Taking account of the family: another form of focusing on health problems in primary care. Instruments of the family approach

Abstract

On many occasions somatic symptoms that do not improve with conventional measures reflect hidden problems related to patient's milieu, and this milieu is usually family. But family is not only what makes it possible to understand problems, it is also a resource of incalculable value for attending to health problems in a global form, and for enriching health from bio-psycho-social model. Scientific research reveals influence of family on process of falling ill; many diseases are preceded by stressful life events, death of spouse being principal one, followed by divorce and matrimonial break-up. Women with a low level of family support suffer from more obstetric complications and diabetic patients receive better care when family is involved. There are several instrument that make it possible to gain knowledge of family: method of circles, or Eco Map, and family map are useful for brief interventions, but Genogram, which is defined as the graphic representation of family over course of time and of relationships of its members, is outstanding because of its functionality. Drawing up this instrument can take from 10 to 30 minutes with patient and, on some occasions, with a family member. The principal uses of its interpretation are: as a system of register, an instrument for relating to patient, for detection of risk factors and psycho-social problems, for identification of family and psycho-social resources and of dysfunctional families, and for teaching and research activities.