Contextual treatment: a conceptualization and systematization from general medicine

Abstract

Family doctors do not treat illnesses but rather care for people in their contexts. And so, an important characteristic of family medicine is that you cannot separate the individual from its context, or the physical from the psychic. General / family medicine is context-oriented. Illness is a relational concept. It is related to contexts; appears between the person and their relationships with the contexts; it does not exist isolated from the contexts. The real object of the work of general practitioner is the "landscape context" formed by the living bodies of the people in a meaningful relationship with others. Contextual landscapes do not exist in isolation. Contexts are "open" systems. The importance of the context is dependent on the phenomenon of interest. Understanding the diseased body in its contextual referents changes the focus of the therapeutic procedures. The clinic emerges -it is perceived by the clinicianwithin its "landscape context" that qualifies the reality presented by the patient. From that moment on, there are a number of clinical strategies to manage the uncertainty of decision making focused on the context. In this scenario, a range of methodological approaches of contextual treatment are presented: 1.-The consultation relational context; 2.-The therapeutic contexts; 3.-Mental landscapes; imagining contexts; 4.-Artistic creation; 5.-Expand or concentrate time; 6.-Be aware of the ecological impact of decisions in the individual patient; 7.-Treatments or reordering situations; 8.-The constructivist treatment; 9.-The concept of cure or resolution; 10.-Treatments that favour internality; 11.-Favor the human factor; 12.-The treatment of the disease in someone other than the one who has the disease-treatment as a dyadic (at least) intervention; 13.-Changes in the external environment; and 14.-Changes in the "micro" context (the environment close to the patient). The magnitude of a health problem in general medicine is a function of scale. Increase the size of the context to be considered in a given case, in which the organism under investigation perceives and responds to the environment, will generally decrease the severity of this problem. In general, the larger the contextual landscape relative to size of the health problem/ patient, more likely will be that medical interventions have positive effects on the individual patient. The "relevant treatment" is a concept always applied to the context: an intervention is relevant in an environment if it gives rise to contextual effects.

Drug Prescription Modifies the Doctor-Patient Relationship in General Medicine

“…It has been reported that this therapeutic context induces biomedical processes in the patient's brain that may enhance or reduce the effects of chosen interventions. The context thus works as a drug, with real effects and side effects [7], and we must remember that, the nocebo-placebo effect is also included here [8,9].…”

The Biopsychosocial Approach Gives Relevance to General Medicine as a Tool of Public Health

“…Therefore, the family and the context must be taken into account as essential elements for the treatment (hygienic measures, diets, taking drugs, exercise or rest, etc.) (17,(28)(29)(30)(31)(32).…”

A Conceptual Framework about Interstitial Space between the Bio-Psycho-Social Structures in Medicine General

“…Here, general practitioner works by occupying the interstices of daily life, and he uses a series of specific tools specific to the specialty of general medicine to work from these "interstices" between biological, psychological and social structures [30]. Table 2 presents a conceptual approach to systematization of these tools and technologies [19,20,22,[31][32][33][34][35][36][37][38][39].…”