This "Occasional Paper" outlines an approach to decision-making in general practice based on Aristotelian practical reasoning. It adds a new dimension to the theoretical basis of good general practice and complements the work of Toon, Marinker, McWhinney, and others at a time of rapid change in helping to define what is the distinctive nature of our discipline.The paper covers literature relating to philosophy and the recent literature concerning the decision-making process in relation to the many and varied complex human interactions that take place in the general practice consultation. It is a watershed in thinking at a time of further proposed modernisation in primary care and the importance of the general practitioner as a personal doctor, ensuring continuity of care, acting as the patient's advocate as well as the gatekeeper in an NHS which is being restructured. The introduction offers a brief summary of the arguments. Chapter one is a short account of general practice in the UK since 1950, focussing on ideas about the discipline from Collings to McWhinney.
Chapter two starts with a discussion of Aristotle's ethics, and briefly discusses utilitarianism and deontology, the dominant normative ethical theories of our time in bioethics. It continues with an exploration of a modern conception of phronesis or practical reasoning based on situational appreciation, the capacity of the virtuous person to respond appropriately to a particular situation, and includes the use of the emotions and imagination. Chapter three discusses how this approach might be of value in making decisions with patients in the consultation. It attempts to make clear the connections between current ideas about general practice and the practical reasoning approach - the practice of perception.