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IMPACT OF

ILLNESS
ON THE FAMILY
(dampak sakit thd kelg)

Tim FOME
Fakultas Kedokteran Universitas Andalas

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The good physician treats the disease; the great
physician treats the patient who has the disease
(mngobati peny><mngobati org yg sakit)

Sir William Osler


Subjective Features of Practice
(gmbarn suby dlm paraktek)

• Health Beliefs (kyakinan kes)


• Somatisation
• The ‘Meaning of Illness’(arti penyakit)
• Ritualistic Chronic Care (tata cara prawtn
peny kronik)

• Fear of Disease (ktakutn akn peny)


• Autonomy & Empowerment
Michael Boland, 2000
(pmbrdyaan)
Importance Of Studying
The Impact Of Illness
(pnting memplajari dampak dr sakit)

• Causes suffering for the family


• (msebabkn pnderitaan thd kelg)
• Can be disruptive to family life and
hazardous to health (mggu khdupn kelg dn
brbhaya thd kes)
• Embedded in a whole matrix of difficult
family problems (tertanam dlm ksluruhan
matrix kelg yg sulit)
Major
Illnesses:(peny
utama)
Involving loss of : (mliputi
hlgnya):
body parts (bgn tubuh)
ability to carry out normal
functions (kmampuan u
mnjalnkn fgsi normal)
sense of self-esteem (rsa hrga
diri)
dreams and plans for future
(mimpi dn rncna u msa dpan)
sense of invulnerability (rasa
kebal)
Investigate illness
• Health belief model of
patient (model
keyakinan sehat dr
px)
• Broad set of
experience and
concerns of patients
(brbagai pngalamn dn
kekhawatrn px)
• Meaning of illness for
the family (makna
sakit u kelg tsb)
Ecological-transactional model of health, sickness and
family-physician care
Individual
Environment
Microsystems Biologic factors
Psycho-cultural
Exosystem factors
MD-Patient Adaptive capacity
Macro system
transaction
Routine
Ceremony
Drama

Health seeking process


Symptom definition
Role shift
Consultation
Healing action Miller, 1990s
Adaptation
Stages in family illness trajectory

• Onset of symptoms
• Reaction to diagnosis
• Major therapeutic efforts (upaya th/utama)
• Early adjustment to outcome
(pnyesuaian awal thd sakit)
• Adjustment to permanency of the
outcome (pnyesuaian thd hsil akhir)
Stage 1: Onset of symptoms
• Experience prior to Lessons for MD:
contact with MD • Explore explanatory
• Issues on acute vs model and fear of patients
chronic onset • Acknowledge and explore
possible conflict
• Characteristics of • Explore aspects of
experience prediagnosis phase
• Impact on family
Stage 2: Impact phase, reaction to
diagnosis
Emotional Plane Cognitive plane
• Onset • Phase 1: Tension/
• Emotional upheaval Confusion
(prgolakn emosi)
• Phase 2: Increased
• Accommodation
tension/ depression
(pnyesuaian)
• Phase 3: Acceptance
Stage 2: Impact phase, reaction to diagnosis

• Clinical judgement on • Acknowledge feelings


(akui prasaan)
disclosure of
diagnosis (pnilaian klinis • Appropriate treatment
thd pngungkapn D/) explained (jlskan
pngobatn yg tpat)
• Explain diagnosis
• Reassurance, support • Help family
and encouragement understand and cope
(kpstian, dukungan, with illness (bntu kelg
dorongan) mngrti dn mngatasi peny)
Stage 3: Major therapeutic efforts
Clinical issues on planning:
• Psychologic states (kead
psikologis)
• Assumption of
responsibilities (anggpn u
brtanggung jwab)
• Economy
• Lifestyle and cultural
characteristics
• Effects of incapacitation
(efek dr ktdmampuan)
Stage 3: Major therapeutic efforts
Lessons for MD
Logistic problem of • Remain open to
hospitalization family (tetap trbuka u
kelg)
• Father • Deal with variables
• Mother • Work with patient/
family
• Children
• Coordinate
• Geriatric
• Anticipate
Stage 4: Recovery, early adjustment
to outcome

Type of outcome Lessons for MD


• Deal with immediate
effects of trauma
• Simplest • Alleviate anxiety, assure
• Psychologic support
• Explore level of
• Partial recovery understanding

• Permanent
Stage 5: Adjustment to permanency of
the outcome

Second crisis
• Acceptance of
outcome

For MD:
• Help family cope
Economic Impact of Illness

• Emotional trauma
• Social dislocation
• Economic catastrophe
Categorization of chronic illness

• Onset: Acute, gradual


• Course of chronic diseases:
progressive, constant, relapsing
• Outcome--> fatal?
• Incapacitation: cognition, sensation,
movement, energy production,
disfiguring, social stigma

Roland
Time phases of chronic illness

• Crisis phase
• Chronic phase
• Terminal
phase
Health seeking process
Role shift

Symptom Consultation Healing Adaptation


Definition Action
Self care Self
Physiologic Lay referral Family
consequences network Adherence
Folk Healer
Conceptual
consequences
Professional
healer

Chrisman, modified
“Caring without science is well-intentioned
kindness, but not medicine. On the other hand,
science without caring empties medicine of
healing and negates the great potential of an
ancient profession. The two complement and
are essential to the art of doctoring.”

Bernard Lawn, 1996