[The psychosomatic approach in general medicine].

When the general practitioner is convinced that a somatic symptom covers a psychosomatic problem, he may choose one of two strategies. The first is to minimize it on the grounds of possible subsequent change or to spare a vital compromise (duty of reservation). The second is to ignore the request in order to offer the possibility of implementing his therapeutic conviction. In this strategic choice, the doctor's authority as a "trustee" is pitted, in practice, against the inconsistent and irresolute nature of the request, and the shortcomings of the institution or socioeconomic level. Strangely enough, psychologising information may jeopardize the therapeutic commitment. The higher the cultural level, the greater the deviation, especially in depression. Observations from everyday practice in urban centers exemplify the variety of these approaches.