Professional Documents
Culture Documents
Orientation To Family Medicine
Orientation To Family Medicine
Contributors:
1. Zorayda Leopando, M.D.
2. Alejandro Pineda, Jr.,M.D.
3. Nelson Rodriguez, M.D.
4. Isabelita Samaniego, M.D.
Editors:
1. Rosalia Fabia-Bugayong, M.D.
2. Alejandro Pineda, Jr.,M.D. (1999)
1
___________________________________________________
THE
PHILIPPINE ACADEMY OF FAMILY PHYSICIANS,
INC.
___________________________________________________
FAMILY MEDICINE:
HISTORY AND PERSPECTIVE
2
FAMILY MEDICINE: HISTORY & PERSPECTIVES
ZORAYDA E. LEOPANDO, MD
HISTORICAL BACKGROUND
A. INTERNATIONAL PERSPECTIVES
There was a time when health care was provided by general practitioners right in
the patients’ homes. The emergence of the different clinical specialties and
subspecialties that focused on the different organ systems or diseases came about with
increased body of knowledge in medicine. Progress in technology and medical
know-how led to the establishment of medical centers and health care complexes ,
which eventually became the locus of health care and services. At the limelight were
specialties and subspecialties. It has been said that the art of general practice was not
emphasized in medical education and clinical practice. Medical graduates wanted to
become specialists as the emerging role models in medical institutions were the
specialists. Medical care naturally evolved into an organ or system focused practice
leading to a fragmented and depersonalized care. Curative medicine was given more
emphasis over preventive medicine. Health care was said to have become
fragmented, depersonalized and costly.
3
Together, the reports served as impetus for the development of Family Practice.
Each chronicled the progressive diminution of the generalist physician trained and
committed to the practice of continuing , comprehensive and personalized health care.
Thus, the concept of Family Medicine was introduced to fill-in the gap between medical
care and the needs of the people.
WONCA:
1. provides a forum for exchange of knowledge and information between
member's organizations.
2. encourages and supports the development of academic organizations
of general practitioners / family physicians
3. represents the educational, research and service provision activities of
general practitioners / family physicians before other world
organizations and forums concerned with health and medical care
In 1979, the WONCA arrived at a definition of what Family Medicine is during its
Regional Conference held in Manila, Philippines.
B. PHILIPPINE PERSPECTIVES:
Growth of Family Medicine in the Philippines:
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1970 Recognition as a Specialty Society by Philippine Medical
Association (PMA)
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1. DISTINGUISHABLE BODY OF KNOWLEDGE
By the end of the training, the physician should be able to provide first contact,
continuing and comprehensive care to members of families, taking into consideration
the socio-cultural and economic factors. Specifically, the graduate of residency
program should be able to gather, organize and record data; to assess data and
manage health problems in surgical and medical cases and to perform diagnostic
procedures.
6
The bases of these competencies are experiences of Family Physicians and
representative Family Physicians all over the country in coordination with
representatives of other specialty groups defined these.
FAMILY MEDICINE:
As an academic discipline, Family Medicine encompasses a distinct body of
knowledge appropriate to the needs of a changing society. It is centered on the family
as a basic social unit. It is not only disease-oriented but health-oriented which
emphasizes on the importance of disease prevention, health maintenance and curative
medicine.
FAMILY PRACTICE:
It is the art of how the body of knowledge is dispersed to the community. It refers
to care that is primary, continuing, comprehensive, preventive, curative, referring to
individuals, their family and community relationship. It encompasses ambulatory care,
home care and appropriate hospital care. It acknowledges the importance of practice
management.
FAMILY PHYSICIAN
The medical practitioner, who implements the principles of the discipline and
provides health care in specialty, is a family physician. The roles played are: healer,
teacher, advocate, manager, scientist, counselor and friend.
The clinical discipline with generalist's approach is Family Medicine. Except for
UST, Family Medicine undergraduate course is integrated with Community Health. In
institutions where there is Family Medicine programs, some of our colleagues
interchange Public Health, Community Health and Family Medicine.
There is a need for as distinct Family Medicine Course for the following reasons:
7
not be able to participate in the modules because it is impossible to leave their practice.
What is suggested is home or self-study technique. The problems anticipated in this
regard are mainly on logistics and human resources.
