Rudebeck C E
Scand J Prim Health Care Suppl. 1992 Jan;10 Suppl 1:61-82. doi: 10.3109/02813439209014091.
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.
如果全科医疗继续几乎完全诉诸实用主义，那么该专业的官方特征，如全面性，将带来一个无限的议程。这种缺乏明确性也使得全科医疗看起来是可替代的，尤其是在其传统地位薄弱的国家，比如瑞典。然而，大多数从业者仍认为他们专业的贡献是独特的。这种情况提出了一个理论挑战，如果成功应对，可能会确定临床诊疗过程中的关键要素，并阐明全科医疗在医学中的地位。挑战在于理解和识别那种在个体患者与生物医学之间起媒介作用、且不论专业如何都有助于熟练临床医生能力形成的一般临床能力。全科医生比其他任何人都更有条件提炼这种能力，因为没有独特的专业关注点持续分散他对临床医学一般特征的注意力。在分别分析了临床流行病学、“以患者为中心的临床方法”、不同的问题解决策略以及沟通对“一般临床能力”的相关性之后，本文将“一般临床能力”追溯到临床实践中一个相当有限但关键的领域，即对症状表现的理解。通常，这种表现既不是疾病的明确直接产物，而是患者自身身体体验变化的一种个人表达，即“身体体验”。对患者“身体体验”的这种理解，在这里被称为身体共情，往往是把握症状特征所必需的，并且有人认为它是一般临床能力的一个主要组成部分。还有人认为身体共情构成了作为一门学科的全科医疗的基础。
