainly encompasses elements of the traditional clinical method, they are executed at different paces and with different objectives, employing distinct strategies. For instance, the epidemiological context with a high prevalence of symptomatic distress but low prevalence of "true" disease needs the early generation of diagnostic hypotheses. These hypotheses are then tested using verbal and physical examinations as exclusion tests with high predictive power. The aim is to arrive at diagnoses that are not exhaustive, yet operational and contextualized. Furthermore, the uncertainty inherent in Gpfm requires the utilization of contextual knowledge related to the patient's environment, negotiation with the patient about the tolerable threshold of decisional uncertainty, their involvement - which increases with greater uncertainty - and the use of the test of time within an organizational and relational protective network. Complex thinking enables reflection on the second value - the relationship - by assigning the physician's subjectivity a place as precious as that of the patient, which is already historically established. Thus, both the physician and patient, as subjects, exist on the same ontological plane but differ methodologically due to their distinct roles. Adopting an epistemology of complexity in Gpfm allows each variable of the system - subjects, context, method, clinical aspects - to regain significance. This approach favours a genuine science in service of humanity.