By the end of the training, the physician should be able to provide first contact,
continuing and comprehensive care to members of families, taking into consideration
the socio-cultural and economic factors. Specifically, the graduate of residency
program should be able to gather, organize and record data; to assess data and
manage health problems in surgical and medical cases and to perform diagnostic
procedures.
Projected Programs include: stronger Family Health Care, Emergency Medicine and
Community Health. Individualization of electives is based on interest of trainees and
needs of areas. There should also be Dispersal Program, and Faculty Development.
8
___________________________________________________
THE
PHILIPPINE ACADEMY OF FAMILY PHYSICIANS,
INC .
___________________________________________________
9
FAMILY AS THE UNIT OF CARE
NELSON RODRIGUEZ,MD
ARTICLE II SECTION 12 :
The state recognizes the sanctity of family life and shall protect and strengthen
the family as a basic autonomous social institution.
The state shall protect and promote the right to health of the people and instill
health consciousness among them.
ARTICLE XV SECTION 1:
The state recognizes the Filipino Family as the foundation of the nation.
Accordingly, it shall strengthen its solidarity and actively promote its total
development.
DEFINITIONS OF THE FAMILY
That social unit whose primary tasks are socialization of children and the
stabilization of adult personalities.
Rogers, 1973:
Murdock , 1965:
Gordon, 1978:
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Smilkstein, 1978:
Adult partners with and without children and single parents with children
who function in a setting where there is a sense of home, and who have an
agreement to establish nurturing relationships.
Berman, 1978:
United Nations:
CHARACTERISTICS:
1. closely knit
2. bilaterally extended
3. strong family orientation
4. authority is based on seniority / age
5. externally patriarchal, internally matriarchal
6. high value on education of members
7. predominantly Catholic (80%) of population
8. child-centered
9. average number of members is 5 (NEDA statistics)
10. environmental stresses: economic, political, urbanization and
Industrialization / urbanization, health problems
1. Lifelong involvement
2. Shared attributes
genetics - physical and psychological
developmental - shared home, lifestyle and social activities
3. Sense of belonging
security / defense against a potentially hostile environment
companionship
4. Societal expectations
sense of responsibility towards members
sense of responsibility towards others
basis of affection / care
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5. Built-in problems
generation gap
dependence of members
emotional attachment / involvement
FAMILY STRENGTHS:
A. The ability to provide for the family's needs.
PHYSICAL Space management, nutritionally balanced meals
family's general health status
EMOTIONAL Helping family members recognize and develop their
capacity
for sensitivity to each other's needs
SPIRITUAL Sharing of basic beliefs and cultural values
CULTURAL Sharing of basic beliefs and cultural values
B. Child-rearing practices and discipline:
The capability of both parents to respect each other's views and decisions on
child-rearing practices
If a single parent, the capacity of the single parent to be consistent and
effective in raising the child or children.
C. Communication:
the ability to communicate and express a wide range of emotions and feelings
both verbally and non-verbally.
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FAMILY HEALTH CARE
FAMILY STRUCTURE:
1. NUCLEAR:
The members of the nuclear family, consisting of parents and their still
Dependent children, ordinarily occupying a separate dwelling not shared with
members of the family of origin / orientation of either spouse…
2. EXTENDED FAMILY
unilaterally extended
bilaterally extended
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3. SINGLE PARENT FAMILY
children < 17 years of age living in a family unit with a single parent,
Another relative, or a non-relative
may result from the loss of spouse by death, divorce, separation, desertion
out-of-wedlock birth of a child
from an adoption
One parent is working outside the Philippines (OCWs, DHWs, etc.)
4. BLENDED FAMILY
1. BIOLOGIC - reproduction
- Child rearing / caring
- Nutrition
- Health maintenance
- Recreation
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FAMILY RELATIONSHIP, INTERACTIONS
AND
EFFECTS ON HEALTH CARE
3. YOUNGEST - demanding
outgoing
occasionally narcissistic
by nature are affectionate
D. FAMILY SET-UP
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___________________________________________________
THE
PHILIPPINE ACADEMY OF FAMILY PHYSICIANS,
INC.
___________________________________________________
16
FAMILY LIFE CYCLE
ISABELITA SAMANIEGO, MD
Families go through developmental processes.
"Between Families." It is the start of the family life cycle wherein the unattached
young adult has come to terms with the family of origin. At this stage, the young adult
formulate personal goals in developing as an individual, including forming a new family.
"The Joining of Families through Marriage" is very true in the Philippines; thus
Filipino families are bilaterally extended. This is the transition stage of the couple from
their lives as an individual to life as couple.
