Integrating the family into routine patient care: a qualitative study.
BACKGROUND
The field of family medicine has been enriched by a family-oriented approach and the inclusion of family systems concepts. Keeping the family as a central focus of care has been a fundamental commitment of family medicine. This research examines how exemplary physicians ("exemplars") integrate a family-oriented approach into the routine care of individual patients.


METHODS
Four family physician exemplars were observed. A total of 16 days was spent observing the physicians; 137 physician-patient encounters were audiotaped, 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 of family-oriented talk and actions. There was modest variation among the physicians in terms of intensity and time spent with patients. Overall, 19% of 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 systems concepts into routine individual patient care. The findings identify characteristics of the family-oriented approach and those circumstances that promote and hinder it. Family physicians can adapt specific components of the family-oriented approach into their routine individual patient care.
Cole-Kelly
K
K
Department of Family Practice, MetroHealth Medical Center, Cleveland, OH 44109, USA. kck3@po.cwru.edu
Yanoshik
M K
MK
Campbell
J
J
Flynn
S P
SP
D003142:Communication; D005190:Family / Q000523:psychology*; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D009819:Office Visits; D018802:Patient-Centered Care; D010686:Philosophy, Medical; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D013598:Systems Theory; D013996:Time and Motion Studies; D014481:United States; D014743:Videotape Recording