FAMILY MEDICINE ROTATION

Prepared By: Shella Akil-Bravo, MD

TASK:

1. Be acquainted with the different family assessment tools and be able to apply and interpret it
given an assigned family.
2. Identify the medical and psychosocial problems of ALL members of the family.
3. Identify both short and long term plans to achieve family wellness.
4. Educate family members to promote health and prevent diseases
5. Review and apply establishing rapport, dealing with different types of patients and family
medicine principle.
6. Use communication and counseling skills in health education
7. Present a FAMILY HEALTH CASE
8. Individual REFLECTION PAPER

WHAT TO TEACH?

1. How to get a family profile? – can go to the house of the family once only
2. Obtain a COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION of the INDEX patient.
3. Describe an FAMILY STRUCTURE
4. Review the family assessment tools then apply it to an assigned family.
a. GENOGRAM - 3 GENERATION
b. ECOMAP
c. APGAR
d. SCREEM
e. FAMILY LIFELINE
f. FAMILY LIFE CYCLE WITH DISCUSSION ON THE 1ST AND 2ND ORDER CHANGE
g. FAMILY DIAGNOSIS
FAMILY GENOGRAM

- Quick overview on the family members and relationship

- Visually overlay biomedical and psychosocial information
- A tool for gaining a comprehensive understanding of multigenerational family system

A complete Genogram should include:

1. The names and ages of all family members

2. Exact date of birth, marriage, separation, divorce, death (including cause and other
significant life events
3. Information covering three or more generation
4. Illnesses
5. Male on the left and female on the right except for sequence of siblings wherein the
firstborn of each family to the left with other siblings sequentially to the right
6. Indication of which members live together in the same household
7. Names of two families with the address of the index family
8. The informant/s
9. Date and place the genogram was generated

Figure 1. Manalo- Losano Family Genogram

 Figure 2. Standard Genogram symbols

FAMILY MAP

- A tool designed to reflect family relationship and interaction patterns

- It is an important tool for physicians to be able to identify therapeutic ally for the delivery of
care in the family
ECOMAP

- Family within a larger system

- A pictorial representation of family’s connections to persons and/or systems in their
environment
- The purpose of this is to support classification of family needs and decision making about
potential interventions

FAMILY APGAR

- A tool that qualitatively measure family functioning

- A reliable and valid measurement of family relationships
- Limitation of the tool is that data obtained is retricted to what the patient is willing to disclose
 Definition of Components of APGAR
ADAPTATION It is the family’s utilization of the resources available within and outside
of the familial system when significant life events pose a crisis.
PARTNERSHIP It is the sharing of the family members in decision-making and
responsibilities.
GROWTH It is the physical and emotional growth attained by each family member
from the family’s ability to support and guide.
AFFECTION It is the loving or caring relationship of the family.
RESOLVE It is the commitment of the family members to devote time to support
each other’s physical and emotional growth. It also pertains to the
sharing of wealth and space.

Almost Always Some of the time Hardly ever

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

Interpretation:

8 – 10 = highly functional family

4 – 7 = moderately dysfunctional family

0 – 3 = severely dysfunctional family

SCREEM

- An acronym that represents family resources.

- A tool where the physician helps the family members identify and assess their resources to
meet a crisis.

RESOURCES PATHOLOGY
SOCIAL + communication isolated
CULTURAL Pride in ethnicity Feels inferior
RELIGIOUS Satisfying spiritual experience Rigid rituals
ECONOMIC stable Problematic
EDUCATIONAL Adequate comprehension Handicapped
MEDICAL Available health care Not utilizing health care facilities
FAMILY LIFELINE

- A tool that summarizes the history of the family, particularly the individual or the family’s
significant experiences over the period of time in a chronologically-sequenced manner.

FAMILY LIFE CYCLE

- A description of the family dynamics through clearly defined stages of development

Stage Task 1st order change 2nd order change Health

”need to do” “need to be” Implications
Unattached -Establishing Extend social contact  Differentiation -episodic
Adult personal outside the home of self into the medical
independence family origin problems
-beginning  Establishment -STDs
emotional of self in work - unwanted
separation from  Development pregnancy
parents of intimate
peer
relationship
Newly Married -intimate Establishing: Formation of marital -STDs
Couple relationship with  home base of system -Infertility
spouse his own -Gynecologic
-developing  mutually problems
further emotional satisfying Realignment of
separation from system for relationships with
parents getting and extended families
spending
money
 mutually
acceptable
patterns of
accountability
 continuity of
mutually
satisfying
sexual
relationship
 system of
intellectual and
emotional
communication
 workable
relationships
with relatives
 way of
interacting
with friends
  facing the
possibility of
children and
planning for
their coming
Family with -opening the Supplying adequate Accepting marital -accidents
young children family to include a space, facilities and system to make space -poisoning
new member equipment for their for children -behavioral
-dividing the expanding family problems
parenting role Taking on parenting
Meeting predictable role
and unexpected costs
of family life Realignment of
relationship with
Sharing responsibilities extended family
within the extended
family and between
members of the
growing family

