The family in family practice: is it a reality?

The purpose of this study was to describe, from multiple perspectives, the extent to which community family physicians focus on the family.

In a cross-sectional study, research nurses directly observed consecutive patient visits for 2 days in the offices of 138 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, and a factor analysis was used to identify subsets of correlated family focus descriptors.

On average, 10% of the time intervals during patient visits was devoted to addressing family issues. Other family members were present during 32% of visits, and another family member's problems were discussed in 18% of visits. Seventy percent of patients reported that other family members see the same doctor. A family history was obtained during 51% of visits by new patients and 22% of visits by established patients. Genograms were present on 11% of charts and family folders were seldom used. The presence or absence of a family history of breast or colon cancer was noted in 40% of charts. A factor 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 assessment that the doctor knew their families.

Family physicians show a high degree of emphasis on the family, and exhibit two different styles of family focus in community practice. The effects of these different approaches to family care on patient outcomes is an important area for future research.