Family Life Cycle

1. Family Life Cycle --As applied to Family Practice

2. Family Life Cycle (FLC): bring-clinic/hospital messages • What is the concept about? • What is the relevance & application? • What are the useful tools to leverage the idea of FLC?

3. Background • Family physicians see as many as 50-75% of patients having psychosocial precipitant (c.f. biomedical) as their main cause of visit (Rakel R.E. Principles of Family Medicine Chapter 9 The Family Life Cycle)

4. Areas of possible psychosocial problems • Work: Type, workload, work environment, goals, work satisfaction • Family: (1). Present family (change of structure & function); (2). Extended family: parents & relatives (3). Growing environment: Family tree • Sex

5. Family structure • (1). Nuclear family: the couple & family • (2). Extended family: couple’s parents & other relatives • (3). Alternate family: Single parent family, adopted family, same sex family

6. Case Scenario • Frank, 15 y.o IDDM • Problem-free since IDDM Dx 4 yrs ago • Recently freq. Admission: • Not eating properly, not taking insulin well • Not monitoring H’stix, started smoking • Upset about his parents setting up many rules

7. Frank’s parents are very anxious… • You’re Frank’s family doctor, what is the problem with Frank’s compliance? • How can you help?

8. Apply FLC in the context of Adolescent Development • Changing goals in life: • Popularity among peers • Building up of self-confidence • Fear of being rejected • Struggling for independence & respect • Social experimentation

9. The lesson… • Understanding the goals/tasks in different stages help the family doctor to address these issues

10. 2 Fundamental concepts in FLC • (1). Family: Structure & function as dynamic inter-personal relationships  Change in one affects whole system • (2). Each stage of FLC has major events requiring adjustment: ( stressful if fail Family Dysfunction)

11. Stages in FLC • Courtship • Marriage (Family Formation) • Child bearing (1st to multiple) • Child rearing  • Child Launching (1st to last leaving) • Empty nest • Retirement Death

12. Features of FLC • Change over time • A beginning & an end • Developmental process with sequential stages • Each stage has specific task • Normal transitional stress Anticipatory counselling

13. Role of each family member • Father: bread-winner; organizer; husband • Mother: Home-maker; mother; wife • Child: leaner; social role, etc.

14. Case Scenario 2 • 18 y.o Catherine • soon leaving her family in HK to study Medicine • Become “independent” • Visit her family doctor for her school body check-up

15. What are the developmental tasks catherine has to complete?

16. The Unattached Young Adult • (1). Accept separation from her parents • (2). Establish personal independence • (3). Develop own behaviours, values, judgement, attitudes, skills • (4). Develop intimate & love relationship • (5). Career development

17. Relevance of FLC to Primary Practice (1) • Sudden change in role (external) or failure to cope with stress in changing (internal) family dysfunction problems surfaced as symptoms

18. Relevance (2) • BUT it is difficult to discover the real origin of these symptoms… •  Hence the need to recognize (1). Normal function of family (2). Criteria for adequate functioning (3). Symptoms suggesting dysfunction

19. Normal Functions of the Family • SCREEM • S---Socialization • C---Cultural • R---Reproductive • E---Economic • E---Emotional • M---Medical

20. Criteria for adequate functioning • APGAR (Useful for quick assessment of family) • A---Adaptation • P---Partnership • G---Growth • A---Affection • R---Resolve

21. Symptoms suggesting family dysfunctioning… • Can be physical/emotional/mixed: • (1). Chronic anxiety & depression • (2). Chronic pain • (3). Primary complaint of chronic fatigue • (4). Insomnia

22. Symptoms suggesting Family Dysfunction (Cont’d) • (5). Multiple pediatric complaints despite repeated child-carer education • (6). Repeated visits by members of the same family for minor, vague symptoms • (7). Substance abuse

23. Case Scenario 3 • Chi-Wai, a 28 y.o married man • His wife is pregnant • Finding difficulty in sleep & concentrating in his work

24. The concerns of Father-to-be… • Increasing responsibility • Obstetric problems • Uncertain Paternity • Financial concern • Social concern • Loss of spouse & child • Being replaced by newborn

25. Family Genogram as a tool • A tool to record the family history • A picture > 1000 words • A matter of fact way of sensitive data collection • Set the scene that doctor is interested in patient’s family • A 3-generation genogram may unravel repeating family patterns • Useful in Dx & Mx of patients

26. 2 important points to note in family Genogram • (1) Life cycle Fit / mis-fit? (E.g. age not catching up class) • (2). Unusual family configurations? (E.g re-marriage) • (3). Pattern repetition across generations (E.g. Alcoholism; poor relationship)

27. Application • “Housewife Syndrome”— • Full-time housewife with young children stress • Occasional low self-esteem • Enmeshment

28. Application • Find ways to improve self-esteem (e.g development of interest) & self-assertiveness • Encouragement of relaxation, meaningful use of time etc.

29. Case Scenario 4 • Mr. KB, 67 yr old retired , living alone • His children married & emigrated • HT + DM Dx 20 yrs ago • Recently Dx OA knees • C/o: headache, dizziness, poorly controlled HT • Claimed life difficult + suicidal idea

30. Family in Later Life… • (1). Dealing with illnesses & death • (2). Accepting the loss of family & loved ones • (3). Accepting the lessened abilities & greater dependence • (4). Financial problem • (5). Higher incidence of suicide & depression • (6). Increasing doctor-seeking behaviour

31. Bring-OPD message • (1). If Vague/non-specific symptoms prevail, think FAMILY as the culprit • (2). Anticipate problems from family genograms  patient doubly grateful