Clinical Family Medicine and Primary Care
Domain 1 - Clinical Family Medicine and Primary Care
This domain tests whether you can practise generalist, continuous, patient-centred care for undifferentiated problems in a Sri Lankan primary care setting - divisional hospital, PMCU or general practice - rather than pattern-matching to a specialist diagnosis.
Core principles
- Family medicine is defined by first contact, continuity, comprehensiveness and coordination; the family and community are the unit of care, not the organ system.
- Most presentations are undifferentiated and self-limiting. Pre-test probability is low, so a positive test in primary care carries a far lower post-test probability than the same test in a tertiary clinic.
- Consultation frameworks (Calgary–Cambridge, Pendleton) structure the tasks: initiating the session, gathering information, building the relationship, explanation and planning, and closing with documented safety-netting.
- The biopsychosocial model (Engel) obliges you to screen for somatisation, depression and social determinants before escalating investigation.
Worked example. A 45-year-old teacher reports three months of daily headache; examination is normal. Serious intracranial pathology in primary-care headache has a prevalence near 1%. Even a red-flag set with 80% sensitivity and 80% specificity yields a post-test probability of only about 4% (0.008 ÷ (0.008 + 0.198)). The correct action is to document the absence of SNOOP4 features (Systemic symptoms, Neurological deficit, thunderclap Onset, Older than 50, Pattern change), treat as tension-type headache and review in two to four weeks - not to order immediate imaging.
Traps
- Ordering CT or MRI "to reassure" - low yield and a heavy false-positive burden.
- Missing depression presenting as a somatic complaint.
- No written safety-net instruction ("return immediately if…").
- Antibiotics for viral URTI; failing to check inhaler technique at asthma review.