This document discusses the importance of family in family practice. It defines traditional and modern family structures and the basic functions of families, including socialization, support, affection, and legitimizing relationships. It outlines the individual and family life cycles and normal stressors families face at each stage. The document also explores how families can impact disease and how disease impacts families, giving examples. Finally, it discusses the levels of involvement for family physicians, ranging from minimal treatment to full family therapy.

1. Dr. Chamath Fernando
Lecturer
Department of Family Medicine
FMS
USJP
FAMILY IN FAMILY
PRACTICE

2. Why is family important in FP?

3. 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

4. Family Structures seen in Western Civilizations
e.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.

5. 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>

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

7. 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)

9. “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

10. • 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

11. • 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

12. 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

13. The Family in Disease
• Two impacts
• 1. Family on Disease
• 2. Disease on Family
Family as a source of Health Problems
1. Physical illnesses– Infectious diseases due to closeness
Genetic predisposition
NCD due to sharing same physical/psycho-social
environment – Malnutrition, DM, Cancer
2. Psychosomatic disorders – Alcoholism
Marital Problems
Stresses can lead to IBS, Asthma

14. 3. Emotional Disorders – e.g.
Death of spouse  Depression in living family
member
AIDS in a member  Anxiety and depression in others
Marital problems of parents  Bed wetting and
acting out in children

15. • 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

16. 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

18. 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

19. Thank you!