Tuesday, April 13, 2010

Family Fanatic: "Families Only" Medical Practice

Over the years, I've become a family fanatic. Family Health Connections, Inc. is the Family Medicine practice that I started eleven years ago. We only take families as patients. This gives us access to the basic decision making unit in America, an age distributed practice, and a rich view of important aspects of individual and family development. We can float into issues of family function, family life-cycle, genealogy and genomics in any clinical encounter since we know about lots of relatives (as confidentiality allows) and engage in multi-generational clinical decision making.

I got the "Families Only" idea from Robert Smith, MD who was residency director in the Ohio State University Department of Family Medicine in the early 1980's, where I was a clinical preceptor. He instituted a "Families Only" practice policy in Medina, Ohio holding a family orientation meeting once monthly at which interested families could learn about the doctor and the practice without obligation. Those who wished to sign up their family members as patients were then free to do so. He had a long waiting list for the meetings and thoroughly enjoyed the richness of family contacts that his practice model afforded him. I was so excited at operationalizing his idea into my practice that I instituted it the next day in my solo practice in Newark, OH. The family learning was an eye opener. I spiced it up by attending the "Families in Health Care" meeting at Amelia Island, FL a few times to get a better handle on family aspects of family medicine.

Doing the "Families Only" (we say that a family is everyone sharing an abode, house, apartment, camper, etc.) practice from solo to group to academic group(s)and back to solo practice has been personally and professionally rewarding. After thirty years as a family fanatic, I share a few reflections:

Families will open up to their family physician, e.g. "Doctor, you need to know that my husband is drinking again." "Doctor, don't say anything to my wife, but she stopped taking her antidepressants again." "I know that my daughter is having sex and I want her on birth control. I don't want her to make the mistake that I made." "My mother was a Christian Scientist, so we never went to doctors. I'm not going to do that to my children, since we have good insurance and I want them to stay healthy." "I'm worried that my children will have the alcohol problems that my mother and her family had." "My father and brother died young of heart attacks and I know I should quit smoking." "My husband told me before he died that he wanted you to have this fishing pole. He liked how you talked to him about going fishing."

Families understand medical heritage, when asked, "What concerns do you have about your family medical history?", all adults who responded to our practice survey had concerns. They were concerned that they might develop Alzheimer's Disease if it affected a parent or grandparent. They were concerned that their children would develop alcoholism or drug dependency if that was in the "family tree". They had few concerns about heart attacks but many about stroke risks if family members had experienced a stroke. If family members had experienced amputation from diabetic complications, they were interested in diabetic prevention or testing.

Families have heart for each other, positive and negative. Mothers and grandmothers of newborns have a special feeling in their heart for the baby and each other. People near the end of life generate focus in their family. Family relationships are enhanced and family values reviewed with family stories before and after the death of a senior family member. Dying persons may delay death until family members arrive for a "farewell". Miserable family members with chronic pain syndromes seem to "suck" energy out of family members. Zero to 12 year olds seem to be able to recharge the energy batteries of grandparents and great- great grandparents. The extra energy, possibly generated by genuine caring and love, helps to decrease pain and fatigue for the ageing person.

The family physician also is heartened by the love and caring shown by family members for each other. I found myself honoring families for their strengths, especially if they had forgotten or needed a reminder. Senior citizens near the end of life sometimes aren't aware of tasks to accomplish in that phase of their life. The family life-cycle developmental tasks literature can be quite helpful to provide the family doctor with broader insights about a family member in the last stage of the life-cycle. I sometimes inquire as to whether the end-of-life senior has made sure that all the photos of previous generations are labeled.

Religious beliefs about the end of life and the afterlife vary widely and families are comfortable sharing these beliefs with the family physician (if the family physician is comfortable). I remember one family member feeling devastated because her sibling was cremated, violating the survivor's expectation for the afterlife of the deceased. Another family fractionated when one member took a photo of the deceased in the open casket at the viewing. Seniors are usually comfortable discussing end of life issues, while there is often a caretaker (also a patient in my practice) who seems to want desperately for mom, grandpa or grandma to live forever. Each family seems to be uniquely one of a kind with beginning of life and end of life beliefs and traditions. I was blessed to learn from and about a vast array of beliefs and traditions.
I'll always be a family fanatic. A lot more about families later.

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