Explaining symptoms in general practice: a predictive processing framework for primary care consultations

Aims To present predictive processing as a clinically useful framework for explaining symptom variability in general practice consultations.Methods Development of a conceptual framework through an iterative process of theoretical synthesis and clinical translation, informed by a supporting literature search integrating literature on predictive processing and symptom perception with primary care literature on consultation practice and persistent physical symptoms.Results Predictive processing conceptualises symptom perception as an interaction between bodily signals and the brain's prior expectations. Symptoms remain real and potentially disabling even when pathology is stable or minimal. The framework provides a structured approach for consultations: validating patient experiences, explaining symptom persistence, and guiding recovery-oriented management. A worked consultation example illustrates clinical application.Conclusions Predictive processing offers a coherent framework to help general practitioners explain symptoms in primary care. Its limitations, including restricted prescriptive guidance and limited direct trial evidence, are acknowledged. The framework supports patient understanding and guides management focused on gradual recovery.