When the family is the main disease

Abstract

Introduction: This case study describes multiple signs of family dysfunction detected by a general practitioner (GP) during office visits as well as attention to the context of the patient in primary health care. Case description: The case involves a nuclear family composed of a couple and their 4 year-old daughter. The index patient is a 27 year-old male who was abandoned at birth by his teenage parents. He was raised by his maternal grandparents, who had few economic resources. During his adolescence he had minimal contact with his mother, who was already married with two daughters and living abroad. At the age of 18 he met a paternal uncle, with whom he established a strong relationship. This interaction led to a reunion with his biological father. The patient occasionally lived with him, his stepmother, and his half-sister, seven years younger, with whom he shared a room. They developed an incestuous relationship, which was revealed as a result of the pregnancy of his half-sister who was 15 at the time. They were then evicted from their father's home. Both members of the couple subsequently visited the same GP in independent consultations with nonspecific complaints without a clinical explanation. The multiple consultations aroused suspicion of family dysfunction. A multidisciplinary approach was helpful in promoting family welfare. Comment: This case study draws attention to warning signs of family dysfunction, the role of the GP in assessing recurrent signs and symptoms, and the use of family assessment tools. The importance of multidisciplinary collaboration for integration of care and family counseling to improve family dynamics are noted.