Family Medicine and Primary Care
Core concepts
Primary care questions test prevention, chronic disease control, and safe decisions in undifferentiated illness. Know screening schedules (cervical, breast, colorectal, hypertension, diabetes, lipids, depression), vaccination, contraception and preconception care, and the management of hypertension, type 2 diabetes, asthma/COPD and dyslipidaemia. Understand multimorbidity and polypharmacy: review every medicine for indication, dose, interaction and anticholinergic burden.
Traps
- Screening intervals and ages: over-screening low-risk patients and under-screening high-risk ones.
- One raised clinic blood pressure is not hypertension; confirm with repeated readings or home/ambulatory monitoring.
- Prescribing antibiotics for acute bronchitis or upper respiratory infection, which are usually viral.
- Anchoring on a single diagnosis in fatigue or weight loss; red flags such as night sweats, bleeding, weight loss or focal neurology warrant investigation.
- Missing drug causes of symptoms: ACE inhibitor cough, beta-blocker fatigue, statin myalgia, NSAID-related hypertension.
- Forgetting vaccine status and cancer screening in patients with chronic disease.
Worked example
A 56-year-old man attends for a routine review. He smokes, has BMI 31, BP 148/92 on two visits, HbA1c 6.3%, and no symptoms. Confirm hypertension with home readings, offer lifestyle advice, calculate 10-year cardiovascular risk, start a statin if risk is high, arrange colorectal cancer screening and influenza vaccination, and discuss smoking cessation with pharmacotherapy. Do not label him diabetic on HbA1c alone: 6.3% is prediabetes.
Rule of thumb
In primary care, ask three questions together: what is the most likely diagnosis, what serious diagnosis must I exclude, and what does this patient want? Then act on all three.