Integrating the family into routine patient care - A qualitative study

BACKGROUND. The field of family medicine has been enriched by a family-orie nted approach and the inclusion of family systems concepts. Keeping the fam ily as a central focus of care has been a fundamental commitment of family medicine. This research examines how exemplary physicians ("exemplars") int egrate a family-oriented approach into the routine care of individual patie nts. METHODS. Four family physician exemplars were observed. A total of 16 days was spent observing the physicians; 137 physician-patient encounters were a udiotaped, transcribed, and analyzed. Grounded theory was used for analysis , and a model of a family-oriented approach was developed. RESULTS. Visits were classified by the reason for Visit and the intensity o f family-oriented talk and actions. There was modest variation among the ph ysicians in terms of intensity and time spent with patients. Overall, 19% o f patient encounters had a high intensity of family-orientedness; 34% were of low intensity, The average time spent with patients was 13 minutes, with visits ranging from 3 to 39 minutes in length. CONCLUSIONS. Our study demonstrated that physicians integrate family system s concepts into routine individual patient care. The findings identify char acteristics of the family-oriented approach and those circumstances that pr omote and hinder it. Family physicians can adapt specific components of the family-oriented approach into their routine individual patient care.