Family Medicine
Family medicine tests longitudinal care: screening, immunisation, chronic disease targets, behavioural counselling and the primary-care approach to undifferentiated symptoms.
Screening
- Colorectal cancer: start at 45–50 with colonoscopy or faecal testing.
- Breast cancer: mammography from around 40–50 depending on the guideline, every 1–2 years.
- Cervical cancer: cytology from 21, or HPV testing from 25–30, to age 65.
- Abdominal aortic aneurysm: one ultrasound for men aged 65–75 who have ever smoked.
- Osteoporosis: DEXA for women from 65.
Chronic disease
- Diabetes is diagnosed with HbA1c ≥6.5%, fasting glucose ≥7.0 mmol/L, or 2-hour OGTT ≥11.1 mmol/L.
- Target HbA1c is individualised, commonly around 7% for most non-frail adults.
- Statins are indicated for established cardiovascular disease and for raised 10-year risk.
Behaviour change
Smoking cessation uses the 5 A's: Ask, Advise, Assess, Assist, Arrange.
Worked example
A 52-year-old smoker with a BMI of 33 asks about prevention. Priorities are blood pressure and lipid assessment, fasting glucose or HbA1c, colorectal screening, and a structured smoking-cessation plan with varenicline or nicotine replacement plus follow-up. Vaccination status, including influenza, should also be checked.
Traps
Screening a symptomatic patient instead of investigating their symptoms, over-tightening glycaemic targets in frail elderly patients, and forgetting that confidentiality exceptions apply when there is serious risk to others.