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  <head>
    <title>071-01 Mechanistic foundations, classification, normal variation, and clinical presentation</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Primary care foundations and presentation">
      <outline text="Scope of primary care">
        <outline text="Undifferentiated symptoms, prevention, chronic disease"/>
        <outline text="Unit is a person, not a disease episode">
          <outline text="Family, work, community, changing risk"/>
        </outline>
        <outline text="Longitudinal observation shifts probability">
          <outline text="Reveals treatment effects, permits prevention"/>
        </outline>
        <outline text="Familiarity must not become complacency"/>
      </outline>
      <outline text="Continuity as a clinical intervention">
        <outline text="Relational: repeated care by clinician or team"/>
        <outline text="Informational: accurate story across records"/>
        <outline text="Management: plans aligned across professionals"/>
        <outline text="Personal baseline reveals subtle decline">
          <outline text="Values read as trajectories"/>
        </outline>
        <outline text="Time reduces uncertainty if follow-up is reliable"/>
        <outline text="Hazards: anchoring, normalising, weak boundaries">
          <outline text="Periodic diagnostic reset"/>
        </outline>
      </outline>
      <outline text="Biological and social systems">
        <outline text="Disease, illness, sickness"/>
        <outline text="Symptoms from tissue, brain, emotion, context">
          <outline text="Not real versus psychological"/>
        </outline>
        <outline text="Social determinants shape exposure and capacity"/>
        <outline text="Racism and exclusion act via stress and deprivation"/>
        <outline text="Inverse care law">
          <outline text="Unaffordable or unreachable plan is ineffective"/>
        </outline>
      </outline>
      <outline text="Multimorbidity">
        <outline text="Coexisting conditions without an index disease">
          <outline text="Shared causes, tradeoffs, burden, competing risks"/>
        </outline>
        <outline text="Concordant versus discordant conditions"/>
        <outline text="Treatments synergistic, neutral, or antagonistic">
          <outline text="Summed guidelines give impossible regimens"/>
        </outline>
        <outline text="Priority by danger, burden, goals, time to benefit">
          <outline text="Individualisation, not age-based denial"/>
        </outline>
      </outline>
      <outline text="Chronic trajectories and adaptation">
        <outline text="Stable, progressive, relapsing, episodic"/>
        <outline text="Test each flare against alternatives"/>
        <outline text="Self-management capacity varies">
          <outline text="Reduce workload rather than blame non-compliance"/>
        </outline>
        <outline text="Adaptation hides decline">
          <outline text="Ask concrete tasks, compare with prior ability"/>
        </outline>
        <outline text="Response shift alters quality-of-life ratings"/>
      </outline>
      <outline text="Prevention across the life course">
        <outline text="Primordial: change conditions creating risk"/>
        <outline text="Primary: reduce disease onset"/>
        <outline text="Secondary: detect presymptomatic disease"/>
        <outline text="Tertiary: limit complications"/>
        <outline text="Quaternary: reduce harm from unnecessary medicine"/>
        <outline text="Thresholds combine absolute risk, harm, preference">
          <outline text="Higher baseline risk, more absolute benefit"/>
          <outline text="Offset by treatment harm, competing mortality"/>
        </outline>
        <outline text="Avoid framing disease as moral failure"/>
      </outline>
      <outline text="Common presentations by pattern">
        <outline text="Fatigue: broad causes, staged testing">
          <outline text="Untargeted tests yield incidental findings"/>
        </outline>
        <outline text="Persistent unexplained symptoms">
          <outline text="Positive formulation and rehabilitation goals"/>
          <outline text="Repeated tests raise fear and iatrogenic harm"/>
        </outline>
        <outline text="Usually benign, occasionally catastrophic">
          <outline text="Red flags have low specificity, combine them"/>
        </outline>
        <outline text="Mental and physical disease coexist">
          <outline text="Neither psychologise nor ignore emotion"/>
        </outline>
      </outline>
      <outline text="Family and community context">
        <outline text="Family history: genetic and shared risk"/>
        <outline text="Household shapes diet, infection, safety">
          <outline text="Preserve confidentiality and autonomy"/>
        </outline>
        <outline text="Community epidemiology changes probability">
          <outline text="Detect clusters, link to public health"/>
        </outline>
        <outline text="Commercial determinants shape exposure">
          <outline text="Regulation, taxation, safer defaults"/>
        </outline>
        <outline text="Health literacy is relational">
          <outline text="Plain language, teach-back, interpreters"/>
        </outline>
      </outline>
      <outline text="Watchful waiting without neglect">
        <outline text="Active management with planned review">
          <outline text="Working diagnosis, warning signs, relief"/>
        </outline>
        <outline text="Safe when probability low, follow-up dependable"/>
        <outline text="Unsafe if rapid deterioration or no return"/>
        <outline text="Continuity needs curiosity, access, accountability"/>
      </outline>
    </outline>
  </body>
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