Community medicine from the point of view of the general practitioner: “Never plump your foot straight into your shoe in the morning"

Abstract

This article aims to reflect and show the changes that community medicine has to be applied from general medicine. The basic concepts of general medicine / family medicine print important special and differential features to the tasks and tools of community medicine, and these have not been sufficiently conceptualized, systematized and highlighted. The three key elements of general medicine, which are the clinical interview, continuity of care and attention to context, have fundamental implications in relation to community medicine. So, on the one hand, the "classic" concepts of community medicine as epidemiology, biostatistics, social medicine, planning, health education, and health promotion, suffer changes and modifications when understood and applied from general medicine; for example, regarding the knowledge of the prevalence and incidence based on the consultations, knowledge of the natural history of a disease, the screening becomes "case finding", the importance of work on small geographic bases increases, as well as Bayesian probability, and concept of "opportunistic prevention" appears. On the other hand, the concept of "community" is modified and replaced by "context"; The practice of community medicine in general medicine is "contextual medicine", which means sharing and empowerment in the connections in the relational matrix of the patient, and this may favor contextual empowerment, that is to say the increase of individual capacity among people who participate in a group action that brings about a consequence about some kind of resources or control of the decision-making process. In conclusion, general practitioner should not apply the concepts of community medicine as person who "plump the foot straight into shoe in the morning", in an unspecified or unreflective manner, as he may be risking finding a "centipede inside" and losing the advantages offered by general medicine.