Family-Oriented Primary Care in the Real World

Ethical and Practical Issues
  • Susan H. McDaniel
  • Thomas L. Campbell
  • David B. Seaburn


This book presents a family-oriented approach to primary care, including the biopsychosocial assessment of the family, the health care of families through the life cycle, and a family-oriented approach to specific medical problems. Implementing this family-oriented approach in daily clinical practice raises broad ethical concerns (“Are family-oriented interventions ethical?”) and specific practical issues (“How will I find the time? Who will pay for this approach?”). These are important issues that we will address in this chapter, starting with common ethical dilemmas, then discussing how to maintain a family-oriented approach when seeing individual patients, and finally presenting specific practical recommendations for establishing a family orientation in primary care.


Nursing Home Home Visit Family Physician Family Therapist Entire Family 
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  1. 1.
    Sherlock R, Dingus CM: Families and the Gravely Ill: Roles, Rules, and Rights. New York, Greenwood Press, 1988.Google Scholar
  2. 2.
    Brody H: Ethics in family medicine: Patient autonomy and the family unit. J Fam Pract 1983; 17: 973–975.PubMedGoogle Scholar
  3. 3.
    Sider R, Clements C: Family or individual therapy: The ethics of modality choice. Am J Psychiatry 1983; 139: 1455.Google Scholar
  4. 4.
    Williamson P, McCormick T, Taylor T: Who is the patient? A family case study of recurrent dilemma in family practice. J Fam Pract 1983; 17: 1039–1043.PubMedGoogle Scholar
  5. 5.
    Karpel M, Strauss E: Family secrets, in Family Evaluation. New York, Gardner Press, 1983.Google Scholar
  6. 6.
    Christianson CE: Ethical issues in family-centered primary care. Counseling and Values 1985; 30: 62–73.CrossRefGoogle Scholar
  7. 7.
    Boszormenyi-Nagy I: Ethics of human relationships and the treatment contract, in Lennard HL, Lennard SC (eds.): Ethics of Health Care. New York, Gondolier, 1979.Google Scholar
  8. 8.
    Mehl LE, Bruce C, Renner JH: Importance of obstetrics in a comprehensive family practice. J Fam Pract 1976; 3: 385–389.PubMedGoogle Scholar
  9. 9.
    Weiss BD: The effect of malpractice insurance costs on family physicians’ hospital practices. J Fam Pract 1986; 23: 55–58.PubMedGoogle Scholar
  10. 10.
    Eastwood MA, Brydon WG, Smith DM, Smith JH: A study of diet, serum lipids, and fecal constituents in spouses. Am J Clin Nutr 1982; 36: 290–293.PubMedGoogle Scholar
  11. 11.
    Glenn M: Collaborative Health Care: A Family-Oriented Model. New York, Praeger, 1987.Google Scholar
  12. 12.
    Gonzales S, Steinglass P, Reiss D: Putting the illness in its place: Discussion groups for families with chronic medical illnesses. Fam Proc 1989; 28: 69–88.CrossRefGoogle Scholar
  13. 13.
    Christie-Seeley J: Establishing a family orientation, in Christie-Steeley J (ed.): Working with Families in Primary Care. New York, Praeger Press, 1983.Google Scholar
  14. 14.
    Rogers JC, Cohn P: Impact of a screening family genogram on first encounters in primary care. Fam Pract 1987; 4: 291–301.PubMedCrossRefGoogle Scholar
  15. 15.
    Ebell MH, Heaton CJ: Development and evaluation of a computer genogram. J Fam Pract 1988; 27: 536–537.PubMedGoogle Scholar
  16. 16.
    Gerson R, McGoldrick M: The computerized genogram. Primary Care 1985; 12: 535–545.PubMedGoogle Scholar
  17. 17.
    Froom J, Culpepper L, Kirkwood RC, Boisseau V, Mangone D: An integrated medical record and data system for primary care, Part 4: Family information. J Fam Pract 1977; 5: 265–270.PubMedGoogle Scholar
  18. 18.
    A Glossary for Primary Care. Report of the North American Primary Care Research Group (NAPCGR). Presented at the Annual Meeting of NAPCRG, Williamsburg, VA, March 1977.Google Scholar
  19. 19.
    Widmer RB, Cadoret RJ: Depression in family practice: Changes in patterns of patient visits and complaints during subsequent developing depression. J Fam Pract 1979; 9: 1017–1021.PubMedGoogle Scholar
  20. 20.
    Froom J: An integrated system for the recording and retrieval of medical data in a primary care setting: Part 4: Family folders. J Fam Pract 1974; 1: 49–51.PubMedGoogle Scholar
  21. 21.
    Huygens FJA: Family Medicine: The Medical Life History of Families. New York, Brunner-Mazel, 1978.Google Scholar
  22. 22.
    Meyer RJ, Haggerty RJ: Streptococcal infections in families: Factors altering individual susceptibility. Pediatrics 1962; 29: 539–549.PubMedGoogle Scholar
  23. 23.
    Siwek J: House calls: Current status and rationale. Am Fam Physician 1985; 31 (4): 169–174.PubMedGoogle Scholar
  24. 24.
    Wsiao W, Braun P, Dunn P, Becker E: Resource based relative value scale: An overview. JAMA 1988; 260: 2347–2353.CrossRefGoogle Scholar
  25. 25.
    Dym B, Berman S: Family systems medicine: Family therapy’s next frontier? Fam Ther Networker 1985; 9: 20.Google Scholar
  26. 26.
    Dym B, Berman S: The primary health care team: Family physician and family therapist in joint practice. Fam Syst Med 1986; 4: 9–21CrossRefGoogle Scholar
  27. 27.
    McDaniel S, Campbell T: Physician and family therapists: The risks of collaboration. Fam Syst Med 1986; 4: 1–4Google Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Susan H. McDaniel
    • 1
  • Thomas L. Campbell
    • 1
  • David B. Seaburn
    • 1
  1. 1.School of Medicine and Highland Hospital, Jacob B. Holler Family Medicine CenterUniversity of RochesterRochesterUSA

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