Alcohol abuse. A family disease.

Alcohol problems have a serious impact on families. Physicians who identify alcohol-abusing persons in their practices will note that these people belong to families who seem "stuck" in a confusing family situation with no ready solution. Research and clinical observations have demonstrated that families adopt roles, rules, and interactional patterns around the alcohol abuse problems that can be destructive to individual development. These consequences of alcohol abuse are particularly troubling when we consider that family dysfunction, like the disease itself, is transmitted from generation to generation. Physicians can be most helpful to these families when they understand how to identify the presence of alcohol use problems, evaluate the impact on both the alcohol abuser and the family members, and facilitate the necessary treatment for these patients.

Validity of the Family APGAR in patients with irritable bowel syndrome.

BACKGROUND: This study explores the validity of the Family APGAR (adaptability, partnership, growth, affection, and resolve), a test of family function, in persons with irritable bowel syndrome (IBS). Previous studies have reported increased stress in persons with IBS in the form of marital and interpersonal relationships. METHODS: The Family APGAR and the MMPI were completed by 198 persons, including 58 who sought care for IBS, 67 with IBS who did not seek care, and 73 who did not have the disorder. Family APGAR scores were compared for the three groups using analysis of variance. Multiple regression analysis was used to compare Family APGAR scores with both IBS group status and MMPI K and L scales. An odds ratio was calculated for the two groups with IBS. RESULTS: Mean Family APGAR scores were in the normal range for all three groups and differed by less than 1 point among the groups. The Family APGAR score did not differentiate among persons with IBS but was strongly related to the MMPI K score, a measure of defensiveness in test taking. CONCLUSIONS: The failure of the Family APGAR to detect the family dysfunction found by psychological interviewing and the strong relationship with the MMPI K scale lead us to question the construct validity of the APGAR. More sophisticated test construction is necessary to measure family dysfunction in patients who may tend to respond defensively.

Behavioral medicine rounds: using a biopsychosocial approach for inpatient teaching.

The inpatient setting is commonly used to teach residents various aspects of the practice of medicine. This paper describes how inpatient teaching rounds can be expanded to teach the biopsychosocial approach to patient care. The background and early development, the structure of the teaching, and specific case examples of behavioral medicine rounds are described.

Patient participation in a medical education environment.

Family practice residency programs are specifically directed toward training primary care physicians to serve the interests of communities. This paper describes two methods of developing a feedback mechanism to increase the awareness of physicians in training to patients' health needs and desires. One method involves the development of a patient advisory group in the Family Practice Center at The University of North Carolina, and the other an ongoing telephone survey of patients who call after hours.