Family Medicine JC126: The "Family" In Family Medicine Flashcards

1
Q

***5 tools for Family Assessment and Interventions

A
  1. Family Life-cycle Theory
  2. Genogram
    - Family organisation
    - Biomedical information
    - Inheritance, risk factors
    - Life events, family stories
    - Family relationships
  3. Family APGAR Questionnaire
  4. Satir’s model of communication stances and sculpting
  5. The theory of Family Structure
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2
Q

Family Medicine

A

Challenges:

  • Ageing population
  • Chronic illnesses
  • Mental illnesses
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3
Q

Marriage and Family therapy

A
  • Evidence-based branch of psychotherapy that assess and treat various mental disorders and health conditions in ***family relationship perspective
  • Diagnose + treat mental and emotional disorders within the context of **marriage, **couples, ***family systems
  • ***Brief, Specific, Solution-focused, Attainable therapeutic goals
  • 50% 1 to 1, 25% couple, 25% family

Management:

  • Mental, Interpersonal, Physical problems
  • Resolve family conflicts and crisis
  • Help family adjust to changes and problems
  • Nurture family relationships and personal growth
  • Advise on work-family-self balance, adjustment to family life-cycle, couple-hood vs parenthood, importance of good marital relationship, family structure, communication
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4
Q

Individual vs Systems perspective

A

Individual perspective:

  • You own your Cognition, Emotions, Behaviour
  • Problem belongs to one person

Systems perspective:
- People are products of their ***Interpersonal context
- People are modified and become what other people expect us to be
- Illness —> Individual —> Family —> Community / Other systems
- Individuals cannot be understood in isolation from one another —> all inter-connected + influencing each other
—> Behaviourally, Emotionally, Cognitively (expectations, assumptions, values)
- Family members can affect therapeutic influence if family is helped to resolve their problems
- Change in one member of family will affect whole family system

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5
Q

Family-oriented approach

A

All clinicians:

  • Patient-centreness
  • Empathy
  • Communication skills
  • Doctor-patient relationship

Family doctor:

  • Point of first contact
  • Comprehensive, continuing, collaborative care
  • Caring for ***other family members as well
  • Think + manage using ***Systems perspective
  • **Family as the unit of treatment:
  • History taking
  • Facilitate help-seeking, compliance, follow up
  • Active involvement in treatment: taking medications, lifestyle modification, practical + emotional support
  • Attending to needs + problems of whole family (ticket of entry for other members)
  • Handle ***multiple problems (curative + preventive) simultaneously
  • Improve family relationships
  • Other social supports and resources
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6
Q

Family Life-cycle stages

A
  • **6 Stages:
    1. Leaving home (i.e. single young adult)
    2. Marriage (i.e. new couple)
    3. Families with young children
    4. Families with adolescents
    5. Families launching children and moving on (empty-nest)
    6. Families in later life
  • Only applicable to ***contemporary 2-parent families
  • ***Adaptation necessary for each change with new skills to be learned and change is followed by period of relative stability
  • There are ***challenges at different time e.g. illness, death, financial, change in family
  • Failure to readjust at transitions / stuck in transition —> Problems
  • Couple as leader in the adaptation process
    —> Provide **anticipatory advices
    —> **
    Normalise difficulties
    —> **Validate efforts
    —> **
    Practical support
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7
Q

Family structure

A

The way a family is organised into subsystems whose interactions are regulated by interpersonal boundaries

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8
Q

Other family structures

A
  1. Staying single
  2. Unmarried couples
  3. Childfree couples
  4. Divorcing families
  5. Single-parent families
  6. Blended couples and families
  7. Couples and families with divorce issues
  8. Multiple relationships, EMA
  9. Interracial marriages
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9
Q

Comprehensive assessment of patients

A
  1. Symptoms
  2. Mental health
    - sleep, mood, difficulties, stressors
    - chair metaphor (4 cornerstones of life)
    —> **Study / Work / Finance (工作)
    —> **
    Family (家庭)
    —> **Self: interests, dreams, meanings, joy (自己)
    —> **
    Intimacy / Friendships (朋友)
  3. Family-oriented approach
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10
Q

Framework for Family-oriented approach

A
Initial assessment of presenting problems —>
4 Steps:
1. Seeing people in family context
2. Exploring family information
3. Assessing family relationships
4. Working with the family as a unit
  • Conceptualise using Systems perspective
  • Probing with reference to her Family life-cycle stage + use Genogram
  1. Know person’s ***different roles in family
  2. Balance between work and family
  3. Listen to narrative of family life, family organisation
  4. Relationship with partner
  5. Other family relationships, family structure, communications patterns
  6. Adjustments of roles: Self vs Husband-wife vs Mother-son vs as a daughter
  7. Draft genogram
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11
Q

