As we prepared to present this topic at CFHA 2016, our team quickly
realized that the therapists in the group used the term "family legacy” while
our physician colleagues used the term "family culture” to describe how
families impact health. We began to wonder, are they the same concept? Related?
Totally different? How could we apply both concepts in our clinical work to
connect better with patients, improve quality of life and daily functioning,
and work towards better health outcomes?
As Ernest Burgess wrote over eighty years ago, "Whatever its
biological inheritance from its parents and other ancestors, the child receives
also from them a heritage of attitudes,
sentiments, and ideals which may be termed the family tradition, or the
family culture.” Family culture encompasses values about what’s important, what
behaviors are acceptable, and what our relationships should be like. We believe
family culture extends beyond parents and children to extended family interactions
and families of choice, those not related by blood.
Patients’ decisions about how to care for themselves and how to
engage with the healthcare system are infused with multigenerational cultural traditions.
Family health culture provides the foundation for beliefs about the role of the
patient and the role of the physician, value and meaning assigned to
caregiving, causes of illness, and confidence to engage in health maintenance
and improvement behaviors. Culture also shapes routine habits and behaviors
related to eating, exercising, managing stress, and taking medications.
or detrimental, we don’t get to choose our family health culture since it’s a
composite of many family members’ beliefs and actions. We can’t change the
foods placed on our childhood dinner table, the ratio of our parents’ active
versus sedentary time, or how our families and communities have navigated
difficult decisions about how and where to care for sick loved ones. As we
acknowledge the role of family health culture, where do we honor the impact of
individuals’ personal choice on health behaviors and beliefs?
Family legacies, on the other hand, emphasize how individuals take
the past and craft it into current actions and use it to influence the future. As
Boszormenyi-Nagy and Krasner wrote, "It is the task of the present generation
to sort out that which is beneficial and
translate it into terms of benefits for future generations.”
In essence, we
funnel down the parts of our familial culture (beliefs, values, attitudes) that
we wish to pass down to future generations to create a family legacy – in this
case, our story about illness and wellness. Rather than passively receiving the
habits and beliefs handed down to us, we have the ability to craft our legacy into
a story we want others to remember. In addition, we can choose to emphasize health-related
habits and beliefs that offer us the most options for a fulfilling life.
As healthcare professionals, what is our role in helping patients develop
a healthier legacy? We recommend starting with one simple question: "If you
were to change one aspect of how your family approached (or approaches) health,
what would it be? How can I partner with you to work towards that goal?” Some
patients might need to be prompted with areas for consideration, such as
balancing work and self-care time, diet and nutrition, exercise, or
communicating with healthcare providers.
The question could also be rephrased
as: "What is one thing you learned from your family about how to take care of
your health that has worked well for you? How has this been beneficial for
you?” We also think it wise to begin asking these questions early with children,
rather than wait until they are adults to reflect on healthy habits: "What is
something you think your family does a good job of to be healthy and set up
good habits? How can you keep up that habit?”
If we want healthier patients who use our
valuable healthcare resources responsibly, we don’t have the luxury of ignoring
familial cultural beliefs that influence their decision making and goals of
care. We must take the time to inquire about patients’ beliefs and habits and
how those are influenced by their family culture, even when we feel pressured
with packed schedules and growing lists of clinical quality measures.
lead the conversation with patients in discussing how to harness the best parts
of that family culture to craft a strengths-based legacy that bolsters personal
purpose and growth, even in the context of disease, pain, and hardship.
Although not the only way, we believe this approach provides a powerful
starting point for helping patients and families enjoy as many days with fair
winds as possible and have the stamina to endure stormy seas.
Burgess, E. W. (1931). Family tradition and personality. In K.
Young (Ed.), Social Attitudes (pp. 188-207). New York, NY: Henry
Boszormenyi-Nagy, I., & Krasner, B. R. (1986). Between give
and take: A clinical guide to contextual therapy. New York, NY:
|Alex Schmidt, PhD, LMFT-A is an avid advocate of family-centered
healthcare. She received her PhD in Marriage and Family Therapy from Texas Tech
University and completed a Medical Family Therapy fellowship at St. Mary’s
Family Medicine Residency in Grand Junction, CO. She now works as an Integrated
Behavioral Health Advisor for Rocky Mountain Health Plans, where she partners
with primary care practices in strategic scheming and dreaming to sustain
integrated behavioral health practices and puts her graduate school research
skills to good use to track down relevant, practical resources for providers. |
|D. Scott Sibley, PhD, LMFT, CFLE enjoys teaching and researches commitment
in couple relationships. He received his PhD in Marriage and Family Therapy
from Kansas State University. He completed an internship at the University of
Nebraska Medical Center in the Department of Family Medicine. He is currently an
assistant professor in Human Development and Family Sciences at Northern
Illinois University. |
|Caroline Dorman, MD attended medical school at Oregon Health
Sciences University after receiving an undergraduate degree in Psychology. She
completed her residency at St. Mary’s Family Medicine Residency in Grand
Junction, CO. Post-residency, she modeled herself after Dr. Quinn Medicine
Woman and practiced in the isolated town of Craig, CO, where she did a little
bit everything including CBT and making house calls on horseback. She returned
to St. Mary’s to teach and mentor family medicine residents, where she has been
inspiring young physicians for ten years. Next year, she’ll enter a new phase
of her career providing hospice care. |