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STAGES OF MARRIAGE
a. Maintaining couple
4. Long-Term Marriage Farewells and Planning functioning
Stage
(25 + years) b. Closing or adapting
family home
This stage starts with pregnancy for the first child to emergence of adolescents. The
coming of children defines a new family status, as the wife becomes the mother, the
husband the father. During this stage also, the child starts going to school, which is his
first significant contact with people outside of the family. Conflict with practices in the
home and school regulations may occur during this stage.
A family with adolescents has generally reached a stage when the parents are
approaching a middle life stage and the grandparents are in the later stage. Hence, it is
not only teenagers but also their parents who are undergoing crisis (i.e. identity) at this
stage.
5. Launching Family
This stage begins when the first child leaves home and ends when the last child
leaves home. In the Philippines, this is prolonged because unmarried children usually
stay with parents. Launched children start their own family life cycle.
This begins with departure of last child and continues through retirement of one or
both of the couple and ends when both are dead.
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THE STAGES OF THE FAMILY LIFE CYCLE
4. Pre-employment
check up
Emotional:
1. Psychosomatic
problems
secondary to
new job, role
and peer group
2. Depression
secondary to
adjustment to life
away from
home, difficulty
in finding
employment
suitable life
partner parental
expectation
Social :
1. Peer group
pressure on
acquiring vices,
such as
alcoholism,
smoking
2. Fiancee
pressure for
marriage and
premarital sex
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Family Life Emotional Second Order First Order Problems
Cycle Process Changes Changes or Encountered at
Stage of Transition: in Family Status Tasks Involved Each Stage of the
Key Required to Cycle
Principle Proceed
Developmentally
Newly Commitment 1. Formation of 1. Establishing a Medical 1:
Married to the new marital system home base in
couple system a place to call 1. Episodic
2. Realignment of their own problems
relationship with
extended 2. Establishing a
families and mutually 2. early pregnancy
friends to satisfying
include spouse system for 3. STD
getting and
spending 4. Job-related
money physical
examination
3. Establishing 5. Gynecologic
mutually problem
acceptable
patterns of 6. Infertility
who does
what and who
is accountable
to whom
Emotional & Social
4. Establishing a 1. Depression due
continuity of to forced early
mutually marriage and
satisfying unwanted
sexual pregnancy
relationship
5. Establishing 2. Jealousy to job,
system of friends, and
intellectual previous
and emotional fiancee
communication
6. Establishing a 3. Emotional
workable problems
relationship relating to new
with relatives role as a spouse
(communication,
7. Establishing personalities and
ways of character
interacting with differences in
friends and habits and
associates in background)
the community
4. Problems
8. Facing the relating to in-
possibility of laws, friends,
children and peers and
planning for money
their coming
5. Demands of new
role
6. Problems of
adjustment to
office and work
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Family Second First Order Problems Problems
Life Order Changes or Tasks Encountered at Encountered at
Cycle Changes Involved Each Stage of the Each Stage of the
Stage in Family Cycle Cycle
Status
Required to
Proceed
Developmentally
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Family Emotional Second Order First Order Problems
Life Process Changes Changes or Encountered at
Cycle of Transition: in Family Status Tasks Involved Each Stage of the
Stage Key Required to Cycle
Principle Proceed
Developmentally
PARENTS:
Medical:
1. common medical
problems
2. OB-Gyne
problems
3. pre-menopausal
symptoms
4. alcoholism and
other vices
Emotional & Social:
1. Middle life crisis
2. male climacteric
3. extra-marital
affairs
4. insecurities
secondary to
changing
appearance
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Family Emotional Second Order First Order Problems
Life Process Changes Changes or Encountered at
Cycle of Transition: in Family Status Tasks Involved Each Stage of the
Stage Key Required to Cycle
Principle Proceed
Developmentally
23
Family Emotional Second Order First Order Problems
Life Process Changes Changes or Encountered at
Cycle of Transition: in Family Status Tasks Involved Each Stage of the
Stage Key Required to Cycle
Principle Proceed
Developmentally
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___________________________________________________
THE
PHILIPPINE ACADEMY OF FAMILY
PHYSICIANS, INC.
___________________________________________________
IMPACT OF ILLNESS
ON
THE FAMILY
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IMPACT OF ILLNESS
ZORAYDA E. LEOPANDO, MD
4. The interaction that takes place between the health care system and the
patient & his family are dependent on:
a. setting of care
b. type of cure
c. ability to pay
d. Flexibility/responsiveness of the health care system.
