Positive practice in family therapy

Positive practice, a brief integrative approach to consultation with families, is described in this paper. A clear distinction is made between the stages of planning, assessment, therapy, and disengagement. Guidelines for progression from one stage to the next are provided. Frameworks for deciding who to invite to preliminary sessions and methods for planning and organizing lines of inquiry are incorporated into this approach to practice. A three-column model is used to construct formulations. The model allows therapists and clients to map information about the pattern of interaction around the presenting problem, beliefs that constrain family members from altering their roles in these problem-maintaining patterns, and factors that have predisposed family members to hold these beliefs. Positive practice offers methods for evolving new behavioral patterns and belief systems within sessions and for arranging homework tasks for clients between sessions. It also incorporates methods for dealing with resistance, for managing therapeutic crises, for convening individual sessions and broader network meetings, for disengaging from the consultation process, and for recontracting for further episodes of therapy. This evolving approach to practice draws on ideas from many traditions within the family therapy field and takes account of recent research relevant to the practice of family therapy.     

A family practice education system based on patient care outcomes in family practice settings

The philosophy, goals, objectives, methodology, and results of a family practice faculty development program are described. Developing family practice educators who will create an education system based on patient care outcomes in family practice settings is the central philosophical purpose of this faculty development program. On completion of the program all participants recognized the essential nature of this philosophical goal and were more comfortable and confident in their ability to: (1) determine resident learning needs; (2) organize curriculum units; (3) use different teaching techniques; and (4) understand their own personal teaching needs and interests. The implications of these changes for developing a family practice curriculum based on patient needs are described.     

Psychotropic drug use in family practice

In an attempt to assess the precision of an illness-treatment "fit" between dispensing and actual need for psychotropic medications, the present study examined the dispensing patterns to consecutive attenders of private general practice. "Conservative" use of psychotropic drugs was indicated insofar as patients were seldom dispensed medication in the absence of emotional problems, and the presence of emotional problems frequently was not accompanied by the dispensing of medication. In addition, specific social and illness factors were located which could differentially predict either the presence of emotional problems, the use of psychotropic drugs, or both of these variables. The potential for constructing a more precise illness-treatment fit was considered.     

Depression in the elderly in family practice

The typical chronic splanchnic syndrome is characterized by upper abdominal pain usually provoked by a meal, the finding of an epigastric bruit and weight loss in conjunction with haemodynamically significant stenosis of two or more of the splanchnic arteries. Diagnosis of chronic splanchnic syndrome depends mainly on a strong clinical suspicion. Usually the classical triad is incomplete or absent. Therefore chronic splanchnic syndrome should be considered, in every patient with chronic abdominal discomfort, after exclusion of other more common causes of upper abdominal discomfort. Findings from nonvasive and invasive diagnostic tests support the presence of chronic splanchnic syndrome. However, until now, the diagnosis of chronic splanchnic syndrome has usually only been made retrospectively if all the symptoms disappeared after technically successful reconstructive surgery. A variety of surgical techniques has been advocated to repair the splanchnic arteries. The choice of the technique is usually based on the preference and experience of the surgeon.     

Doctor-patient communications in a private family practice

One hundred fifty-five randomly selected patients in a private family physician's office were interviewed immediately before and immediately after their visit with the doctor in an attempt to assess the degree of misunderstanding that occurs in doctor-patient communications. Fifty-four percent of these patients either forgot to mention all their medical problems to the physician or they confused or forgot certain instructions concerning their diagnosis or treatment. A X2 analysis failed to reveal any significant sex or age differences in the proportions of misunderstandings. There was also no correlation between the number of misunderstandings, the amount of time the doctor spent with the patients, the patient's rating of their own health on a scale of one to ten, and the patients' complaints or praises about their medical treatment. The number of years of formal education completed by the patient showed a direct relationship to the number of misunderstandings. Patients on their first three visits to this office tended to misunderstand more of their medical instructions. Furthermore, the study suggested that patients with chronic internal diseases and those who express excessive trust in their physician might have an increased proportion of misunderstandings.     

Research in the family practice residency program

Research activity in family practice is becoming increasingly important as the specialty matures past its initial organizational and developmental phase. Family practice residency programs are directly involved in the definition and implementation of modern concepts in family medicine and frequently have available the necessary tools and resources for substantive research of various types. These programs therefore have both the opportunity and responsibility to become actively involved in research. Significant contributions have already been made in this area by faculty and residents in a number of family practice residency programs. This paper provides an overview of research areas in family practice, presents some examples of research to date, and suggests some practical approaches to facilitate further research efforts in family practice residency programs.     

A study of thyroid disease in family practice

Thyroid disease is relatively common in family practice, yet is often undiagnosed or poorly managed. This study examines several aspects of thyroid disease in a large, semirural family practice setting and exemplifies the type of practical clinical research that can be done in family medicine. An overall prevalence of approximately one percent was determined for thyroid disease in this practice. In a series of 85 patients, the ratio of hypothyroidism:hyperthyroidism:euthyroid goiter was 9:2:1 respectively. Initial signs and symptoms recorded for these patients conformed closely to the findings in other large series. Eighty percent of the patients with idiopathic hypothyroidism never had enlarged glands, whereas 100 percent of the patients with hypothyroidism associated with Hashimoto's thyroiditis had enlarged glands. Laboratory aids such as serum thyroid stimulating hormone (TSH), anti-thyroid antibodies, and radioactive iodine uptake (RAIU) and scans were inadequately utilized. Medical and/or surgical consultation was obtained in 17.5 percent of patients with hypothyroidism, 80 percent of patients with hyperthyroidism, and 63 percent of those with euthyroid goiter. Currently 95 percent of the hypothyroid patients and 100 percent of the hyperthyroid patients are euthyroid.     

The practice of science in the family.

Responds to comments by B. D. Forman (see record 1990-29006-001), S. A. Kirschner (see record 1990-29011-001), and M. Rohrbaugh (see record 1990-29019-001) on the present authors' (see record 1990-29009-001) work on the use of paradoxical interventions with couples. Focus is on (1) the subjectivist and objectivist research approach; (2) language, relationship, and content analysis; and (3) the relevancy of science to practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical therapy education in family practice residency programs

BACKGROUND: This study investigated the role and extent of physical therapy education in family practice residency programs. Physical therapy is not specifically included in graduate curricula guidelines, and the literature contains little information on its involvement in programs. METHODS: A questionnaire was developed to determine how physical therapy education is taught in family practice residencies. The questionnaire was mailed to all (391) directors of US-accredited family practice residency programs. RESULTS: A total of 256 directors (65.5%) responded. The majority of directors (67%) stated that there was a significant need for the physical therapy component. Only 52% (133/256), however, included physical therapy in their curricula. Physical therapy education was most frequently (67.6%, 92/136) included in required rotations (eg, orthopedics) and taught mostly by hospital-based physical therapists (77.0%, 104/135) or subspecialists (55.6%, 75/135). CONCLUSION: This study shows that physical therapy education offers a potentially relevant and important element of family practice residency training, but it has been underemphasized.