Family medicine

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Family medicine is a branch of general medicine . Family medicine takes an integrative approach, which explicitly includes consideration of somatic, psychological, systemic and socio-cultural aspects. The family as a social system is included in the planning and implementation of medical interventions.

According to the German Society for General Medicine and Family Medicine (DEGAM), the family medical function includes “caring for the patient in the context of his or her family or social community, including in the home environment (home visit)”. DEGAM explicitly names family medicine in its positions on the future of general medicine and general practice:

“ Family medicine is an important task in general practitioner care . Caring for the population across generations and taking into account the social context requires knowledge of family living conditions. Family medicine as an integral part of general practitioner practice must interlock in an interprofessional manner in everyday life. […] However, the focus is always on the patient, their living environment and its effects on their health. The relationship can exist both with the individual patient in their family context and with the family as a whole, as a system. "

The benchmark of family medicine changes with the social structures of society. In this context, “ family ” no longer just means the classic core or extended extended family, but rather the patient's primary living environment, which includes household and living communities, blended families and people who relate to one another emotionally.

"The diversity of family forms results not only from family relationships and new forms of living together, but also from new, often unfamiliar and unknown family traditions through immigration."

In the Social Security Code, family medicine is covered as part of family doctor care via statutory health insurance and includes: "General and ongoing medical care for a patient in diagnostics and therapy with knowledge of his home and family environment" (Section 73 SGB V, Paragraph 1).

In many European and non-European countries there is no clear distinction between general medicine and family medicine. The terms family medicine , primary care and general practice are sometimes used synonymously. The term (systemic) family therapy has become established for psychotherapeutic and psychological work with families .

history

Historically, family medicine can be traced back as an independent discipline to the middle of the 20th century. With his publication “Patients have families” (1945), which emerged from a research project, H. Richardson is considered the founder of family medicine in the USA. He said at the time: “The statement that patients have families is like the statement that a sick organ is part of a person.” With this perspective, the disease “becomes an integral part of the continuous life process. The family is the unity of illness because it is the unity of life. "

In Europe, Frans JA Huygen from the Netherlands is considered the founder of family medicine. In 1978 he formulated in his book "Family Medicine: Task for the General Practitioner", like Richardson, the thesis "The family as a unit is the patient". With his textbook “General Medicine and Family Medicine” from 1980, Hans Hamm laid the foundations for family medicine in Germany. Even if, from his point of view, the family is rarely the treatment unit in family medical practice, it still forms the therapeutic framework. During his presidency in 1981, DEGAM defined family medicine as one of 12 key research areas in general medicine and designed content for a family medicine curriculum. Another leading protagonist of family medicine in Germany is Eckart Sturm with his publication “The Renaissance of the House Doctor” (1983) and his comprehensive textbook on family doctor care (2006).

Family medicine has been part of the specialist designation of the German Society for General Medicine and Family Medicine (DEGAM) since 1998 .

In 2016 a comprehensive working definition “Family medicine in the family doctor's practice” was developed, which is intended to serve as a common starting point for further research in this area.

Working basis

The working basis of family medicine is a long-term patient-doctor relationship, the previous history of the patient and his family that can already be identified from the family environment, as well as the socio-demographic characteristics of the population group to be cared for by a family doctor, which vary from place to place. This contextual knowledge is taken into account in the care of patients and their families.

Family medicine assumes an interaction between patient, illness and family. Family can be both a resource and a risk to the health and well-being of individual family members. The basic assumption is that the involvement of the family and the social environment in the therapy process is helpful in the treatment of somatic disorders. Studies show that including family members in treatment has significantly positive effects on the physical and mental health of both patients and family members.

The close connection between patient, illness and family can be seen in the following areas:

  • the family shapes attitudes towards health,
  • the family influences behavior during illness, the family is often affected when a family member falls ill,
  • family life itself can lead to illnesses.

Family medicine is at the interface with other medical specialist disciplines such as psychosomatics, psychotherapy, social medicine, pediatrics, child and adolescent psychiatry, geriatrics, palliative medicine or family therapy.

Core tasks

As part of general medicine, family medicine is responsible for the primary care of patients, taking into account somatic, psychological and psychosomatic diseases. The observation and clarification of social events that do not correlate directly with medical findings are also included.

