Table 1 By making three basic judgments, the GP frames the problem in professional terms. Their choice of frame reflects how their attention is called to different morally relevant aspects of the situation

Intervene

The patient is my first concern

I must cultivate those skills and relationships that I need to understand and address their problems

I speak frankly and clearly

I must say what needs to be said to effect positive change, even when doing so feels awkward

I apply myself with discretion

I must concern myself with and only with the most pressing issues, switching focus if and only if necessary

I demand a better work environment

I must refuse to carry out tasks that do not require my skills, and demand to be assisted with those that I struggle with

Stay my hand

I stand back and observe when there is time

I must not rush in or do anything in vain, but listen intently and weigh my words carefully

I refuse to do harm

I must object to interventions that would cause disproportionate harm or incur unacceptable risks

I enjoy being good enough

I must maintain a self-image that does not depend on the approval of others, celebrate my triumphs and refrain from destructive self-critique

I uphold the integrity of my profession

I must protect general practice against undue expansion, rejecting responsibilities that would require me to quack