Is Specialization compromising the Core Competencies of a family doctor?

Primary Health Care is essential to sustainable health systems, and Family Medicine is its central provider. Defined by WONCA Europe as both a clinical specialty and an academic discipline, it is guided by universal principles despite national variations. The Wonca Tree illustrates this framework by linking the specialty’s six core competencies to twelve key attributes.This…

When the Story Behind the Symptoms Emerges

Patiens in general practice often present a challenge, especially when their concerns do not align with identifiable biomedical causes. Psychosocial and family-related factors may play an invisible significant role in their behaviour when seeking consultations, This practice-based case explores how structured family assessment tools can uncover hidden determinants of health and reshape the physician’s understanding…

Compassion in the Clinical Interview: The Key to Meaningful Care

A 48-year-old man came very often to the clinic requesting high-dose benzodiazepines for anxiety and insomnia. He showed clear signs of dependence and initially behaved in a rude, evasive, and verbally aggressive way, making it difficult to assess issues beyond his physical symptoms.Despite his rude behavior, I stayed calm and tried to understand his distress…

Family-Centred Approaches to Familial Dyslipidaemia in General Practice: A Narrative Literature Review

Familial dyslipidaemia is a significant cause of premature cardiovascular disease but remains frequently underdiagnosed in general practice. The principles of family medicine, including continuity, holistic care, and attention to family systems, create favourable conditions for early recognition of hereditary lipid disorders. Understanding family structures, shared behaviours, and intergenerational patterns enhances risk identification. The genogram, in…

Embedding CAREMELO-Driven Digital Engagement to Transform Long-Term Condition Management and Reduce Rural Health Inequalities in Primary Care Across England

This work applies the CAREMELO principles to strengthen digital, person-centred long-term condition care in a rural English practice. Co-design with patients ensured that digital questionnaires, monitoring tools, and educational modules reflected local needs and priorities. Relevance was embedded through tailoring content to common multimorbidity profiles—including diabetes, hypertension, COPD, asthma and cardiovascular disease—while empowering patients to…

Acral fibrokeratoma: recognizing a rare but treatable skin lesion

Dermatological conditions are common in general practice and can present diagnostic challenges. Acral fibrokeratoma is a rare, benign, slow-growing tumour, usually hyperkeratotic, affecting extremities such as fingers, toes, or nails. Although uncommon, it should be considered in differential diagnoses of acral lesions. Diagnosis is histological and treatment requires complete excision. (1)A 61-year-old previously healthy woman…

Looking for the culprit, a case of hard “detective work” to reach the correct diagnosis

Case report of an unusual cause of severe hypocalcemiaData extracted from patient´s elctronic medical records. 64-year-old male patient, smoker, diagnosed with high blood pressure(HBP), rheumatoid arthritis(RA), hiperuricemia, gastroesophageal reflux disease(GERD), on chronic treatment with olmesartan/hydrochlorotiazide 40/12,5mg, lorazepam 1mg, methotrexate 15mg, adalimumab, paracetamole/tramadol 650/75mg and omeprazole 40mg, sometimes prednisone added for acute pain. Followed-up by rheumatologyst…

Catching Our Breath: A Simple Plan to Improve Pneumococcal Vaccination in COPD

Pneumococcal vaccination is essential for preventing pneumonia and reducing exacerbations in patients with Chronic Obstructive Pulmonary Disease (COPD), a particularly vulnerable group and a priority according to national and international guidelines. At USF do Arco, pneumococcal vaccination coverage was found to be below recommended levels, prompting the development of an intervention project aimed at improving…

From a Simple Urine Dipstick to Complex Diagnoses: The Power of a Tiny Test

A 70-year-old man with no relevant medical history appear  with legs edema coinciding with the onset of warm seasonal temperatures.  While initially evaluating for peripheral venous insufficiency, a rapid urine test was performed.The urine test showed significant proteinuria, leading to urgent labs that confirmed nephrotic-range proteinuria, hipoalbuminuria, hyperlipidemia and high triglycerides. A kidney biopsy was…