Dodici suggerimenti per una buona consultazione medica nelle cure primarie

Background. The recent pandemic has brought into sharper focus the need, long emphasised in the scientific literature, for a change in primary care that goes beyond the limits of the hyper-specialisation constitutive of Western health systems. While the direction of the cultural and organisational change that needs to be developed is well outlined, little is written about the competencies and values that physicians must acquire in order to shape a new and coherent organisation of services. The patient encounter is the frame in which these competencies take shape, and it is from this perspective that these competencies are examined here. Objectives: The aim of this narrative review of empirical studies and the multisciplinary literature is to provide primary care physicians with some tips for a good management of the medical consultation. These tips outline the competencies needed in general practice, rethought within the paradigm of complexity of care. Results: The concepts, practices and values on which the 12 tips are based are: a) an attitude of attention to the complexity of care in which the patient's subjectivity can only be understood through an encounter with one's own subjectivity; b) the peculiar method of clinical reasoning in general practice, which includes the early generation of diagnostic hypotheses to be verified using simple and inexpensive tests, such as history taking and physical examination; these tests should have a high negative predictive value to rule out more serious conditions; c) the contextualisation of the working diagnosis (opposed to a definitive diagnosis) as a tool for dealing with complexity; d) the analysis of the evolution of scenarios as a tool for planning and choosing courses of action; e) the assessment of uncertainty in addition to that of measurable risk; f) the involvement of the patient and the use of the test of time as tools for managing uncertainty; g) the centrality of sharing the decision with the patient.