FAMILY MEDICINE

Family medicine is a specialty which provides continuous, comprehensive and coordinated health care to an individual in a holistic manner within the context of the family, environment, culture and community irrespective of age, sex, religion, race and type of disease. The Family Physician accepts everyone seeking care whereas other health providers limit access to their services on the basis of age, sex and/or diagnosis. He is a five star doctor who is a caregiver, communicator, decision maker, community leader and manager. His patient has one doctor that specializes in the patient. He knows the patient and his family and offers them comprehensive medical care that emphasizes the family unit. He works with the principles of family medicine which are:1) The family physician is a skilled clinician 2) Family medicine is a community based discipline 3) The family physician is a resource to a defined practice population 4) The patient-physician relationship is central to the role of the family physician The care of the family is governed by the concept of family dynamics in health and disease plus the concept of family system theory. Dr Murray Bowen defines family dynamics as the way in which family members interact with each other and in relation to the group as a whole. Family dynamics is influenced by traditions, communication styles, behavioural patterns and emotional interdependence. Because humans are capable of change, the dynamics within a family never remain the same. The stability of the dynamics within a family is mainly influenced by illness, death, financial
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concerns and behavioural change. The overall functions will be affected by how each family adapts to change and crisis in any of these areas. The dynamics within a family are important because the family remains the most basic relational unit and intimate social environment in our society. Changes in each familys dynamics invariably affect the community in which they function negatively or positively. The family systems theory was introduced by Dr. Murray Bowen suggesting that individuals cannot be understood in isolation from one another, but rather as a part of their family, as the family is an emotional unit. Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system. Each member of the family system had a role to play and rules to respect. Members of the system are expected to respond to each other in a certain way according to their role, which is determined by relationship agreements. Within the boundaries of the system, patterns develop as certain family member's behaviour is caused by and causes other family member's behaviours. Maintaining the same pattern of behaviours within a system may lead to balance in the family system, but may also lead to dysfunction. Change in roles may maintain the stability in the relationship, but it may also push the family towards a different equilibrium e.g when a father dies and the eldest son is expected to take up his role as bread winner and family head. Taking into cognizance the family system and family dynamics the role of the family in the illness and health of an individual includes:1) Influence on the cause of acute disease: Unhealthy behaviors or risk factors tend to cluster within families, because family members tend to share similar diets, physical activities, use and abuse of substances. Unhealthy behaviors in
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turn have devastating consequences on the health of the individual e.g. heart disease, cancer, diabetes, stroke, malnutrition and obesity. 2) Impact on the rehabilitation of chronic disease patients. Family members help in caring, giving emotional support, giving financial support, remembering physicians instructions and in advocacy. 3) Determining therapeutic success or failure (including medication compliance). 4) Determining the degree of mental health and illness when present. 5) Determining preventive and wellness aspects of health care (through culture, beliefs, religion and spirituality). The family has effects on health and disease which include:1) Genetic Predisposition everyone is a product of the interaction between his genotype and the environment. 2) Influence on child growth and development The parents personalities and interactions as well as the transactions of the family as a whole influence the childs development and who the child becomes as the family is the earliest and most persistent influence on the growing infant and small child. 3) Influence on transmission of disease use of preventive measures in homes e.g. use insecticide treated nets, taking advantage of infant immunization, washing hands before handling food. 4) Influence on morbidity and mortality absence of family support increases morbidity and mortality in individuals.

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5) Influence on recovery from illness emotional, financial environmental and social support are keys to ensuring and accelerating recovery. 6) Resource for preventing and solving health problems The family physician, understanding the influence of an individuals health on his family and the influence of the family on his health, treats him in the context of his family. He also identifies problems in the community that extend beyond the present complaint. He understands health related behavior in the community and supports community efforts in prevention of illness, promotion of health, management of illness and rehabilitation.

OGUNSANYA MONISOLA. O.