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Family Issues on the CCFP exam

2 key features, the mistakes that cost marks, and a practice question.

Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.

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What the exam tests

Key features

The CFPC’s 2 key features for Family Issues. Each one below has how the exam asks it, the common mistakes and the approach.

Source: CFPC Assessment Objectives, 2020, p. 100

01Home and illnessHome shapes illness. Illness shapes home.02When to ask againAsk when care that should work fails.

Practice question

Try one before you read

A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.

Key feature 1 · Home and illnessShort menu · Select four

A 34-year-old man comes to your office for a diabetes check between visits to his diabetes clinic. He has had type 1 diabetes since age 12 and takes insulin glargine 28 units at bedtime and insulin aspart 1 unit per 10 g of carbohydrate with meals, and takes no other prescription or over-the-counter medications. His hemoglobin A1c (HbA1c) is 9.8 %, up from 7.3 % a year ago, despite two dose increases by the clinic in the past six months. He says he never misses a dose. His meter holds readings from only two of the last four weeks, mostly 7–12 mmol/L, with three below 4 mmol/L after his weekly hockey game. His father has hypothyroidism. His weight is steady at 80 kg. He says his wife thinks he "just doesn't care anymore."

Before examining him, which of the following are the most important to explore with him to understand why his diabetes control has worsened? Select FOUR.

0 of 4 picked

Key feature 1 of 2

Home and illness

In every patient, learn how home life affects their health, and how their health affects the household.

CFPC skill Patient-centred approachPhase HistorySources Choosing Wisely Canada

On the exam

A teen with type 1 diabetes now lives in two homes. Expect a short menu of questions, then one best plan.

Pick what to ask about each home.

Common mistakes

Screening for celiac or thyroid disease because they cluster with diabetes. Neither explains a meter left blank for whole weeks. Teaching only the parent who copes is wrong too.

Approach

  • Ask who lives at home, and where the patient sleeps each night. With separated parents, ask about each home.
  • Ask who does the care: who gives medicines, checks readings, drives to visits and stays up at night.
  • Ask how the illness is changing the family: money, work, sleep, conflict, a worn-out caregiver.
  • Ask what each person believes about the illness and its treatment. Beliefs at home decide what gets done.
  • Make sure each home has an adult who can handle the emergency. In type 1 diabetes, that means someone trained to treat a severe low.
  • A preschooler with signs of ADHD: ask about stress at home, neglect, abuse or violence. Start with teaching and support for the parents, not medicine.
  • See a teen alone for part of the visit. Some things will not be said in front of a parent.

Key feature 2 of 2

When to ask again

Come back to home life at regular visits, at big life changes, and when sound treatment is not working.

CFPC skill Patient-centred approach, clinical reasoningPhase Hypothesis generation, history

On the exam

A rising A1c after two dose changes, and readings missing for whole weeks. Expect one best answer from a short list.

Pick the question that finds the cause.

Common mistakes

Another A1c, a complication screen, or a third dose change. None finds the cause. Blaming a rebound high after a low is wrong too: lows pull the A1c down.

Approach

  • Ask about home at routine visits, even when all seems well. Things change between visits.
  • Ask at life changes: a new baby, a child leaving home, a separation, a move, a lost job, retirement, a death.
  • When the right treatment fails, ask about home before you add a drug or a test. Think of high blood pressure, diabetes, or pain such as fibromyalgia.
  • Ask about missed doses without blame: “Many people miss doses. How often does it happen for you?”
  • Look for a pattern. Readings missing in one home, or on certain days, point to home life, not a new disease.
  • Test each guess against the pattern. Low mood, or skipping insulin to lose weight, would show in both homes.
When to ask about home
When to ask about home
MomentExamplesWhat to ask
Regular visitsA check-up, a chronic disease reviewWho is at home now? Has anything changed?
Life changesA new baby, a child leaving home, separation, retirement, a deathHow has this changed your days, and who helps?
Treatment not workingBlood pressure, diabetes, fibromyalgia, pills not takenWho gives the medicine? What gets in the way at home?

Flashcards

Answer it first, then check.

  1. KF 1A teen with type 1 diabetes spends every other week at his father's. What do you ask?

    Who gives insulin and checks readings there, and whether an adult there can treat a severe low.

  2. KF 1His father cannot treat a severe low, and the next stay starts Friday. When do you teach him?

    Before Friday. Teach the father himself, not only the mother who already copes.

  3. KF 1A preschooler shows signs of ADHD. What do you ask before any stimulant?

    About stress at home: neglect, abuse or violence. Then start with teaching and support for the parents. Source: Choosing Wisely Canada

  4. KF 1A man looks after his wife, who has dementia. What do you ask him about?

    His own sleep, mood, health and help at home. A worn-out caregiver changes her care too.

  5. KF 2A man's blood pressure stays high on two drugs at good doses. What do you ask first?

    How he takes them, and what is going on at home. Missed doses and stress often explain it.

  6. KF 2Name three life changes that should prompt questions about home.

    Any three: a new baby, a child leaving home, separation, a move, retirement, a death.

  7. KF 2His meter is blank only in his father's weeks. Is it depression?

    Not on its own: low mood usually shows in both homes. Ask what happens at his father's, and still ask about mood.

  8. KF 2Her fibromyalgia pain is not easing with good care. What do you ask about?

    Home: stress, conflict, the care she gives others, and abuse in the past or now.

FAQ

Is there a Canadian guideline for family issues?

No single one covers it. The exam marks a habit: ask about home at regular visits, at big life changes, and whenever sound treatment is not working.

Do I need a genogram or a named family model?

No tool earns marks by itself. Ask who lives at home, who does the care, what has changed, and how the illness affects each person.

How do I ask a teen about home when a parent is in the room?

See the teen alone for part of the visit. Say what stays private and when you must share, such as a risk to safety. Then ask about each home.

Does asking about home mean I stop looking for disease?

No. Test for what the facts point to. But when results fit missed doses, another test rarely helps. Ask about home before you order it.

Sources

Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.

Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.

  1. Assessment Objectives for Certification in Family Medicine, 2nd edition
    College of Family Physicians of Canada · 2020
  2. Choosing Wisely recommendations
    Choosing Wisely Canada

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