Disease: Illness:
- primary biologic & psycho- includes the sufferer's
Physiologic disorder. experience of the disease & the
broad range of dislocations felt
by both the sufferer and his
family
Deeply embedded in the social,
cultural & family context of the
person who is ill.
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DISCOVERING THE MEANING OF ILLNESS FOR THE FAMILY
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Stage I - ONSET OF ILLNESS
The warning sign of malaise which initiates preliminary stage of the illness
trajectory.
The stage experienced prior to contact with medical care providers. Medical
beliefs & previous experiences provide influence to meaning of illness.
Nature of onset may play an important role on impact of illness on a family &
some meaning of experiences are formulated here.
1. explore routinely the explanatory model & fear that patients bring to the
Clinic set-up.
2. with inappropriate label of illness, acknowledge & explore conflict the
patient maybe experiencing
3. explore several aspects of pre-diagnostic phase of patients & families
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2 PLANES OR AREAS BY WHICH FAMILY & PATIENT REACT AND
ADJUST:
29
3. The physician should help the family assess the likely effect of the
illness on the family, predict problems likely to arise; develop plans for
realistically coping with them; and assess the family capabilities to deal
with such stress.
4. The physician should briefly help the family understand some of the
problems as well as benefits to be expected from family & friends who
offer support.
5. Offer alternative interpretation of proposed therapeutics-bolster family's
denial & inability to accept reality.
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STAGE IV - EARLY ADJUSTMENT TO OUTCOMES - RECOVERY
Return from the hospital or major therapy initiates a period of gradual
movement from the role of being sick to some form of recovery or adaptation,
with corresponding adjustments of relation within the family.
Experience of recovery or adjustment to the illness outcome is an important
phase for patients & families. It varies according to the type of outcome
anticipated.
Simplest outcome is return to full health
* Gains from illness experience
* Patient nurtured & allowed to take over the abandoned obligation,
New responsibilities and privileges when sick.
Partial recovery followed by a period of waiting to learn if disease will
return or fear of death, because of long period of waiting. They
maintain constant sense of vulnerability.
Recovery is quite different if it requires acceptance of a known
permanent disability.
For Acute Illness: There is potential for crisis especially when family routines
are suspended. Emotions are high & can lead to anger especially if the
family perceives that the care given by the doctor is not satisfactory. Because
of suddenness of illness, family may find it difficult to face the stress.
For Terminal Illness: This is highly emotional & potentially devastating. The
moment of diagnosis of a major debilitating or terminal disease is often
remembered by patient in their families as the single most difficult time of the
entire illness experience. As a reaction to shattering diagnosis, the patient &
his family anticipate grief reaction. If the family is functional, members will be
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drawn close together to provide care & support to the patient & to each other.
If the family is dysfunctional, it can be the seed for future family discord and
breakdown.
The initial response in diagnosis of terminal illness is that of shock &
overwhelming anxiety. As they respond to the pain with denial and
disbelief, the patient may say, "this could not be happening to me."
The Physician can:
(1) Assist the patient and the family in relating to health care system;
(2) Aid the patient & the family in efficient & functional readjustment;
(3) Provide quality care. Home care is the best & most accepted & the
last demanding, thus it should be facilitated.
FAMILY IN CRISIS
Family is in crisis when it moves into a state of dis-equilibrium in response
to any situation or event that it cannot resolve by use of available
problem-solving skills, behavior or resource. When illness is perceived as threat
to its equilibrium, a crisis response is set in motion.
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___________________________________________________
THE
PHILIPPINE ACADEMY OF FAMILY PHYSICIANS,
INC.
___________________________________________________
TOOLS
IN
FAMILY ASSESSMENT
33
TOOLS FOR FAMILY ASSESSMENT
ALEJANDRO V. PINEDA, JR.,MD
The patient is a member of a family and studies have shown that the way a patient
reacts to an illness depends a lot on his family. Many health problems seen in practice
can neither be understood nor successfully dealt with when considered as isolated
phenomena affecting only one person. The works of several investigators lend
credence to the hypothesis that the treatment of the family as a unit yields more certain
and complete diagnosis, better medical outcome, and better benefits with regard to
prevention. Thus, it depends entirely on the family physician to what level he will
involve the family in evaluating a patient's problem. This discussion presents an
overview of family systems medicine and outlines the way in which a practicing family
physician can incorporate family orientation into clinical practice.