Family medical tasks are in detail:

  • Family doctor care for patients in the context of their family / social environment, also for several family members,
  • Attention to family pressures that can be harmful to health,
  • Prevention / health promotion,
  • Knowing and taking into account the resources and risks of family (s).

Working method

Focusing on the family makes it possible to take preventive action, to offer treatment options tailored to the family situation and to take systemic aspects into account in therapy planning. The way of working covers a broad spectrum from “somatic treatment” to “psychotherapeutic interventions”. Three working methods in family medicine can be identified that relate to the family in different degrees:

  • Relationship to the individual patient in his family context,
  • Focus on patients and their families who live in need in family structures,
  • Accompanying and therapeutic relationship and attitude towards the family as a whole, as a system.

With family medical anamnesis, general practitioners benefit from long-term treatment of families and knowledge from the living space ("experienced anamnesis"). This includes in detail:

  • Family structure
  • General practitioner perspective,
  • Medical history
  • family burdens
  • Health behavior
  • Social situation
  • Job-related situation
  • Economic situation
  • Help and resources in the family.

When it comes to implementation, it makes sense to work with other medical disciplines and other providers of help for families.

literature

  • Susanne Altmeyer, Askan Hendrischke: Introduction to systemic family medicine . Heidelberg. Carl-Auer, 2012, ISBN 978-3-89670-829-8 .
  • Susanne Altmeyer, Friedebert Kröger: Theory and Practice of Systemic Family Medicine . Vandenhoeck & Ruprecht, Göttingen 2003, ISBN 3-525-46173-9 .
  • Ulrike Borst, Hans R Fischer, Arist von Schlippe (Hrsg.): Family medicine. In: Family Dynamics. Systemic practice and research. 2/2013.
  • Manfred Cierpka, Sabine Krebeck, Rüdiger Retzlaff: doctor, patient and family . Klett-Cotta, Stuttgart 2001, ISBN 3-608-94009-X .
  • Jürgen Collatz (Ed.): Family medicine in Germany. Necessity, dilemma, prospects. For a content-oriented health reform . Pabst, Lengerich et al. 2010, ISBN 978-3-89967-614-3 .
  • Hans Hamm (ed.): General medicine, family medicine. Textbook and practical guidelines for the family doctor . Klett-Cotta, Stuttgart 1986, ISBN 3-13-574802-2 .
  • Thomas Hegemann among others: Family medicine for practice . Schattauer, Stuttgart 2000, ISBN 3-7945-1978-7 .
  • Wolfgang Himmel, Michael M Cooking: The family medicine approach in general medicine. In: Dtsch. Medical journal. 95 (28-29), 1998, pp. A-1794-1797.
  • Frans JA Huygen. Family medicine. Task for the family doctor . Hippocrates, Stuttgart 1979.
  • Vera Kalitzkus, Stefan Wilm: Family in Medicine - Family Medicine. In: Astrid Wonneberger, Katja Weidtmann, Sabina Stelzig-Willutzki (Eds.): Family Studies - Basics and Overview. Springer VS, Wiesbaden 2017, pp. 417-450, ISBN 978-3-658-17002-8 .
  • Vera Kalitzkus, Stefan Wilm (Hrsg.): Family medicine in the family doctor care of the future . düsseldorf university press, Düsseldorf 2013, ISBN 978-3-943460-44-5 .
  • Michael M. Cooking: General Medicine and Family Medicine. (= Dual row). 4th edition. Thieme, Stuttgart 2012, ISBN 978-3-13-141384-0 .
  • Hagen Sandholzer, Manfred Cierpka: General medicine is family medicine. A methodical and casuistic contribution to a family doctor essential. In: Journal of General Practice. 72, 1996, pp. 1016-1022.
  • Peter-Ernst Schnabel: Family and health: conditions, possibilities and concepts of health promotion (= basic texts health sciences). Beltz-Juventa, Weinheim / Munich 2001, ISBN 3-7799-1561-8 .
  • Eckart Sturm: The renaissance of the family doctor . Springer, Heidelberg 1983.
  • Eckart Sturm et al. (Ed.): General practitioner patient care. Concepts - Methods - Skills . Thieme, Stuttgart 2006, ISBN 3-13-141031-0 , pp. 57-101. (Chapter III Outpatient care patient-family)
  • Karl J Wittmann, Rudolf Schoberberger (Hrsg.): The human being in the environment, family and society: A text and work book for the first section of medicine. (= MCW 6, MedUni Vienna). facultas, Vienna 2014, ISBN 978-3-7089-1093-2 .

