Taking account of the family: another form of focussing 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 the patient's milieu, and this milieu is usually the family. But the family is not only what makes it possible to understand the problems, it is also a resource of incalculable value for attending to health problems in a global form, and for enriching health from the bio-psycho-social model. Scientific research reveals the influence of the family on the process of falling ill; many diseases are preceded by stressful life events, the death of the spouse being the 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 the family is involved. There are several instrument that make it possible to gain knowledge of the family: the method of circles, or Eco Map, and the family map are useful for brief interventions, but the Genogram, which is defined as "the graphic representation of the family over the course of time and of the relationships of its members", is outstanding because of its functionality. Drawing up this instrument can take from 10 to 30 minutes with the 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 the patient, for the detection of risk factors and psycho-social problems, for the identification of family and psycho-social resources and of dysfunctional families, and for teaching and research activities.