A good way to obtain and record this information about the family structure is to
complete a Family Genogram. The Family Genogram is a scheme or graphic chart
representation of both the genetic pedigree of family and key psychosocial and
interactional data using standardized symbols.
B. Functional Chart
This gives a more dynamic image of the family, especially of relationship of
members. It allows one to judge the totality of the family unit, its strengths (as in strong
bond between the husband and wife) and weaknesses (as in the presence of marital
discord or separation of the parents) and its ability to withstand future stressful
situations (as knowing those who are actually living together in the household).
C. Family Illness/History
This denotes the presence of inherited diseases or familial tendencies indicating
potential problems in the family.
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Step Two: Understanding Normal Family Function
2. Families establish autonomy and independence for each person in the system,
which enhance personal growth of individuals within the family. Each
individual in the family has defined roles to play within and outside the limits of the
family. Thus, while families do a lot of things together, they do other things
separately. The essence of the autonomy function is the ability to maintain the
integrity of each individual member.
3. Families create rules that govern the conduct of the family and of the
individuals within the family. These rules often deal with interaction patterns,
privacy, authority, and decision-making. These are rules of behaviors that are
mostly unwritten and become apparent when an outsider visits the family.
5. Families communicate with each other. These are mostly verbal, non-verbal, and
implied messages. Other functions become impossible without communication.
Normal Families
RIGID
STRUCTURED
CHAOTIC
ADAPTABILITY
35
Before progressing to a pragmatic format for family study, a model is needed to
present an empirical view of the response that may result when family members
experience stressful life event. This is designed to reflect the pathways that must be
explained in assessing these responses.
Family in
Functional Stressful
Equilibrium (1) life event (2)
(Functional or nurturing)
Adaptation
[Coping] (5)
Resources
Adequate (4)
Family in
Disequilibrium (3)
Maladaptation
Pathologic Defense
Mechanism (9)
A stressful life event, which occurs in a family in functional equilibrium, puts the
family in Disequilibrium. If the resources are adequate adaptation or coping are utilized
to bring back the family into a functional equilibrium.
However, if the resources are inadequate, crisis ensues. But, if the extra-familial
resources are adequate, adaptation will occur to bring back the family into a functional
state. If still extra-familial resources are inadequate, some forms of maladaptations of
the family members are seen. Here, pathologic defense mechanisms such as denial,
repression, somatization and projection are employed.
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12. Has this family not used community resources at times when they would have been
appropriate?
13. a. what does each parent expect of each child, both on day to
day basis & for the future?
b. What do the children expect of each parent?
c. Are these expectations realistic?
14. What does each member of the family have to do to get attention?
15. How much tolerance for individual differences is there in the family?
16. What are the goals, interests, and values of the family?
17. Do all the family members work together toward these goals?
18. What is the educational level & financial status of the parents?
Meeting the family as a unit has become the standard medical practice in the
context of a patient with life-threatening ailment who is brought to the emergency room,
chronic illnesses or even death of a family member. However, the process involves
transfer of clinical information from the doctor to the family members.
To assess the family, the flow of information should be otherwise. The family
physician should be able to listen more and talk less. More often than not, family
physicians are unprepared to convene families for family assessment. Thus, family
assessment tools have been devised to aid the family physician in practice. Each of the
family assessment tools has its own advantages and disadvantages. A common
waterloo of a lot of these instruments is that they obtain data from only one family
member. But this does not deter the family physician to use such tools often.
1. Family Genogram
2. Family Circle
3. Family APGAR by Smilkstein
4. FACES (Family Adaptability and Cohesion Evaluation Scale)
5. FES by Moos (Family Environmental Scale)
6. Clinical Biography & Life Events
7. SCREEM
8. DRAFT (Draw A Family Test)
FAMILY GENOGRAM.
Uses/Informations:
1. records names and roles of each member of the family.
2. separates extended family into several household
3. documents medical problems of each member of the family.
4. documents significant dates in the family history.
5. reveals more subtle information about the family.
The Genogram is a very excellent tool to use in learning about the family
structure. However, it has limited role in assessing family functions. To complete a
basic family Genogram, 10-15 minutes are needed making it impractical in routine clinic
visits. It has been suggested to place the basic structure of the Genogram in the chart
to shorten time consumption.
