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Make Family Great Again

Posted By Matthew P. Martin, Tuesday, January 10, 2017


According to the U.S. Census, 87% of Americans live with a family member. That’s 8.7 out of 10 human beings in the U.S. living with a loved one. That’s huge! Let that sink into your brain for a moment. That means that most of us are sharing a house, a condo, an apartment, or other dwelling with someone we consider to be "family”, however you define it. In the words of Joe Biden, "That’s a big … deal”. My goal is to convince you that the family should be at the heart of our health care system but that evil forces are conspiring to kick it to the curb in favor of "population health” and "community” (I’m dramatically using both of my hands to make these air quotes).


Family relationships impact your health. Did you know that family dynamics can even lower glycated hemoglobin levels and increase knowledge of chronic disease like diabetes? It can even predict the body mass index of youth! Imagine a doctor prescribing family time like a drug. "And one more thing, Mr. Martin. I’m prescribing you 20 mg of quality communication with your wife. There may be some side effects like loss of football knowledge and increased libido but you should be okay.”


Despite this evidence, family-centered care is much more the exception than the norm. Even though many medical clinics emblazon the words "family care” on their door sign, you would be hard pressed to find physicians who encourage bringing family members to an appointment or who even ask how family life is affecting your health. Usually "family care” means that the physician can treat anyone in your family; just don’t expect the doctor to ask a patient what his wife thinks about his smoking.


It wasn’t always this way. In the famous painting "The Doctor” by Sir Luke Fildes (1891), a general practitioner sits all night with parents whose daughter is sick from an infection. Sure it’s a romanticized ideal, but house calls in the past probably included a conversation with the rest of the family. An astute doctor making a house call would collect more health information in 30 seconds than in three medical appointments. Fun fact: in 1949, this painting was used by the American Medical Association in a campaign against a proposal for nationalized medical care put forth by President Harry S. Truman. How times have changed!

House calls aside, we have lost our way in this post-family 21st century of self-driving cars and 3-D printers. The family has been cast aside in favor of the greater neighborhood and community. Public health officials and policy wonks dream of a health care machine that looks beyond the tight-knit relationships of family units to broader systems of "population health”. This globalist view maligns the bi-directional influence of family dynamics and health and supplants it with a broad focus on systems that are too big for any medical exam room.


It’s time to bring health back to the family! Imagine a health care system in which nurses inquire about blood pressure as well as marital pressure. Imagine a system in which physicians ask how the newly diagnosed diabetes is affecting family meals or how the adult children can help the patient manage stress better. That is the kind of system that will make family great again and lower health care utilization and costs. That is the system that leads to winning, so much winning that you may get tired of it and say to your physician, "Doctor, please, we’re tired of all this winning”. And she’s going to say, "I’m sorry but we have to keep winning”.


Now, a word of caution: the other side will attempt to convince you that the family is passé and that the future is the "population”, the "community”. They will cleverly concede that the family was instrumental in helping our pre-industrial progenitors but that now is the time for the physician to look beyond the family and into a patient’s "community”. They believe that it takes a village to care for your sickly grandfather and not the adult children. They believe your neighborhood is going to give you a hug and encourage you to cut back on your drinking. They believe in population health, not family health. Little do they know, the family is the basic unit of any population. Strong families lead to a strong population. It’s a beautiful thing, am I right? Of course I’m right.

Here are two ways to make the family great again in our healthcare system. First, family caregivers need more support and attention. Most patients want to stay at home and be cared for by a loved one, but this presents financial and medical challenges for caregivers. Insurance companies should make it easier for caregivers to be trained and compensated for their time. Not only does this save money for society, it improves the patient’s quality of life.


Second, researchers need to determine the best practices of family-centered care and educators need to teach these practices to healthcare professionals. Right now, we have a strong group of cheerleaders championing family-centered care but no clinical competencies and evidence-based teaching strategies. We need family champions, but we also need a big, beautiful wall of evidence that family-centered care works.


We need to drain the swamp of public health and policy centers everywhere and get "Big Data” out of the healthcare system. If not now, then when? If not us, then who? Please join with me in bringing health back to the family, back to the basic unit of society. Thank you and God bless.


Matt Martin, PhD, LMFT, serves as the Director of Behavioral Medicine at Southern Regional AHEC in Fayetteville, NC. He is the CFHA Blog Editor. 

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Barry J. Jacobs says...
Posted Wednesday, January 11, 2017
Matt--While I share your passion for family-centered care, I disagree with your argument that we have to decide between a focus on "family" and "population." As a number of researchers have been demonstrating recently, family-centered care furthers population health goals, including lowering healthcare costs. Please see the link below to a presentation that I recently gave at Thomas Jefferson University entitled "Promoting Family Resilience as a Population Health Strategy." Your pal, Barry
Permalink to this Comment }

Matthew P. Martin says...
Posted Wednesday, January 11, 2017
Wish I could have been there for your presentation, Barry, before I wrote this divisive piece. The slides have some great stuff in them. I especially like your quote from Alan Stevens: "Improved population
health is unlikely without greater attention to the role of family caregivers, and the platform of population recognizes the full value of
family caregivers…” Maybe family and pop health are reconcilable after all.
Permalink to this Comment }

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