From Management to Symbiosis: A Five-Layered Model of Negative Capability in Primary Care

Modern medicine has traditionally emphasised certainty, which may contribute to intolerance of uncertainty, physician burnout, and premature diagnostic closure. In recent years, the concept of 'Negative Capability' (NC) has emerged as a novel perspective to address this challenge.

This study aimed to explore the perspectives of general practitioners (GPs) on the multi-layered roles of NC across individual cognition, the physician-patient relationship, and team dynamics, thereby developing a conceptual framework for clinical practice.

We conducted a qualitative study using a hermeneutic phenomenological approach in Japan. Focus group interviews were held with a total of 12 participant-sessions (comprising 11 unique general practitioners and an academic philosopher specialising in NC, including one clinician who participated iteratively across sessions to enrich data depth). The verbatim data were analysed manually using the Steps for Coding and Theorisation (SCAT) method, ensuring credibility through continuous peer debriefing and member checking.

Clinical NC was conceptualised as five interconnected layers: (1) structural limitations of the medical paradigm, (2) individual transformation, (3) cultivation within a secure base, (4) joint engagement with uncertainty, and (5) inheritance of clinical philosophy. NC functions as an internal 'mental cane' for physicians, supporting a shift from managing uncertainty to remaining with it.

This perspective reframes clinical uncertainty from an individual cognitive burden to a shared relational space, alleviating the pressure to prematurely resolve it. This multi-layered approach provides a sustainable philosophy for primary care, supporting clinician well-being and helping clinicians move from rapid resolution towards more meaningful engagement with patients by relational care in complex clinical environments.