Genogram

A
  • Comprehensive + Clear pictorial display of personal relationships + medical history of a family ***>=3 generations
  • Use:
    1. Information collection
    2. Analysis
    3. Hypothesis formulation
    4. Management planning
    5. Record keeping
  • ***Assess:
    1. Family organisation
    2. Biomedical information
    3. Inheritance
    4. Risk factors
    5. Life events
    6. Family stories
    7. Family relationships
  • Construct genogram with the ***family —> feel more comfortable talking about certain relationships, losses, histories
    1. See themselves in new ways
    2. Identify new supports and strengths
    3. Recognise patterns that can be changed
  • Understand the family of origin —> rules and beliefs from past generations can have great effects on family’s value system
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12
Q

Family APGAR Questionnaire

A

5 questions:

  1. I am satisfied that I can turn to my family for help when something is troubling me
  2. I am satisfied with the way my family talks over things with me and share problems with me
  3. I am satisfied that my family accepts and supports my wishes to take on new activities / directions
  4. I am satisfied with the way my family expresses affection and responds to my emotions, such as anger, sorrow and love
  5. I am satisfied with the way my family and I share time together

Scoring:

  • 2: Always
  • 1: Sometimes
  • 0: Never

Overall score: Impression on ***Family functioning

  • Active listening, Circular questioning, Empathy, Enactment, Feedback, Reframing, Sculpting (Blaming, Placating, Computing, Distracting)
  • Trying not to blame one but to externalise the difficulties
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13
Q

Complementarity

A
  • Refers to Reciprocity in every relationship
  • One’s behaviour is yoked to the other’s in any relationship
  • Mutual training will take place and pattern repeats and perpetuates
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14
Q

3 important elements in relationship

A
  1. Do not insult others
  2. Do not say things you won’t do
  3. Love has to be expressed
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15
Q

John Gottman’s Love Lab

A

5: 1 ratio

- 5 good things to counteract / compensate for 1 bad thing

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16
Q

Satir’s model of communication stances and sculpting

A

Experiential intervention that helps family members to reflect and improve their communication styles and family relationships

4 stance model:

  1. Blaming
  2. Placating (和事佬)
  3. Computing (appear cold or unfeeling, display no emotion)
  4. Distracting (seek attention to compensate for their feelings of loneliness or inadequacy)
17
Q

Psychosomatic families

A

Families that may produce somatic symptomatology

Characteristics:

  1. Enmeshment of subsystems (e.g. Mother-Child: become same hierarchy, parenting becomes ineffective, child will share mother’s emotions, child will be involved in parental relationship)
  2. Conflict avoidance / Poor conflict resolution
  3. Overprotection
  4. Parental conflict was detoured via the triangulation of the child patients

Most commonly seen psychosomatic family structure: **Mother-child enmeshment / **Disengaged father

18
Q

Satir’s growth model

A
  1. The problem is not the problem, Coping is the problem
  2. We cannot change past events, only the effects they have on us.
  3. Appreciating + accepting the past increases our ability to manage our present
  4. Change is possible. Even if external change is limited, internal change is possible
  5. We all have internal resources we need to cope successfully and to grow
19
Q

Scenarios indicated for Family-oriented approach

A
  1. ***Mental health problems
  2. ***Psychosomatic symptoms, MUPS (Medically Unexpected Physical Symptoms)
  3. ***Adjustment to life stressors, illnesses and death
  4. ***Children and adolescent problems
  5. Elderly problems
  6. ***Couple problems
  7. ***Infertility, Sexual dysfunction, HIV, STD
  8. Chronic illnesses: e.g. DM, Asthma, Eczema
  9. Serious illnesses: e.g. Cancer, Stroke, Degenerative diseases
  10. Routine obstetrical and well-child care, annual checkups
  11. Health promotion and disease prevention including lifestyle modification
  12. Concordance problems
20
Q

Difficult cases: Think about family

A
  1. ***Somatic symptom disorder / MUPS
  2. Tics
  3. Hair loss / Trichotillomania
  4. Secondary enuresis
  5. Encopresis (Faecal incontinence)
  6. Anorexia nervosa
  7. Globus hystericus
  8. Recurrent abdominal pain
  9. ***School refusal
  10. ***Internet addiction
  11. ***ADHD-like condition
  12. ***Autistic spectrum disorder, SEN
  13. ***Depression, anxiety disorders
  14. Temporal relationship with family events
21
Q

Circular questions

A

Designed to shift people from thinking about individuals and linear causality —> towards **reciprocity and **interdependence

  • Bring people into constructive discussion on their differences and come up with a more effective way to relate + cope with each other
  • Promote mutual understanding, empathy, new way of interacting