Y





Y
u Patient coming in to the clinic with health
problem cannot be fully understood if only
the pathophysiology of medical problem is
considered

u Family relationship + family social system +

family cultural system = better evaluation &
better health care

u Family systems approach to common clinical

situation can facilitate a new level of
understanding of patients problem
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
 V


  
V

 

 

u V
P 1

R

FAM
V RU UR

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

   
V


u mnow individuals in the family

u names, place of residence, specific roles in

the family, stage of family in family life
cycle, significant dates in the family

u complete a family genogram

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

  
u Mery excellent tool in learning about family
structure
u Records names and roles of each member of the
family
u Veparates extended family into several
household
u Documents medical problems of each member
of the family
u Documents significant dates in the family history

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

  

u raphic representation of following

components of a family:
1. Family ree
2. Functional hart
3. Family illness/History

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

 male death

female index patient

spontaneous abortion marital discord & F


pregnancy adopted

cause of death 

marriage and year

!"#
separation & year not married

conflictual relationship distant relationship

close relationship overly close

dominant relationship marital discord

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.46

 
u $   %





  &

'
 (
') $


u  )
 (



  (

  

( &* )(  * 
 
'


()

u 

') +

,

($
u +

'



')
 *

) 
u 

)

 (( (




'
(
)
$
 (
-'
.
 
 &'
 (
'* 

*/
u 0
'
'*

*'
+
 
'
 
* $')
',$
' +

 

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

1

u ives a more dynamic image of family

u Allows one to judge totality of family unit
(strengths & weamnesses, ability to
withstand future stressful situations)

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

  VV21V

u Denotes presence of inherited diseases or

familial tendencies indicating potential
problems in the family

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

 V  0

V+'
&"% 5
 &
&3% 
&4#
 !!" !3 %





 6 ,   

 V$

3# 3" 3 %4 % % !

'$&33 +
&3!



&% 
& 
&

& & ! 0 &4

cancer asthma

allergy




 

cardiac pathology 
u V
P 2

0 V0



Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.37

   $  
Provide support to each other

stablish autonomy & independence for each

person

reate rules governing conduct of family & of

individuals within the family

Adapt to change in environment

ommunicate with each other

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.37

u V
P 3

  VV VV 

VV 
V

V



 0

0





Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39

 VV VV 
V
 V
1. Family enogram
2. Family ircle
3. Family Map
4. Family APAR by Vmilmstein
5. linical Biography and ife
vents
6. VR

M

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39

 




 '

(
' '

((

  

$

7
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39
 

6

V




  

 5


amen from the Daffodil case presentation
 
u Developed by Valvador Minuchin
(Psychiatrist--Family therapist)
(Psychiatrist

u Facilitates communication of information

about a family system to colleagues so
that they can be understood

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.50

functional relationship

dysfunction

over--involved relationship with plenty of

over
intrusion

rigid boundary where rules are clear but non-

non-negotiable

clear boundary but negotiable

boundary that is diffuse or unclear

presence of coalition or alliance between these people

escape from the system

third person is triangulated by conflict between the

other 2
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.50
amen from the Daffodil case presentation
 

u Rapid screening test instrument for family

dysfunction
u Has adequate reliability and validity to
measure individuals level of satisfaction
about family relationships

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40

 

u A ADAP A 
u P PAR 
RVHP
u  R
H
u A AFF
 
u R R
VM

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40
u ADAP A 
u apability of family to utilize & share inherent resources
(intra/extra--familial)
(intra/extra
u PAR 
RVHP
u Vharing of decision-
decision-maming; measures satisfaction attained in
solving problems by communicating
u R
H
u Physical & emotional growth; measures satisfaction of
available freedom to change
u AFF
 
u How love, anger, hatred are shared between members;
measures members satisfaction with intimacy & emotional
interaction existing in the family
u R
VM

u How time, money, space are shared; measures members
satisfaction with commitment by other members of family
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40
 
 


'
'8
1.
hen family is directly involved in caring
for the patient
2.
hen treating a new patient in order to
serve as general view of family function
3.
hen treating a patient whose family is
in crisis
4.
hen patients behavior mames you
suspect a psychosocial problem possible
due to family dysfunction
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40
 ALMOST SOME OF HARDLY




 ALWAYS THE TIME EVER
Score = 2 Score = 1 Score = 0
  

 



 

 
   
2  

  



  

    



 
  


 
   
 
 
 

      





   

 
 
 
 

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.41

u VR:

8 10 HH FU A

47 MD
RA
 D VFU A

03 V
M
R
 D VFU A

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.41

 A BRAPH & F


M
 V
u Maluable tools which can facilitate analysis
of connection

u ndividuals experiences with health and

sicmness are connected with his personal
life

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48

 .
- 9
(
:0(( ';



   /

!#< ' '



!#<
!#%<< V)+

!#%
!!<< : 
  +
;
!!
< 0(($ 

!!<< V
.$5 
'
!!
!!4 < 
 ))
 ))   
  <<*

  
!!!<< ' 


!!!
<< %
' 



< 
   ( ))
 <
< :$
 
  ((

;

:
*) (

'; 3  


<< :
*) (

';


3<<   


3
< 
   *  ))

<< 

)



"<< 5)

'
"
< 1  =
'
=
'


+

 V 
u mportant as to assess familys
capacity to participate in
provision of health care and its
capacity to cope with crisis

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48

SCREEM
RESOURCE
Social interaction is evident among family members. Family
SOCIAL members have well-
well-balanced lines of communication with
extra--familial social groups.
extra
Cultural pride or satisfaction can be identified, especially in
CULTURAL distinct ethnic groups.

Religion offers satisfying spiritual experiences as well as

RELIGIOUS contacts with an extra-
extra-familial support group.

Economic stability is sufficient to provide both reasonable

ECONOMIC satisfaction with financial status and an ability to meet
economic demands of normative life events.
Education of family members is adequate to allow members to
EDUCATIONA solve or comprehend most of the problems that arise within
the format of the life style established by the family
L
Health care is available through channels that are easily
MEDICAL established and have previously been experienced in a
satisfactory manner
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48