1. Family Life Cycle --As applied to Family Practice

2. Family Life Cycle (FLC): bring- clinic/hospital messages  What is the concept about?  What is the relevance & application?  What are the useful tools to leverage the idea of FLC?

3. Background  Family physicians see as many as 50-75% of patients having psychosocial precipitant (c.f. biomedical) as their main cause of visit (Rakel R.E. Principles of Family Medicine Chapter 9 The Family Life Cycle)

4. Areas of possible psychosocial problems  Work : Type, workload, work environment, goals, work satisfaction  Family: (1). Present family (change of structure & function); (2). Extended family: parents & relatives (3). Growing environment: Family tree  Sex

5. Family structure  (1). Nuclear family: the couple & family  (2). Extended family: couple’s parents & other relatives  (3). Alternate family: Single parent family, adopted family, same sex family

6. Case Scenario  Frank, 15 y.o IDDM  Problem-free since IDDM Dx 4 yrs ago  Recently freq. Admission: – Not eating properly, not taking insulin well – Not monitoring H’stix, started smoking – Upset about his parents setting up many rules

7. Frank’s parents are very anxious…  You’re Frank’s family doctor, what is the problem with Frank’s compliance?  How can you help?

8. Apply FLC in the context of Adolescent Development  Changing goals in life: – Popularity among peers – Building up of self-confidence – Fear of being rejected – Struggling for independence & respect – Social experimentation

9. The lesson…  Understanding the goals/tasks in different stages help the family doctor to address these issues

10. 2 Fundamental concepts in FLC  (1). Family: Structure & function as dynamic inter-personal relationships  Change in one affects whole system  (2). Each stage of FLC has major events requiring adjustment: (  stressful  if fail  Family Dysfunction)

11. Stages in FLC  Courtship   Marriage (Family Formation)   Child bearing (1 st to multiple)   Child rearing   Child Launching (1 st to last leaving)   Empty nest   Retirement  Death

12. Features of FLC  Change over time  A beginning & an end  Developmental process with sequential stages  Each stage has specific task  Normal transitional stress  Anticipatory counselling

13. Role of each family member  Father: bread-winner; organizer; husband  Mother: Home-maker; mother; wife  Child: leaner; social role, etc.

14. Case Scenario 2  18 y.o Catherine  soon leaving her family in HK to study Medicine  Become “independent”  Visit her family doctor for her school body check-up

15.  What are the developmental tasks catherine has to complete?

16. The Unattached Young Adult  (1). Accept separation from her parents  (2). Establish personal independence  (3). Develop own behaviours, values, judgement, attitudes, skills  (4). Develop intimate & love relationship  (5). Career development

17. Relevance of FLC to Primary Practice (1)  Sudden change in role (external) or failure to cope with stress in changing (internal)  family dysfunction  problems surfaced as symptoms

18. Relevance (2)  BUT it is difficult to discover the real origin of these symptoms…  Hence the need to recognize (1). Normal function of family (2). Criteria for adequate functioning (3). Symptoms suggesting dysfunction

19. Normal Functions of the Family  SCREEM  S---Socialization  C---Cultural  R---Reproductive  E---Economic  E---Emotional  M---Medical

20. Criteria for adequate functioning  APGAR (Useful for quick assessment of family)  A---Adaptation  P---Partnership  G---Growth  A---Affection  R---Resolve

21. Symptoms suggesting family dysfunctioning…  Can be physical/emotional/mixed:  (1). Chronic anxiety & depression  (2). Chronic pain  (3). Primary complaint of chronic fatigue  (4). Insomnia

22. Symptoms suggesting Family Dysfunction (Cont’d)  (5). Multiple pediatric complaints despite repeated child-carer education  (6). Repeated visits by members of the same family for minor, vague symptoms  (7). Substance abuse

23. Case Scenario 3  Chi-Wai, a 28 y.o married man  His wife is pregnant  Finding difficulty in sleep & concentrating in his work

24. The concerns of Father-to-be…  Increasing responsibility  Obstetric problems  Uncertain Paternity  Financial concern  Social concern  Loss of spouse & child  Being replaced by newborn

25. Family Genogram as a tool  A tool to record the family history  A picture > 1000 words  A matter of fact way of sensitive data collection  Set the scene that doctor is interested in patient’s family  A 3-generation genogram may unravel repeating family patterns  Useful in Dx & Mx of patients

26. 2 important points to note in family Genogram  (1) Life cycle Fit / mis-fit? (E.g. age not catching up class)  (2). Unusual family configurations? (E.g re-marriage)  (3). Pattern repetition across generations (E.g. Alcoholism; poor relationship)

27. Application  “Housewife Syndrome”—  Full-time housewife with young children  stress  Occasional low self-esteem  Enmeshment

28. Application  Find ways to improve self-esteem (e.g development of interest) & self- assertiveness  Encouragement of relaxation, meaningful use of time etc.

29. Case Scenario 4  Mr. KB, 67 yr old retired, living alone  His children married & emigrated  HT + DM Dx 20 yrs ago  Recently Dx OA knees  C/o: headache, dizziness, poorly controlled HT  Claimed life difficult + suicidal idea

30. Family in Later Life…  (1). Dealing with illnesses & death  (2). Accepting the loss of family & loved ones  (3). Accepting the lessened abilities & greater dependence  (4). Financial problem  (5). Higher incidence of suicide & depression  (6). Increasing doctor-seeking behaviour

31. Bring-OPD message  (1). If Vague/non-specific symptoms prevail, think FAMILY as the culprit  (2). Anticipate problems from family genograms  patient doubly grateful