Facharzt Allgemeinmedizin common mistakes
Facharzt Allgemeinmedizin · Understand the traps and how to avoid them.
When a patient presents with undifferentiated fatigue or dizziness, the candidate jumps straight to a single-organ workup (e.g., orders a full cardiac or thyroid panel) and never articulates a structured problem list or safety-netting plan.
Exam habit from inpatient training: candidates are used to being rewarded for exhaustive diagnostic lists and treat primary care vignettes as diagnostic puzzles rather than as longitudinal management problems. They also fear omitting a test more than they fear over-investigating.
What to do instead
Practise a fixed primary-care script for undifferentiated symptoms: red-flag screen, focused history and exam, targeted baseline tests, explicit working problem list, and a written safety-net with named triggers and review interval. Rehearse stating the review interval and the return-precautions out loud in every such case.
The candidate manages each chronic condition in isolation, adjusting diabetes, hypertension and COPD in separate silos, while ignoring the interaction of the resulting medications and the patient's renal function and falls risk.
Guidelines are learned condition by condition, and candidates reproduce single-disease algorithms because those are easier to recall than prioritisation across diseases. Multimorbidity requires weighing competing goals, which is harder to verbalise under time pressure.
What to do instead
For every multimorbidity vignette, produce an explicit prioritised problem list with one agreed treatment goal per problem, check the cumulative regimen against renal function and anticholinergic/sedative burden, and name what is being deliberately not intensified and why. State shared decision-making with the patient explicitly.
The candidate screens for polypharmacy only by counting medications and listing interactions, without applying a structured tool, without a falls/cognition assessment, and without a deprescribing plan with monitoring.
Candidates confuse 'knowing the drug list' with 'doing a medication review'. The geriatric syndromes (falls, delirium, orthostasis, incontinence) are often treated as separate items rather than as consequences of the regimen.
What to do instead
Run a standard sequence in every elderly vignette: complete medication list including OTC and supplements, indication check per drug, anticholinergic and sedative burden, renal/hepatic dose check, then a written deprescribing proposal with a monitoring plan and a review date. Link each geriatric syndrome to the drugs that plausibly cause it.
The candidate answers a vaccination or screening question with a bare age-based rule and omits the individual risk assessment, the contraindication check, and the documentation or catch-up logic.
Vaccination schedules are memorised as tables and then recalled as a single trigger age. Candidates underuse the concept of risk-group indications and forget that an incomplete history is itself a reason to defer and check rather than to proceed.
What to do instead
Build an answer template for immunisation and screening items: indication (age plus risk group), contraindications and precautions, catch-up or interval logic, and documentation/reminder. Practise stating explicitly which information you would verify before administering.
The candidate treats a psychosomatic or depressive presentation as either purely organic or purely psychological, ordering full somatic workup without addressing the mental health, or dismissing the somatic complaint without a physical examination.
Candidates fear missing organic disease and therefore over-investigate, or they over-identify with the psychological framing and skip the exam. The primary care skill of parallel somatic and psychosocial assessment is rarely practised in exam preparation.
What to do instead
Use a dual-track answer: describe the focused physical assessment and the simultaneous psychosocial screen (e.g., mood, sleep, function, substance use, social context), then state how findings in each track would change the plan. Explicitly name a review interval and a symptom-contingent safety net.
During a consultation-skills station the candidate delivers information as a monologue, does not check understanding, does not elicit the patient's preferences, and never summarises or agrees a next step.
Candidates optimise for covering content and fear silence; they also mistake 'informing the patient' for shared decision-making. Under time pressure, the closing summary is the first element dropped.
What to do instead
Rehearse a fixed structure: agenda setting, chunked information with teach-back, explicit preference elicitation, then a summarised agreed plan with follow-up. Practise with a timer so the closing summary is protected rather than sacrificed.
In an emergency scenario the candidate starts a diagnostic discussion or orders tests before securing airway, breathing, circulation, calling for help, and assigning roles.
The clinical-reasoning reflex dominates under stress, and candidates have often rehearsed resuscitation as a knowledge topic (drug doses, algorithms) rather than as a team-leadership sequence with explicit role allocation and closed-loop communication.
What to do instead
Rehearse every acute scenario with a fixed opening: safety, ABCDE, call for help and assign named roles, then reversible causes. Practise declaring 'I am the team leader' and giving closed-loop instructions aloud until it becomes automatic.
The candidate describes referral or rescue coordination vaguely ('refer to hospital', 'call an ambulance') without specifying urgency, the information to hand over, the receiving destination, or what is done for the patient while waiting.
Referral is treated as a disposition rather than a communication task. Candidates rarely practise structured handover formats and underestimate how much of the mark depends on the content and completeness of the transfer.
What to do instead
Use a structured handover (situation, background, assessment, recommendation) in every referral answer, state the urgency category and destination capability (e.g., stroke unit, catheter lab), and name the interim management and monitoring during transfer.
The candidate answers questions on incapacity certification, billing or quality management with general principles and never names the concrete legal criteria, the documentation required, or the boundary of the physician's role.
These topics are perceived as administrative and are under-rehearsed relative to clinical content, so candidates fall back on vague statements. The legal framework is also jurisdiction-specific, which makes candidates avoid committing to details.
What to do instead
Learn the statutory criteria and documentation requirements of your jurisdiction as a checklist (assessment basis, duration, expected recovery, work demands versus functional capacity, conflict-of-interest rules). Practise writing a short certificate-style justification and a quality-circle/audit description in exam format.
The candidate applies adult dosing, adult reference ranges or adult red-flag thresholds to a paediatric, pregnant or elderly patient, or performs an age-inappropriate examination sequence without explaining the approach to the child or parent.
Adult internal medicine dominates study time, and age-specific norms are recalled imprecisely. Candidates also forget that communication with child and caregiver is part of the assessed competence, not a preliminary.
What to do instead
Maintain a one-page age-band reference for weight-based dosing, normal ranges and red flags in neonates, infants, children, pregnancy and the very old, and rehearse the paediatric consultation structure (address the child, obtain history from the caregiver, explain the examination) as an explicit scored step.