Thrower has described this family assessment technique, ET al. Family circles are
often used on individuals, but they can be applied to small groups as well. The family
physician draws a large circle on a piece of paper and instructs the patient as follows:
37
The advantage of this particular tool is the fact that the family physician can see
another patient during the time the other patient is busy completing the Family Circle
technique. Actual assessment of the family occurs when the patient explains the
diagram he or she made. A disadvantage of this tool is the difficulty one encounters in
standardizing and interpreting this particular assessment instrument.
FAMILY APGAR.
1. Adaptation is the capability of the family to utilize and share inherent resources,
which are either Intra-familial or extra-familial.
3. Growth refers to both physical and emotional growth. This measures the
satisfaction of the available freedom to change.
4. Affection is how, emotions like love, anger, and hatred are shared between
members. This measures the members' satisfaction with the intimacy and
emotional interaction that exist in the family.
5. Resolve refers to how time, space, money are shared. This measures the
members' satisfaction with the commitment made by other members of the
family.
1. When the family will be directly involved in caring for the patient.
e.g. Post MI/CVA patients with specific disabilities that will require rehabilitation
therapy.
2. When treating a new patient in order to get information to serve as general view of
family function. All Family Health Care Programs shall have the initial APGAR
scoring of families enrolled in their clinic.
3. When treating a patient whose family is in crisis e.g. family therapy for drug
addicts.
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FAMILY APGAR QUESTIONNAIRE
PART I
Almost Some of Hardly
Always the Time Ever
TOTAL
PART I: Helps define degree of patient's satisfaction or dissatisfaction with family
function.
FAMILY APGAR II
Questionnaire:
If you don't live with your own family, How you get along?
list the persons to whom you turn to
for help
Part II delineates relationship with other members. Also, it identifies persons who
can give assistance to the patient. And lastly, it indicates conflict not revealed in Part I.
The scoring:
almost always = 2 points
some of the time = 1 point,
hardly ever = 0 point.
39
FILIPINO FAMILY APGAR QUESTIONNAIRE
PART I
SAGUTIN AND MGA SUMUSUNOD AYON SA RELASYON NINYONG MAG-ANAK.
PALAGI PAMINSA HALOS
N-MINSAN HINDI
(2) (1) (0)
A Ako’y nasisiyahan dahil nakakaasa
ako ng tulong sa aking pamilya sa
oras ng problema.
PART II
Sino-sino ang nakatira SA inyong tahanan? Paano ang iyong relasyon?
PANGALAN RELASYON KASARIAN MABUTI HINDI HINDI
GAANONG MABUTI
MABUTI
1.
2.
3.
4.
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FACES (Family Adaptability and Cohesion Evaluation Scale)
The basis of this assessment tool in the Olson's circumflex model of Family Function.
Face is a self-reported scale wherein the patient rates his or her family on 30 items on a
1 to 5 scale.
We know that illness is not randomly distributed within or among population. Some
people get sick more often than others. The individual's experiences with health and
sickness are connected with his personal life. If doctors understand the life story and
the connections between a person's experiences of health and illness, they might be
better doctors. Clinical biographies and life charts are valuable tools, which can
facilitate analysis of connection. If life events and clinical events are put side by side
according to dates of occurrence, we will be able to show the correlation between the
two.
SCREEM
Resource Pathology
______________________________________________________________________
Social
Social interaction is evident among
family members. Family members have * isolated from extra-
well-balanced lines of communication familial
with extra-familial social groups * problem of over-
such as friends, sports, clubs, and commitment
other community groups.
Cultural
Cultural pride or satisfaction can
be identified, especially in * ethnic/cultural
distinct ethnic groups. Inferiority
Religious
Religion offers satisfying spiritual
experiences as well as contacts with * rigid dogma/rituals
an extra-familial support group.
Economic
Economic stability is sufficient to * economic deficiency
provide both reasonable satisfaction * inappropriate economic
with financial status and an ability plan
to meet economic demands of normative
life events.
Educational
Education of family members is
adequate to allow members to solve * handicapped to
or comprehend most of the problems comprehend
that arise within the format of the
life style established by the family
Medical
Medical: Health care is available
through channels that are easily * not utilizing health
established and have previously care facilities/
been experienced in a satisfactory resources
manner.
