Imagination and empathy in the consultation.

C self-fulfilment is a basic human need. Imagination is the power of the mind to find meaning and coherence in the world, and to create new meaning where it is not immediately given.1 Imagination makes me move beyond myself, in time and in space. It makes it possible for me to play with alternatives. Imagination is not magic, creating anything out of nothing. It is informed, based on the continuous learning process that life is. Even fantasy has its reference in reality. What is the importance of imagination in general practice? My non-scientific impression is that most GPs are much involved in their work. The spirit my colleagues mediate contradicts the supposition that they spend their working hours first and foremost reproducing evidence-based knowledge. They make a personal investment, they experience many efforts, but they get much in return. To me, such an experience would not be possible unless they challenged their imagination and creative potential. To understand general practice it is not enough to start from the patients’ needs. The force that makes GPs go to their surgeries morning after morning, year after year, passing by the crowded waiting room, where everything may seem exactly as usual, cannot be purely altruistic. I think they feel the urge to see more, and to learn more, to feel the joy of maintaining the art of general practice. There is an aesthetic dimension in doing a good job, the sense of which is perhaps the most reliable personal assessment and the most endurable drive to keep going. Imagination in general practice is about finding out the meaning in what patients experience and present and about making the doctor–patient relationship a creative alliance, where the possibilities outweigh the imperatives. It is the very nerve of competence. In this essay I will explore two ways it may act.