Maintaining mutually
satisfying sexual
relationship

Creating and
maintaining effective
communication system
within the family

Cultivating the full

potentials of
relationship with
relatives

Tapping resources

Facing dilemmas and

reworking philosophies
Family with -increasing the Providing facilities for Shifting of parent-child -drug and
adolescents flexibility of the widely different needs relationships to permit substance
family bounderies the adolescent to abuse
to allow Working out money move in and out of the -STDs
adolescents to matters in the family system -menstrual
move in and out of problems
the family system Sharing the tasks of Refocus on midlife, -circumcison
responsibilities of marital and career
family living issues

Putting the marriage Beginning the shift

relationship into focus towards concern for
the older generation
Keeping the
communication system
open

Maintaining contacts
with the extended
family

Growing into the world

as a family
 Reworking and
maintaining a
philosophy of life
Launching -accepting Adjusting to physiologic Realignment of marital -pre/post
Family multitude of exits changes of middle age system as a dyad menopausal
from and entries syndromes
into the family Discovering new Development of adult -degenerative
system satisfaction in relation relationship between dse
-adjusting to with spouse grown up and children -malignancies
ending of & their parents
parenting roles Setting up a
comfortable home for Realignment of
themselves relationships to
include in-laws and
Helping their grandchildren
adolescent children to
free themselves and Dealing with
become responsible disabilities and death
adults of parents and
grandparents
Reexamining their
living arrangements
with their own parents

Adjusting to the reality

of their own work
situation

Assuring security for

their later years

Participating in
community life

Reaffirming the value of

life that have real
meaning

Sexual relationship with

spouse
Family in later -adjusting to Adjusting to physiologic Maintaining couple -degenarative
years/life ending of wage- changes of later life functioning & interest dse
earning roles in the face of -malignancies
-dealing with Reexamining their physiologic dwcline, -chronic illness
losses of family living arrangements exploration of new
members, friends familial and social
Participating in group options
activities
Support for more
Maintaining contact central role of the
with the younger middle generation
generations
Making room in the
system for wisdom
and experience of the
elderly generation
without over-
functioning them

Dealing with the loss

of spouse, siblings,
peers and preparation
for own death
FAMILY STRUCTURE

- Describes the family

The P family is a nuclear type of family composed of the father E. P., the mother P. P.,
children D. P. and El. P living together in one household but with 2 other families from the
side of E. P. living around the block.
The family lives on the earnings of both E. P. and P. P., who both works as employees of
Department of Private Works and Highways. The income is divided into basic expenses in the
house and the children’s education.
This is a democratic family wherein a decision is made after discussing it with the members of
the family. The parents guide their children at the same time respect their opinions.
There are well-defined boundaries with clear rules and expectations yet balanced with
adequate flexibility that allows adaptation.

BIOMEDICAL PROBLEM LIST

PROBLEM ASSESSMENT INTERVENTION SHORT TERM LONG TERM
GOAL GOAL
Back, leg and Compression Pain relievers: Pain relief No pain
anterior chest fracture Oxycontin 10mg recurrence
pain 1 tab TID
Tramadol 50mg 1
tab TID PRN for
breakthrough pain
Vomiting NUD Antiemetics: Cessation of No recurrence
Metoclopramide 1 vomiting of vomiting
amp IV Q8h PRN
Domperidone
10mg 1 tab Q6h
Decreased Depressed state Encourage to eat Prevent weight Continous
appetite and take in small loss and other psychotherapy
frequent feedings metabolic
With Nutren abnormalities Family support
Optimum 2-3 brought about and encourage
scoops in 1 glass nutritional family bonding
of water QID deficiencies to lessen
depression
Psychotherapy
 More time with
loved ones and
friends as not to
alleviate
depression
Elevated blood Hypertension I Low salt, low fat BP lowering BP control
pressure diet
BP monitoring Prevention of
complications
Antihypertensive: of hypertension
Amlodipine 5mg
1 tab OD

WELLNESS PLAN

E. P. FAMILY
 Compliance to medications and wearing of back brace
 Regular follow up with physicians
 Monitoring of Blood pressure, CBC (hemoglobin, WBC, platelet), sugar, creatinine, and
Calcium levels
 Encourage open communication with his family for him to vent out his feelings
P. P.
 Annual physical examination
 Screening: FBS, lipid profile, pap smear, breast exam
 Screen for caregiver fatigue
 Encourage open communication and bonding with her family to relieve stress from work
and from being a caregiver.
D. P.
 Educate about personal hygiene
 Educate about common adolescent issues: sexuality, premarital sex, sexually transmitted
diseases, vices
 Encourage open communication with other family members especially regarding his
thoughts on his father’s illness
EL. P.
 Educate about personal hygiene
 Educate about common adolescent issues: sexuality, premarital sex, sexually transmitted
diseases, vices
 Encourage open communication with other family members especially regarding his
thoughts on his father’s illness