Dr. Chamath FernandoLecturerDepartment of Family MedicineFMSUSJP

FAMILY IN FAMILY PRACTICE

Why is family important in FP?

Traditional family structures• Nuclear Family: Heterosexual couple with or without children• Father + Mother + Children• Husband + Wife

• Extended Family: Nuclear Family + Others related by blood or marriage. • E.g. Uncles/ Aunts, Grand parents, Nieces/Nephews living under the

same roof

Family Structures seen in Western Civilizationse.g.• Unmarried sisters living together• Brothers and sisters living together /with an adopted child• Adult couples who are co-habiting• Single parent (unmarried/ divorced/ separated) with children

• Hence what is a family?• A group of individuals living together who share emotional

bonding, a history and a future.

Basic functions of a Family….• Socialization- Interpersonal relationships and social skills start with the new born establishing eye contact with the mother.• Support and nurturing of the family members (food, shelter, warmth, protection)• Affectionate relationship• Legitimization of sexual relationships and procreation• Sense of security influenced by sharing educational, occupational and socio-economic factors e.g. advice, help

• <The roles of the “home maker” and “breadwinner” interchangeable• Children play a passive role>

Individual Life Cycle• Pre- natal period• Neonate and Infant• Preschooler• School child• Teenager/ Adolescent• Early adulthood• Mid life crisis• Middle adulthood• Retirement• Dependent elderly

Family Life Cycle – more important• 1. Married couple without children• 2. Families with oldest child between 0-30 months• 3. Families with pre-school children (oldest child between 30 months-6years)• 4. Families with school children (oldest child between 6 – 13 years)• 5. Families with teenagers (oldest child between 13 – 20 years)• 6. Families launching young adults (First child left – last child leaving home)• 7. Middle aged parents – “Empty nest’ to retirement• 8. Ageing family members (From retirement to death of one or both spouses)

“Normal Stressors” of the Family Life Cycle Stages• 1. Married couple without children – • Intense physiological development of the foetus• “Nesting”• Pre-natal counseling important

• 2. Child-bearing family – • Emotional bonding between the baby and the mother• Social smile in 6/52• Developmental mile-stones • Counseling regarding crying, sleeping, feeding patterns, toilet

training, separation anxiety, what is normal and what is not

• 3. & 4. Families with pre-school children/ children• Child may be anorexic, malnourished and susceptible to infections

as a result• Behaviour problems, Temper tantrums, Thumb sucking, Breath

holding attacks• Prone to accidents – prevention• Monitoring growth and Immunization • Parents worried about schooling

• 5. Families with adolescent children• Difficulties in adopting to the physiological changes• Psychological changes in puberty (Becoming independent)• Peer pressure (Drugs, Alcohol, Sex)• Conflicts with parents

• Parents (35-45 years of age) – Marital crisis, Career isssues

• 6. Families Launching Young Adults• Children – Choosing life partner, career• Parents – NCD, Career responsibilities, Maternal menopause

• 7. Retirement • Retirement – having to adopt to a new life style• Chronic disease, disability, Empty nest syndrome

• 8. Old age• Disabilities – Poor mobility, hearing and vision• NCDs• Readiness for death

Family Physician should place the patient in the corresponding stage of the life cycle and provide anticipatory guidance and counseling….

• Unexpected events : e.g Death, Devorce, Migration, Losing job, conflicts within

The Family in Disease• Two impacts • 1. Family on Disease• 2. Disease on Family

Family as a source of Health Problems1. Physical illnesses– Infectious diseases due to closeness

Genetic predispositionNCD due to sharing same physical/psycho-social environment – Malnutrition, DM, Cancer

2. Psychosomatic disorders – AlcoholismMarital ProblemsStresses can lead to IBS, Asthma

3. Emotional Disorders – e.g.Death of spouse Depression in living family

memberAIDS in a member Anxiety and depression

in othersMarital problems of parents Bed wetting

and acting out in children

• Impact of disease on the Family• Family has to adopt for • Treatment and hospitalization• Patient’s dependence on the family for care• Changes in patient’s behaviour and appearance• Possibility of death• Economic crisis• Social issues – Cannot attend social events, AIDS?

• Use Family’s own strength to solve the problem More successful recovery• Maintain confidentiality

Family Genogram• Depicts the three generations family tree regarding the patient including• Members and their ages• Deaths • Inter personal relationships/ Separations – Family circles• Chronic illnesses

Levels of Family Physician Involevement• 1. Minimal involvement – Gathers biomedical data, diagnoses and treats the patinet• 2. Explains the family the medical findings, treatment options, prognosis• 3. Both above + Understanding the emotional aspects of the family and provides psychological support• 4. Family conference/ Meeting – acts as a catalyst to solve issues• To develop a plan of care following discharge from a hospital• To negotiate a management plan for a Terminally ill patient• For the physician to understand the psychosocial aspects of the

patients• To help family members cope better with a chronic illness

• 5. Family therapy – Needs more expertise and special training• Planned course of therapy for a dysfunctional family

Thank you!