How to Master Red Flags in MSK and Impress Any FCP Interview Panel

One of the most common questions I get from clinicians preparing for First Contact Practitioner (FCP) interviews is this:

“How do I perfect my red flag screening so I stand out in the interview?”

Honestly, the answer is simple, but it also requires a shift in mindset.

What Are Clinical Red Flags?

Clinical red flags are signs and symptoms that may point to a serious, potentially life-threatening condition masquerading as an MSK issue. These are not conditions you treat but rather, they are conditions you must spot and refer.

Definition:
Clinical red flags are warning signs that suggest a serious underlying pathology, such as cancer, infection, fracture, or neurological compromise. They indicate that the patient may not be suitable for MSK treatment and requires urgent medical referral.

As an MSK clinician or FCP, your job is not to diagnose conditions like cervical myelopathy or spinal infections in clinic. Your job is to recognise the signs, suspect that something sinister might be going on, and refer accordingly. That is your strength.

Step 1: Know Your Role

Understanding your role is the first step to mastering red flag screening.

As a traditional MSK clinician: Your goal is to treat. You help patients improve using exercise, manual therapy, education, and support.

As an FCP: Your job is not to treat first. It is to screen and triage. You need to make sure that what the patient is presenting with is an MSK issue and nothing more.

Your number one priority is patient safety.

Step 2: Stop Trying to Diagnose

This is where many clinicians I have spoken to mess up. You are not in the clinic to diagnose red flag conditions. You are not going to diagnose cancer or meningitis. That is not your lane.

Instead, your job is to spot signs that make you think:

“Hmm, this could be something more serious.”

And when you have that doubt, you escalate or refer. That is how you protect your patient. That is how you protect your practice.

Step 3: Use a Framework

You cannot rely on memory alone. Frameworks help you stay sharp, especially in busy clinics or high-pressure interviews.

Personally, I use:

• TUNA-FISH – a general red flag mnemonic

• CANCER SPINE – a cervical-specific red flag checklist

• PAIN SOAP+J – a subjective assessment blueprint I developed to structure my clinical reasoning (you can grab the full blueprint in my e-book here: https://selar.com/t82615

These tools keep your thinking organised and ensure you do not miss something important.

Step 4: Learn to Interpret Symptoms

It is not enough to ask the right questions—you need to know what the answers mean.

• “My hands feel clumsy.” → Could indicate spinal cord compression.

• “Pain is worse at rest.” → Could point to cancer or infection.

• “It throbs all the time.” → Might suggest a vascular cause.

• “It shoots down when I cough.” → Could be nerve root involvement.

Interpretation is what sets apart a good clinician from a great one.

Step 5: Think Beyond MSK

This was exactly my interviewer told me in 2022 when I had my first interview for an FCP role. Too many of us are locked into an MSK-only mindset. Someone walks in with neck pain, and we immediately think posture, disc, or joint stiffness.

But what if it is not that? You need to train your mind to go:

“Could this be something sinister?”
“What is the worst-case scenario here?”

Then, work backwards and rule it out. That mindset will keep your patients safe and help you shine in interviews.

Step 6: Show Confidence in Interviews

When red flag questions come up in interviews, do not panic. Use them as an opportunity to show that:

• You understand your role

• You prioritise patient safety

• You think broadly not just MSK

• You have a structured approach to screening

Mention the frameworks you use. Explain how you interpret symptoms. Make it clear that you are not just there to “treat joints” you are there to protect lives.

And Finally

You do not master red flags by memorising a list.
You master them by understanding your role, using structured frameworks, interpreting symptoms, and thinking outside the MSK box.

Always remember: Your job is not to diagnose. Your job is to suspect, to refer, and to keep your patient safe.

And if you want to go deeper into cervical spine red flags, I have written an e-book that breaks it all down for you. It is available now here: https://selar.com/5655lg and it is perfect for FCPs who want to boost their confidence as well.

Thanks for reading.