Session 2: The role of family in health and illness

From Iusmicm

Contents

[edit] Notes from "The family system" by Campbell, McDaniel, and Seaburn

[edit] Educational objectives

  • Understand the importance of the family in health and illness: how families can influence health and how health affects families
  • Know how to implement a family-oriented approach in clinical practice and particularly in the treatment of chronic illnesses
  • Know how to obtain and utilize a family tree or genogram
  • Understand the concept of the "therapeutic triangle" and how to maintain alliances with all family members without taking sides
  • Know when to meet with family members or convene a family conference and when to refer to a mental health professional
  • Understand how the physician's own family-of-origin issues can influence clinical practice

[edit] Introduction

  • The family unit remains the most important functional social unit despite many demographic and sociological changes over the last 50 years.

[edit] The family system

[edit] Definition

  • We recognize that as the U.S. demographics and social ideas change the idea of a family must evolve, too.
  • Therefore we broaden our definition from father (breadwinner), mother (home keeper), and children to "any group of people related either biologically, emotionally, or legally."
  • This evolution is not limited to the U.S. however; even the World Health Organization has broadened it's definition to "Any group whose bonds are based upon trust, mutual support and a common destiny may be regarded as a family."
  • In considering the family unit in health care, we have developed the biopsychosocial model which takes a systems based approach to understanding the interdependent affects of biology, psychology, and society.
  • Just as one cannot study the movements of a planet without considering the other elements of the solar system, in health care we cannot study and treat the body (biology) without considering the other elements of the biopsychosocial system (psychology and relevant society).

[edit] The family's impact on health

  • We know that the family is very important in health care; "the family is the primary social context in which health promotion and disease prevention takes place."
  • Some of the evidence for the importance of family in health care includes:
    • risk reduction analyses that show stronger correlations between family and disease than smoking and disease
    • behavioral risk factor clustering within families,
    • increased success in health initiatives when family-based,
    • strong correlations between blood pressure, cholesterol, blood sugar, smoking, and lung function between spouses
    • divorced individuals have been shown to have poorer health and cellular immunity,
    • family caregivers for patients with Alzheimer show poorer immune function,

[edit] The biopsychosocial approach

  • In medical training and treatment there has been a custom of separating the biophysical and psychosocial issues and treating them as separate issues.

[edit] The family context of the presenting problem

  • Most illnesses either affect the family or the family affects the illness; therefore, it is important that physicians understand the family context in which the illness takes place.
  • One should ask questions of the patient regarding who is involved in the disease and affected by it. 
During your genogram presentation, name one way that a family illness has affected you and your own illness has affected someone else.

[edit] Use of the genogram for family assessment

  • Genograms provide a quick, important view of the family structure and illness.
  • Genograms are increasingly important as we elucidate the genetic component of diseases.
  • The genogram is easily taken during routine visits and will often reveal more sensitive issues when part of a routine, non-threatening interview.
  • As we've seen that the divorced / remarried / blended family is at higher risk for disease and poor treatment, the genogram is especially important in these circumstances.

[edit] The family life cycle

  • The family goes through development life cycles just like an individual.
  • This life cycle includes specific developmental tasks that should be achieved by the family at each stage.
  • If the tasks are not achieved, the family is at risk for difficulties with the next developmental steps.
  • Since divorce rates and care for elderly parents are increasing, physicians are now more often challenged with treating patients with these additional psychosocial stresses.

[edit] The therapeutic triangle

  • The therapeutic triangle includes the physician, patient, and family.
  • Family members have a powerful influence and can undermine or support the physician-patient relationship.
  • When conflict occurs between two parties, a third is often pulled in by one or the other as an ally or to relieve the stress.
  • Physicians often empathize with a patient's complaint about a family member and by doing so, inadvertently take sides.
  • Physicians must strive to maintain positive relationships without blaming or taking sides--a challenging aspect of medicine.

[edit] The family conference

  • Sometimes we not only ask about the patient's family situation but see the patient with family members present.
    • In this case the family members are often instrumental in:
      • helping to communicate the patient's concerns,
      • helping patients remember the physician's recommendations,
      • and assisting the patient in making decisions.
  • Sometimes it is appropriate to meet with the entire family in a family conference.
    • This is especially important when "bad news" is given such as terminal illness diagnosis or death.

[edit] Levels of working with families

  • Physicians, as in any area of medicine, need to be constantly assessing their interest in obtaining skills and knowledge in the area of family systems counseling.
  • There are 5 levels of family involvement:
    • Level 1 limits engagement to what is necessary for medical-legal reasons.
      • Level 1 requires no additional training.
    • Level 2 involvement is simply providing ongoing medical information and advice to families.
      • Level 2 involvement requires no additional training.
      • It is important to function at least at level 2 because providing medical information only to the patient can often lead to confusion and conflict when the family tries to decide what activities and treatments are safe for the patient.
    • Level 3 involvement intentionally elicits feelings and provides support to the family and therefore provides a basal level of therapy.
      • Levels 3 requires no extra training but does require that the physician be comfortable eliciting, attending to, and normalizing strong emotions.
    • Level 4 (called "systematic assessment and planned intervention") provides brief and focused family counseling for uncomplicated family problems.
      • Level 4 requires additional training in family systems theory.
    • Level 5 is generally beyond the interest of physicians and provides full counseling services for the family unit.
      • Level 5 requires 3 to 5 years of postgraduate training and supervision.

[edit] Collaboration with a mental health provider

  • Because of changing demographics and social ideas, it is increasingly important that physicians develop and maintain positive relationships with the entire family of their patient.
  • A family system works through a biopsychosocial model to put special emphasis on the role of the family in health care.
  • Some physicians obtains special training in family systems but all physicians can develop a basal level of family interaction in order to benefit the medical outcomes of the patient and her family.
  • It is important that physicians be able to assess the level of the family problem they have encountered and to know their own limits of training.
  • Many psychosocial problems can be handled by a competent, interested family physician.
  • Chronic, severe, or treatment-resistant problems should be forwarded on to specialty care.
  • Note that physicans need to recognize their own psychosocial issues that could interfere with the way they thinkg about the issues their patients bring and they way they counsel their patients and patients' families.

[edit] Physician self awareness and family of origin

  • Physicians can leverage their own family experiences if they are self-aware enough to recognize when such family experiences are coloring their view of their patient's situation or affecting the way they treat the patient.
  • Therefore, it is important that physicans recognize their own family issues--resolved or ongoing.
  • When a physican recognizes that his own family issues may affect his treatmet of the patient he can choose to treat, to refer to a colleague, or consult with a colleague.

[edit] Conclusion: Collaborative family health care

  • The changing demographics (aging population, increasing divorce rate) and the growing emphasis on primary care make practicing medicine in the context of a family system an important goal.
  • A family systems approach to medicine follows the biopsychosocial model but puts extra emphasis on the family unit.
  • While many physicans recieve extra training for handling psychosocial family issues, some cases will have to be referred to professional mental health services.


[edit] Questions for the group

  • Do you have an anecdotes from your own family regarding the role of family in health care?
    • At what age did you stop having your parents at your doctor appointments?
  • At what level do you think you'd like to practice medicine? Why?
  • Do you think all doctors should be required to work at least at a certain level?
  • Do you know of any cultural differences that apply to the family system model?
  • Are there unique aspects to the family systems and biopsychosocial models in palliative care?


  • Go through the cases at the end of the reading.
  • Go through the session objectives.
  • Go through the reading objectives.
Retrieved from "http://editthis.info/iusmicm/Session_2:_The_role_of_family_in_health_and_illness"
Personal tools