Family Medicine
Family Medicine
Family Medicine tests whole-person care across the life course: the consultation, continuity, family systems, and community-oriented primary care. The exam favours scenarios where biomedical and psychosocial factors interact.
Core rules and concepts
- Consultation frameworks: Calgary-Cambridge (initiating, gathering, physical examination, explanation, closing); Neighbour's five checkpoints (connecting, summarising, handing over, safety netting, housekeeping).
- Biopsychosocial model: biological, psychological, and social dimensions must all be explored.
- Family life cycle stages (Carter and McGoldrick): leaving home, joining families, young children, adolescents, launching, later life.
- Genogram symbols: square male, circle female, horizontal line marriage, vertical line descent, double line consanguinity.
- Continuity, coordination, comprehensiveness, and first-contact access are defining features.
Worked example
A 45-year-old woman presents with 6 months of recurrent headaches. Neurological examination is normal. She has recently taken on care of her mother with dementia, and her son has failed school exams. Rather than label somatisation, use FIFE (Feelings, Ideas, Function, Expectations) and a genogram. The formulation links headache to stress and sleep disruption while keeping red flags (new onset after 50, thunderclap headache, focal signs) in view. Management includes analgesia review, sleep hygiene, and planned follow-up-not immediate neuroimaging.
Traps
- Anchoring on a biomedical diagnosis and missing depression or domestic violence.
- Ordering imaging before red-flag assessment.
- Confusing family medicine with family therapy: the former uses family information, the latter is a formal therapy.
- Losing continuity by referring without a plan.