Family as a Unit of Care

Alex J. B. Alip, Jr., M.D., FPAFP

Chairman and Associate Professor
Department of Family and Community Medicine
University of the Philippines
Concept why family-oriented medical
care; why study the family
Patients are linked with and lives within a larger context the family
Potential source of problem, also a major resource
A sense of responsibility towards its members
Views symptoms in the context of a persons significant others
Family care:

Taking care of all individuals in the family one by

one
Basic premises

Family-oriented medical care is based on the biopsychosocial

model
The primary focus is the patient in the context of the family
-source of many health beliefs and
behavior
-valuable resource for management
-stress in a family can manifest as physical
symptoms
-somatic symptoms serve an adaptive function
Influencing family members to change factors affecting an
individuals health
Dealing with the family as an object of management
Basic premises (2)

The patient, family and physician are partners in health care

-therapeutic triangle
The physician is seen as a part of rather than apart from the
treatment system
- biomedical: physician as outsider
Definition

Sociologic enduring social form in which a person is incorporated

Biologic genetic transmission unit
Psychologic matrix of personality and the most intimate emotional
unit of society
United nations: a group of people related by blood, marriage or
adoption, which live together in one household
Definition (2)

A small social system made up of individuals related to each other,

biologically or by strong affections and loyalty, that comprises a
permanent household (or cluster) & persists over decades. Members
enter thru birth, marriage or adoption and leave by death; roles of
members change over time
Characteristics of family

Family membership implies a lifelong involvement:

no exclusion on the basis of inability to function or a change in priorities
Family relationships are primarily affectional in
nature:higher value on caring than other groups / fundamental part
of an individuals identity
Family endures through time: identification of self as part of
family / sharing bonds of affection, a sense of responsibility, a sense of
belonging
Family members have shared attributes: a common
background
Basic areas of family function

Biologic: reproduction, childrearing, nutrition, health

maintenance, recreation
Economic: financial security & resource allocation
Educational: teaching attitudes and skills
Psychologic / affection: development of personality and
relationships
Socio-cultural:socialization and maintenance of status
Types of families

Nuclear parents and their still dependent children,

occupying a separate dwelling; economically
independent, subsisting on the earnings of the
husband
Nuclear family dyad childless or empty nesters
Extended family three generations or more, living
in a household either unilaterally or bilaterally
extended
Types (2)

Kin network family nuclear households or

unmarried members living in close geographical
proximity and operating within a reciprocal system
of exchange
Single parent this consists of only one parent with
one or more children, an arrangement resulting
from divorce, separation, adoption, or working
away from the family
Types (3)

Blended family remarried men and women, living

in a common household with children from
previous marriages. The new family may have
offspring of its own
Communal / corporate family groupings formed
for specific ideological purposes. Considered as an
alternative lifestyle for people who feel alienated
from the predominant society
Institutional family living in orphanages, other
institutions
Areas of family participation in wellness

PRIMARY PREVENTION
LIFESTYLE: diet, habits, leisure activity
HEALTH MAINTENANCE: immunization,
screening activities
FAMILY LIFE EDUCATION:
sexuality, marriage, pre-natal care, problem of
aged members, personal hygiene & sanitation,
health risk behavior, disease prevention
Areas of family participation in wellness

SECONDARY PREVENTION
Shared responsibility between patient, family
and doctor
Monitoring of well-being is done by the
doctor & the family
Encourage sick members to seek appropriate
help
Compliance monitoring
Areas of family participation in wellness

TERTIARY PREVENTION
Balanced support between compliance
monitoring & independence of chonically-ill
member
Adjustment of all members in the different
aspects of life due to illness in the family
Coping with crisis: dying family member
The Filipino family

Closely-knit
Bilaterally extended
Strong family orientation
Authority is based on seniority / age
Externally patriarchal, internally matriarchal
High value on education
Predominantly catholic
Child centered
Environmental stresses