Management and treatment planning
Domain 3 - Management and treatment planning
This domain tests construction of an individualized, evidence-based plan: goals, first-line and alternative therapy, monitoring, follow-up, and deprescribing.
Core rules
- Define the goal - cure, control, or palliation - before choosing treatment.
- Use guidelines as a starting point, then adjust for comorbidity, pregnancy, renal and hepatic function, interactions, and patient preference.
- Prescribe the dose, route, duration, and monitoring plan; a drug without a stop date is an incomplete order.
- Plan for failure: state what will be checked, when, and what the next step is.
- Deprescribe when benefit no longer outweighs treatment burden.
Worked example
A 62-year-old with type 2 diabetes, eGFR 38 mL/min/1.73 m², and albuminuria is taking metformin 1 g twice daily. Metformin should be reduced to a maximum of 1 g/day at this eGFR, and an SGLT2 inhibitor added for renal and cardiovascular protection. An ACE inhibitor or ARB is indicated for albuminuria, with potassium and creatinine checked 1–2 weeks later. Statin therapy continues. The plan includes a BP target, an individualized HbA1c target, and review of NSAID use.
Traps
- Treating the number rather than the patient, such as intensive glycaemic control in frailty.
- Forgetting renal dose adjustment and drug interactions.
- Failing to specify monitoring or follow-up.
- Continuing a drug after its indication has resolved.