Family Life CycleFamily Life Cycle

--As applied to Family Practice

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?

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)

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

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

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

Frank’s parents are very anxious…

You’re Frank’s family doctor, what is the problem with Frank’s compliance?

How can you help?

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

The lesson…

Understanding the goals/tasks in different

stages help the family doctor to address

these issues

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)

Stages in FLC

Courtship Marriage (Family Formation) Child bearing (1st to multiple) Child rearing Child Launching (1st to last leaving) Empty nest Retirement Death

Features of FLC

Change over time A beginning & an end Developmental process with sequential sta

ges Each stage has specific task Normal transitional stress Anticipatory counselling

Role of each family member

Father: bread-winner; organizer; husband

Mother: Home-maker; mother; wife

Child: leaner; social role, etc.

Case Scenario 2

18 y.o Catherine soon leaving her family in HK to study Me

dicine Become “independent” Visit her family doctor for her school body

check-up

What are the developmental tasks catherine has to

complete?

The Unattached Young Adult

(1). Accept separation from her parents (2). Establish personal independence (3). Develop own behaviours, values, judg

ement, attitudes, skills (4). Develop intimate & love relationship (5). Career development

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

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

Normal Functions of the Family

SCREEM

S---Socialization C---Cultural R---Reproductive E---Economic E---Emotional M---Medical

Criteria for adequate functioning

APGAR

(Useful for quick assessment of family) A---Adaptation P---Partnership G---Growth A---Affection R---Resolve

Symptoms suggesting family dysfunctioning…

Can be physical/emotional/mixed:

(1). Chronic anxiety & depression

(2). Chronic pain

(3). Primary complaint of chronic fatigue

(4). Insomnia

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

Case Scenario 3

Chi-Wai, a 28 y.o married man

His wife is pregnant

Finding difficulty in sleep & concentrating in his work

The concerns of Father-to-be…

Increasing responsibility Obstetric problems Uncertain Paternity Financial concern Social concern Loss of spouse & child Being replaced by newborn

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

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)

Application

“Housewife Syndrome”—

Full-time housewife with young children stress

Occasional low self-esteem Enmeshment

Application

Find ways to improve self-esteem (e.g development of interest) & self-assertiveness

Encouragement of relaxation, meaningful use of time etc.

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

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

Bring-OPD message

(1). If Vague/non-specific symptoms prevail, think FAMILY as the culprit

(2). Anticipate problems from family genograms patient doubly grateful