Dialogue Volume 12 Issue 4 2016 - Page 53

practice partner

Family Histories

To promote better outcomes , explore how health issues interact with the family dynamic


By Stuart Foxman illUSTRATION : ian mitchell

In a way , any physician is a “ family ” doctor . That ’ s because family dynamics are at the centre of so much of what matters to a patient . “ The whole family is affected by disease and the experience of disease ,” says Dr . Maria Muraca , Medical Director at the North York Family Health Team . Consider a patient of hers who has breast and ovarian cancer . This woman is dealing with more than just her treatment . “ She ’ s struggling with keeping the family together ,” says Dr . Muraca . The illness has had enormous ramifications for the patient ’ s family . There is worry in all corners about the future . Family dreams , big and little , are in flux . The patient has two adult daughters , and one moved up her wedding because of the prognosis . Beyond that stress , both daughters decided to get tested ; they each carry the BRCA1 mutation , which has taken an added toll on the mother . “ That was her biggest fear ,” Dr . Muraca says . “ She has guilt .” Those family issues are as real as a cancer diagnosis . And Dr . Muraca has had to help her patient work through them . How can doctors acknowledge such issues and help people through them ? That ’ s an underappreciated part of doctor-patient communications , suggests Dr . Muraca . If doctors are to understand the whole person when they treat their patients , then embedded in that is understanding the context of family . Here ’ s how Dr . Judith Belle Brown of Western University puts it : “ Families can either aggravate or ameliorate

ISSUE 3 , 2016 Dialogue