______________________________________________________________________
41
DRAW-A-FAMILY TEST: (D.R.A.F.T.) COMMUNITY-BASED FAMILY ASSESSMENT
TOOLS
After interview, the family will be informed of the purpose of the assessment tool,
which was to gain more insights into family situations in order to have a better
understanding of the nature of their problems. The family can be seated around a table
where each family member can be provided with a blank, clean unruled bond paper and
a lead pencil with an eraser. Subjects are to be instructed as follows: “Kindly draw your
family and its members, the whole body, you may include and exclude anybody you
wish. There’s no right or wrong, you can draw any member of your family who comes
first into your mind. Take your time, there are no hard and fast rules.”
The examiner notes subject’s comments, sequence in which the parts are drawn
and other procedural details. Drawings will be analyzed using the interpretations made
by a Clinical Psychologist based on Draw-A-person Test and Kinetic Family Drawing.
Projective drawing like DRAFT has been found to be useful and revealing
because of the following reasons:
The DRAFT does not however measure the person’s inherent ability to draw but
how he pictures his family members. The configuration of the father, mother and
siblings, the sequence of succession, quality of lines and significant details like
omissions of some parts are all-important in the evaluation and interpretation.
Identifying the possible risk factors that are present in each member of the family using
this screening device is one of its advantages.
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FAMILY ASSESSMENT MODEL [ San Jose State University (1982) ]
I. FAMILY IDENTIFICATION
A. COMPOSITION - who are the family members currently living in the household?
Are they kin or non-kin? What are their ages?
FAMILY MAPPING
____ / ____ A single line with a break in the middle indicates dysfunction.
An arrow pointing away from the system signifies escape from the
system.
An open ended arrow with its open end embracing two individuals
and the pointed end pointing to a third signifies that the third person
is being triangulated by the conflict between the other two.
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REFERENCES
TEXTBOOKS
Essentials of Family Medicine / Philip D. Sloane, MD, Lisa M. Slatt, M.Ed. and
Richard M. Baker, MD; Williams & Wilkins - Baltimore Hongkong London Sydney, 1988.
Family Medicine: Principles And Practice, Fourth Edition / Robert B. Taylor MD,
editor: associate editors, Alan K. David MD, Thomas A. Johnson, Jr. MD, D.Melessa
Philipps MD and Joseph E. Sherger MD, MPH.; Springer-Verlag Heidelberg New York,
1994
Family Medicine: Principles And Practice, Third Edition / Robert B. Taylor MD,
editor: associate editors, John L. Buckingham MD, E.P. Donatelle MD, Thomas A.
Johnson, Jr. MD and Joseph E. Scherger MD; Springer-Verlag New York Berlin
Heidelberg London Paris Tokyo, 1988
Family Therapy and Family Medicine: Toward the Primary Care of Families /
William J. Doherty and Macaran A. Baird; The Guilford Press New York & London, 1983
Textbook of Family Practice, 4th Edition / Robert E. Rakel, MD; W.B. Saunders
Company-Philadelphia London Toronto Montreal Sydney Tokyo, 1990
PROCEEDINGS:
Making Medical Practice and Education More Relevant to People’s Needs: The
Contribution of the Family Doctor, A Working Paper of the World Health Organization
and the World Organization of Family Doctors, From the Joint WHO_WONCA
Conference in Ontario, Canada November 6-8, 1994.
Making Medical Practice and Education More Relevant to People’s Needs: The
Contribution of the Family Doctor, A 1998 Progress report on the 1995 World
Health Organization and the World Organization of Family Doctors Working Paper
DRAFT 3.
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JOURNALS:
Liz Corazon Cabahug, MD and Alejandro V. Pineda, Jr., MD. Family APGAR: Its
Validation Among Filipino Families, Emergency Room, Outpatient Department,
Santo Tomas University Hospital, January to April, 1992. The Filipino Family
Physician, July-September, 1993; Volume 31 Number 3: 69-80.
Steven R. Hahn MD, Joel S. Feiner MD and Evan H. Bellin MD; the Doctor-Patient-
Family Relationship: A Compensatory Alliance. Annals of Internal Medicine, 1
December 1988; 109:884-889.
Alejandro V. Pineda, Jr., MD. Family Medicine - Attitudes and Concepts of Filipino
Physicians towards the Specialty. The Filipino Family Physician, July-September,
1989; Volume XXVII -, No.3: 10-12.
Goran Sjonell MD Ph.D. The Family Doctor 6 WONCA with a grant from Glaxo Group
Research Limited, 1995.
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