THE FAMILY IN FAMILY-PRACTICE - IS IT A REALITY

BACKGROUND. The purpose of this study was to describe, from multiple p erspectives, the extent to which community family physicians focus on the family. METHODS. In a cross-sectional study research nurses direct ly observed consecutive patient visits for 2 days in the offices of 13 8 community family physicians. Data were collected on 4454 outpatient visits using direct observation, patient and physician questionnaires, and medical record review. Descriptive statistics were calculated, an d a factor analysis was used to identify subsets of correlated family focus descriptors. RESULTS. On average, 10% of the time intervals duri ng patient Visits was devoted to addressing family issues. Other famil y members were present during 32% of visits, and another family member 's problems were discussed in 18% of visits. Seventy percent of patien ts reported that other family members see the same doctor. A family hi story was obtained during 51% of visits by new patients and 22% of vis its by established patients. Genograms were present on 11% of charts a nd family folders were seldom used. The presence or absence of a famil y history of breast or colon cancer was noted in 40% of charts. A fact or analysis identified two different physician styles: family history as a context for care of an individual patient, and the family as the unit of care; The latter approach correlated with the patient's assess ment that the doctor knew their families. CONCLUSIONS. Family physicia ns show a high degree of emphasis on the family, and exhibit two diffe rent styles of family focus in community practice. The effects of thes e different approaches to family care on patient outcomes is an import ant area for future research.