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Published byJodie Watson Modified over 9 years ago
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Family Life Cycle --As applied to Family Practice
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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?
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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)
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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
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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
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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
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Frank’s parents are very anxious… You’re Frank’s family doctor, what is the problem with Frank’s compliance? How can you help?
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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
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The lesson… Understanding the goals/tasks in different stages help the family doctor to address these issues
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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)
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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
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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
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Role of each family member Father: bread-winner; organizer; husband Mother: Home-maker; mother; wife Child: leaner; social role, etc.
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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
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What are the developmental tasks catherine has to complete?
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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
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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
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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
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Normal Functions of the Family SCREEM S---Socialization C---Cultural R---Reproductive E---Economic E---Emotional M---Medical
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Criteria for adequate functioning APGAR (Useful for quick assessment of family) A---Adaptation P---Partnership G---Growth A---Affection R---Resolve
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Symptoms suggesting family dysfunctioning… Can be physical/emotional/mixed: (1). Chronic anxiety & depression (2). Chronic pain (3). Primary complaint of chronic fatigue (4). Insomnia
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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
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Case Scenario 3 Chi-Wai, a 28 y.o married man His wife is pregnant Finding difficulty in sleep & concentrating in his work
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The concerns of Father-to-be… Increasing responsibility Obstetric problems Uncertain Paternity Financial concern Social concern Loss of spouse & child Being replaced by newborn
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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
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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)
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Application “Housewife Syndrome”— Full-time housewife with young children stress Occasional low self-esteem Enmeshment
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Application Find ways to improve self-esteem (e.g development of interest) & self- assertiveness Encouragement of relaxation, meaningful use of time etc.
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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
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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
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Bring-OPD message (1). If Vague/non-specific symptoms prevail, think FAMILY as the culprit (2). Anticipate problems from family genograms patient doubly grateful
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