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BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 ncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

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Page 1: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

BJ’s Last TestimonyFamily Medicine Case Presentation15 January 2010

Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Page 2: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

CASE BACKGROUND

Page 3: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong
Page 4: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

FAMILY SYSTEM

Page 5: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Family System

Page 6: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Family SystemPatient

◦Single, Young adult, Lives alone◦Several partners

Parents◦Father works as the church minister, ◦Mother is the children’s primary

caregiverFamily

◦Eldest brother, 2 younger sisters

Page 7: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

IMPACT OF ILLNESS

Page 8: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Family Life CycleLaunching

◦Goal: Being one’s own person◦Secondary task

Differentiation of self from family of origin Development of peer relationships

Page 9: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

APGARAlmost always

Some of the time

Hardly ever

1. I am satisfied that I can turn to my family for help when something is troubling me.

1. I am satisfied that my family talks things over with me and shares problems with me.

1. I am satisfied that my family accepts and supports my wishes to take on new activities or directions.

1. I am satisfied that my family expresses affection and responds to my emotions, such as anger, sorrow and love.

1. I am satisfied with the way my family and I share time together.

Total Score 6/10

Modified from Smilkstein G: The family  APGAR: A proposal for family function test and its use by  physicians, J . Family Practice 6(6), 1978.  Reprinted by  permission of Appleton and Lange, Inc

Page 10: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Stakeholder AnalysisStakehold

erInterest in Issue Role Level of

Influence

BJ Getting well, Controlling my illness, Confidentiality

Ally High

Mother Getting my son well, safe and home; Keeping the family together

Ally High

Father Getting my son well, safe and home

Ally Medium

Siblings For my brother to get well and go home soon

Ally Low

Grandmother

Caregiver when the mother needs to rest; For my grandson to get well and go home soon

Resistor

Low

Page 11: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Other Family IssuesOther family issues

◦Religion Iglesia ni Kristo Father is a minister

◦Patient’s decision and confidentiality Only the mother knew

◦Communication to other family members Pneumonia not responding to antibiotics Why the need to confine in an ICU

Page 12: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

SCREEMAddressing Disease within a Family Framework

Page 13: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Social-Cultural-Religion-Economic-Education-Medical Tool

Resources PathologySocial Network in the workplace Lack of communication with

familyCultural Harmonious relationship with

colleaguesRespect for parents

Stigma for possible venereal disease

Religion There are no religious differences in dealing with the sick among Iglesia Ni Cristo

Conservative group who would disapprove of the illness

Economic

Personal incomeEmpowerment to make own financial decisionsFamily members are open to financially assisting

Expensive medical care requirementsNo known savings yet

Education

Patient is a college graduate who is able to comprehend the medical needs required for his illness

Medical Health card holder and immediate access to health needs, improving health seeking behavior

Non-coverage for illness related to risky lifestyle behaviorsIn a tertiary hospital with high price for health care without his HMO coverage

Page 14: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

MEDICAL ISSUES AND INTERVENTION

Page 15: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong
Page 16: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

PSYCHOSOCIAL ISSUES AND PROPOSED INTERVENTION

Page 17: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Psychosocial IssuesThe Family Profile

◦Cultural and Religious reprisal A lifestyle preached against by church and

family His being as a moral fault His disease speaks against his whole family

◦Financial burden Class C family HMOs do not cover this risqué lifestyle

disease Cannot proceed to church’s hospital for

confidentiality

Page 18: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Psychosocial IssuesThe Family Profile

◦DNR and INC doctrines about life No clear practice on remembering those

who died No doctrine on the issue of DNR

◦Bereavement and Acceptance of loss No clear understanding of how this came

about Difficult to communicate to family

members the reason for BJ’s confinement The issue of communicating his testimony

to their community

Page 19: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

FAMILY WELLNESS PLAN

Page 20: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

Family Wellness PlanAcceptance of GriefDNR

Page 21: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

LEARNING ISSUES

Page 22: BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong