The family as a resource unit in health care: Changing patterns

Medicine has long asserted that the family is one of the principal units of medical care. Concurrent with a resurgence of interest in holistic medicine, there has been a major increase in attention being paid to the role of the family unit in health care. There are, however, very few examples of how this interest has been put into practice, nor is it evident that it is reflected in teaching or graduate training programs. This paradox persists in spite of the growth of family medicine as a primary care discipline, especially in North America. The results of three studies are summarized to support the impression that, in general, these 'family specialists', along with other primary care practitioners (e.g. pediatricians), know relatively little about the structure or functioning of the families of patients they treat. The findings also suggest that there is little relationship between such knowledge and various indicators of the processes or outcomes of medical care. The question then arises whether such knowledge is lacking because it is truly of little value clinically, or whether these findings reflect methodological limitations in research of this kind. Intuitively it is reasonable to suppose that such a relationship does exist, and there is an extensive body of well-documented theory to support this view. How relevant such knowledge could or should be in practice, is an issue of particular importance in the context of the rapid changes taking place in the nature of the family itself. These changes, viewed alongside those affecting the competition among various primary care disciplines for access to the family, lend credibility to the idea that medicine may be using the family as an agent of social control.