Salience as an Integrative Process in Symptom Formation: A Conceptual Analysis for Generalist Practice.

BACKGROUND: Clinicians in generalist practice frequently encounter symptoms that fluctuate across bodily, interpersonal and situational contexts, often without corresponding changes in identifiable structural pathology. Existing frameworks, such as the biopsychosocial model and the patient-centred clinical method, have broadened the understanding of symptom experience, but they do not fully describe how bodily signals, subjective experience, attention and context are integrated into symptom perception. AIMS: To propose salience as an interpretive process integrating bodily signals, attention and contextual meaning for understanding symptom formation and fluctuation in generalist practice. DESIGN AND SETTING: A practice-informed conceptual analysis situated within generalist outpatient care. METHODS: This paper develops a conceptual framework through interpretive integration of selected concepts from generalist practice, interoception, predictive processing, narrative medicine and symptom perception research. The analysis was informed by longitudinal clinical experience in community-based outpatient generalist practice, not by a formal observational data set. A clinical vignette is used as an illustrative analytic example. RESULTS: Salience is conceptualized as the dynamic process through which certain bodily signals acquire experiential and clinical prominence within specific attentional, interpersonal and contextual conditions. The framework describes symptom formation as a process in which bodily signals become foregrounded through salience allocation, rather than as direct reflections of pathophysiological intensity alone. CONCLUSION: The salience framework may help clinicians understand fluctuating and context-dependent symptoms by linking bodily signals, subjective experience, narrative context and clinical intervention.