Preventive Medicine, Screening and Health Promotion
Preventive medicine, screening and health promotion tests screening principles, immunisation, cardiovascular risk, cancer screening, smoking cessation, alcohol and travel advice. The exam asks whether a screening test does more good than harm and whether it is delivered to the right person at the right interval.
Core rules
- Apply Wilson-Jungner criteria: important condition, accepted treatment, suitable test, early detection benefit, acceptable and cost-effective.
- Understand lead-time bias, length bias and overdiagnosis; survival rates can improve without mortality benefit.
- Cardiovascular risk: use a validated risk tool, then treat risk not a single cholesterol value.
- Cancer screening: breast, cervical and colorectal programmes have age and interval criteria; shared decision-making is essential.
- Smoking cessation: combine behavioural support with pharmacotherapy; ask, advise, assist and arrange follow-up.
- Travel: review destination risks, vaccines and malaria prophylaxis.
Worked example
A 50-year-old asks for a check-up. Calculate cardiovascular risk, check BP and weight, confirm cervical and colorectal screening status, and discuss breast screening. Do not order a PSA test without shared decision-making. Reasoning: screening should be targeted and preference-sensitive.
Traps
False reassurance from a normal screen; ignoring overdiagnosis; screening without consent; and missing vaccination catch-up.