Family Medicine and Primary Care: Continuity, Complexity, and Stewardship
Priority concepts
Primary care questions test breadth, prioritisation, and long-term relationship management rather than rare diagnoses. Expect multimorbidity, polypharmacy review, screening and immunisation, mental health in the consulting room, musculoskeletal complaints, and antibiotic stewardship. Learn the criteria that make a screening test worthwhile: an important condition, an acceptable test, an accepted treatment, and evidence that earlier detection improves outcomes.
Common presentations have well-defined red flags. Low back pain needs imaging and referral only with features such as age over 50 with new pain, trauma, weight loss, fever, night pain, neurological deficit, or sphincter disturbance. Headache needs escalation with sudden onset, fever and neck stiffness, focal signs, or a change in a known pattern.
Traps
Questions often test whether you resist an unnecessary test or prescription. A normal examination is not a reason to order imaging. Antibiotics for an upper respiratory infection are the classic wrong answer. Equally, watch for the opposite trap: a reassuring label such as 'muscular pain' applied despite red flags.
Worked example
A 58-year-old smoker with a 25 pack-year history asks about lung cancer screening. Using typical criteria (age 50 to 80, at least 20 pack-years, current smoker or quit within 15 years), low-dose computed tomography is indicated and should be discussed with shared decision-making - not a chest radiograph.
Rule of thumb
Motivational interviewing beats advice-giving: use open questions, affirmations, reflections, and summaries, and explore ambivalence before planning. Before ordering any test, ask how the result would change what you do next; if it would not, do not order it.