Web links

Individual evidence

  1. ^ DEGAM - German Society for General Medicine and Family Medicine: Technical definition . DEGAM, German Society for General Medicine and Family Medicine ( Memento from September 8, 2015 in the Internet Archive ). Resolution of the annual general meeting on September 21, 2002, accessed August 5, 2015.
  2. ↑ Thomas Hegemann among others: Family medicine for practice . Schattauer, Stuttgart 2000.
  3. ↑ DEGAM - German Society for General Medicine and Family Medicine : DEGAM future positions. General medicine - specializing in the whole person . ( Memento from June 26, 2016 in the Internet Archive ) Frankfurt am Main 2012, p. 8, accessed on August 5, 2015.
  4. ↑ See Wolfgang Himmel et al.: The patient in the context of the family . In Michael M. Cooking: General Medicine and Family Medicine. (= Dual row). Thieme, Stuttgart 2012, p. 568.
  5. ↑ Social Code (SGB V) Book Five - Statutory Health Insurance Accessed on August 10, 2015
  6. ↑ Richardson 1945, quoted from Susanne Altmeyer, Friedebert Kröger: Theory and Practice of Systemic Family Medicine . Vandenhoeck & Ruprecht, Göttingen 2003, p. 16.
  7. ↑ Ibid.
  8. ↑ Frans JA Huygen. Family medicine. Task for the family doctor . Stuttgart: Hippocrates, 1979.
  9. ↑ See Hans Hamm (Ed.): General medicine, family medicine. Textbook and practical guidelines for the family doctor. Klett-Cotta, Stuttgart 1986, p. 524.
  10. ↑ Vera Kalitzkus, Stefan Wilm: Early protagonists of family medicine in Germany - an interview study. In: Journal of General Practice 2017; 93 (12): 502-507.
  11. ↑ Eckart Sturm: The renaissance of the family doctor . Heidelberg: Springer 1983.
  12. ↑ Eckart Sturm et al.: (Ed.): General practitioner patient care. Concepts - Methods - Skills . Thieme, Stuttgart 2006.
  13. ↑ See DEGAM 2002.
  14. ↑ Vera Kalitzkus, Horst Christian Vollmar: Family medicine in the family doctor's practice. A Delphi study to develop a common working definition. In: Journal of General Practice 2016; 92 (5): 208-212.
  15. ↑ See Himmel et al. (2012), pp. 564-565.
  16. ↑ See M. Hartmann et al.: Effects of interventions involving the family in the treatment of adult patients with chronic physical diseases: A meta-analysis. In: Psychotherapy and Psychosomatics. 79, 2010, pp. 136-148.
  17. ↑ See Himmel et al. (2012), p. 564.
  18. ↑ See Himmel et al. (2012), pp. 564–577; Manfred Cierpka, Sabine Krebeck, Rüdiger Retzlaff: doctor, patient and family. Klett-Cotta, Stuttgart 2001
  19. ↑ See Vera Kalitzkus, Stefan Wilm: Family in medicine - family medicine. In: Astrid Wonneberger, Katja Weidtmann, Sabina Stelzig-Willutzki: Family Studies - Basics and Overview. Springer VS, Wiesbaden 2017, pp. 422–424.
  20. ↑ See Vera Kalitzkus, Stefan Wilm: Introduction. In: Kalitzkus / Wilm (Hrsg.): Family medicine in the family doctor care of the future. düsseldorf university press, Düsseldorf 2013, p. 15.
  21. ↑ See Himmel et al. (2012), p. 567.
  22. ↑ See Vera Kalitzkus, Stefan Wilm: Family in medicine - family medicine. In: Astrid Wonneberger, Katja Weidtmann, Sabina Stelzig-Willutzki (Eds.): Family Studies - Basics and Overview. Springer VS, Wiesbaden 2017, p. 436.