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1st - Basic Science

Family as a Unit of Care

2nd - Parasitology, Pharmacology etc.

Dr. Samaniego

3rd - Theoretical Clinical

Family Oriented Medical Care

4th - Clinical Practice

Concept
Bio-pyschosocial appraoch

FAMILY CODE in the 1987 Philippine Constitution


provisions
o
Article II Sec 12: State shall protect and
strengthen the society as a basic autonomous
social institution
o
Article XV Sec 1: Recognizes that the Filipino
family as the foundation of the nation
o
Article XIII Sec2: shall adopt an integrated
and comprehensive approach to health
development at an affordable cost
Family oriented medical care/Family care mean:
1.
Taking care of all individuals in the family
one by one
2.
Influencing family members to change
factors affecting an individual's health
1.
Dealing with the family as an object of
management

Basic Premises

Bio - Medical--> Prescription

Identify disease producing factors

Limitation: excludes to evaluate


social and psychological contributors

Sign: objective as seen by the doctor;

Symptoms: something a patient feels;


Abdominal symptom
Psycho-Social

Disease: more concern on the BIO


part of medicine

Illness: more concern of the contacts


of the sickness, leaning toward the
psycho-social part of the sickness

Therefore,
Family medicine is concerned is
Patient centered

1 Family oriented medical care is based on the


biopsychosocial model
Understand the hierarchy
1 Family as a Unite of Care

Family focus

Community oriented
1 The primary focus of medial is the patient in
the context of the family
a Families are a primary source of many health
beliefs and behaviors

Family beliefs about health: basis of


the initial appraisal of physical symptoms
is usually made within the family

Family health expert: makes the initial


health assessment, treatment plan and
decides if a consultation with a physician
is necessary

Members of the family share many


health behaviors and risk factors
a Families are valuable resource and source of
support for the management of illness

Physicians don't treat illness, they


only recommend the treatment. Actual
treatment is provided by the family
members

Most chronic illness: physician rely on


family members
a The stress that a family feels when going
through development transitions can manifest
in physical symptoms

Life cycle changes make a member


vulnerable to illness
1.
Marriage
1.
Birth of 1st child
1.
Adolescence
2.
Leaving home
1.
Mid-life
1.
Death
1.
Retirement
2 Family as a Unite of Care

Somatic symptoms can serve an adaptive


function with the family and be maintained by
family patterns
Inc family conflict can adversely affect
management of chronic childhood illness
1.
e.g. DB children involved in
parental conflicts --> experience an
acute rise in free fatty acids and
worsening of the DB control
1 The patient family and physician are partners
in medical care
o
Illusion of the DYAD in medical care =
illusion of the one to one relationship of
the patient and the doctor
o
Reality of the TRIANGULAR
PERSPECTIVE: involves the physician,
patient and family

Together, the identifying


symptoms, treatment plan and
clarifying responsibilities are defined
1 The physician is seen as 'a part of' rather than
'apart from' the treatment system
o
Biomedical approach: physicians being
objective outsides who assess, diagnose
and treat patient's illness
o
Biopsychosocial approach: takes
cognizance of the fact that physicians
behavior may also influence patient's
behavior

Concept of the Family

Definition of the Family

Sociological viewpoint: enduring social form in


which a person is incorporated
Biologic viewpoint: genetic transmission unit
Psychological viewpoint: matrix of personality
development and the most intimate emotional unit
of society
United Nations Definition: group of people related
by blood marriage or adoption, which live together
in one household
Person and Bales:
o
A small social system made up of individuals
related to each other, biologically or by reason
of strong affections and loyalty, that comprises
a permanent household (or cluster of
household) and persists over decades
o
Members enter through birth, marriage,
adoption
o
Members leave by death
o
Roles of members change over time and
through the history of the group
Common to all definitions of family are that
families comprise more than one person with at
least one adult, and that these persons are related
to one another by blood or social contact.

Characteristics of Family

Families place a higher value on caring, long


and affection than other social groups
o
Family membership constitutes a
fundamental part of each individual's identity
Family endures through time
o
Despite conflicts, the family's bonds of
affection, a sense of responsibility and sense of
belonging draws them together
Family members have shared attributes
o

Basic areas of Family Function


Biologic

Reproduction
Child rearing/caring
Nutrition
Health maintenance
recreation

Economic

Provision of adequate financial resour


Resource allocation

1
1

Family membership implies a lifelong involvement


o
Membership in the family unit is virtually
permanent
Family relationships are primarily affectional in
nature
3 Family as a Unite of Care

Ensure financial security of members

Childless husband or wife or to empty nesters


whose children have grown and left home
Father, Mother (empty nest)

Educational

Teach skills, attitudes etc.

Psychologic/Affection

Promote the natural developmemt of


personalities
Three generations of more living in a household

either unilaterally or bilaterally extended


Offer optimum psychological
protection
Father, Mother, Children and Mother and in law

Father, Mother, Children, Nephews


Promotes ability to form a relationship with
people in the family circleBlended

Extended

Socio-Cultural

Remarried men and women living in a common


household with children from previous marriages
Socialization of children

"yours, mine, ours"

Father, Mother, Children and a child out of wedlock


Promotion of status and legitimacy

Kin network family

Types of Families
Nuclear

Consist of parents and their dependent children


occupying separate dwellings not shared with
members of the family of origin/orientation of their
spouse
Father, Mother and children
Father, Mother and Children, and Driver, Maid

Nuclear Diad
4 Family as a Unite of Care

Nuclear household or unmarried members living in


close geographical proximity and operating within a
reciprocal system of exchange of goods and services
Same compound, different house

Corporate/Communal family

Groupings formed for a specific ideological societal


purpose
Considered as an alternative lifestyle for people
who feel alienated from the predominantly
economically oriented society

Corporate family

o Work/Alumni etc etc


Communal family

o 'Moonies'
1
2

Monogamous: household of >= one monogamous


couple with children sharing common facilities;
socialization of the child is a group activity
Group marriage: household of adults and off
springs where all individuals are married to each
other and all parents to the children; develops
status system with leaders believed to have
charisma
a Highly formalized structure: Amish Community
in Lancaster Country Pennysylvania
a Loosely knit groups: Sta Cruz mountains near
Boulder Creek in California

5 Family as a Unite of Care

Institutional Family

The Filipino Family

Children in orphanages, residential schools or


correctional institutions

Family Social Class Patterns

1
2
3
4
5
1
1
2
3
4

Closely knit
Bilaterally extended
Strong family orientation
Authority is based on seniority/age
Externally patriarchal, internally matriarchal
High value on education of children
Predominantly Catholic (80% of the population)
Child centered
Average number is 5 (NEDA Statistics)
Environmental stresses: economic, political,
industrial/urbanization, health problems

Upper Class

Middle Class

Much more closely knit

Believes in hard work, initiative,


independence, responsibility, economic
security and self improvement through
education

Greater concern for


maintaining family name
and prestige

Like being touch, a bit defensive


Don't like being touch, very
direct to the point

6 Family as a Unite of Care