1. BJ’s Last Testimony Family Medicine Case Presentation 15 January 2010 Asuncion-Dalman-Doromal-Dy-Generoso-Mejia-Ong

2. CASE BACKGROUND

4. FAMILY SYSTEM

5. Family System

6. Patient ◦ Single, Young adult, Lives alone ◦ Several partners Parents ◦ Father works as the church minister, ◦ Mother is the children’s primary caregiver Family ◦ Eldest brother, 2 younger sisters

7. IMPACT OF ILLNESS

8. Family Life Cycle Launching ◦ Goal: Being one’s own person ◦ Secondary task  Differentiation of self from family of origin  Development of peer relationships

9. APGAR Almost always Some of the time Hardly ever 1.I am satisfied that I can turn to my family for help when something is troubling me.  1.I am satisfied that my family talks things over with me and shares problems with me.  1.I am satisfied that my family accepts and supports my wishes to take on new activities or directions.  1.I am satisfied that my family expresses affection and responds to my emotions, such as anger, sorrow and love.  1.I am satisfied with the way my family and I share time together.  Total Score6/10 Modified from Smilkstein G: The family APGAR: A proposal for family function test and its use by physicians, J. Family Practice 6(6), 1978. Reprinted by permission of Appleton and Lange, Inc

10. Stakeholder Analysis StakeholderInterest in IssueRoleLevel of Influence BJGetting well, Controlling my illness, Confidentiality AllyHigh MotherGetting my son well, safe and home; Keeping the family together AllyHigh FatherGetting my son well, safe and home AllyMedium SiblingsFor my brother to get well and go home soon AllyLow GrandmotherCaregiver when the mother needs to rest; For my grandson to get well and go home soon ResistorLow

11. Other Family Issues Other family issues ◦ Religion  Iglesia ni Kristo  Father is a minister ◦ Patient’s decision and confidentiality  Only the mother knew ◦ Communication to other family members  Pneumonia not responding to antibiotics  Why the need to confine in an ICU

12. SCREEM Addressing Disease within a Family Framework

13. Social-Cultural-Religion-Economic- Education-Medical Tool ResourcesPathology Social Network in the workplaceLack of communication with family Cultural Harmonious relationship with colleagues Respect for parents Stigma for possible venereal disease Religion There are no religious differences in dealing with the sick among Iglesia Ni Cristo Conservative group who would disapprove of the illness Economic Personal income Empowerment to make own financial decisions Family members are open to financially assisting Expensive medical care requirements No known savings yet Education Patient is a college graduate who is able to comprehend the medical needs required for his illness Medical Health card holder and immediate access to health needs, improving health seeking behavior Non-coverage for illness related to risky lifestyle behaviors In a tertiary hospital with high price for health care without his HMO coverage

14. MEDICAL ISSUES AND INTERVENTION

16. PSYCHOSOCIAL ISSUES AND PROPOSED INTERVENTION

17. Psychosocial Issues The Family Profile ◦ Cultural and Religious reprisal  A lifestyle preached against by church and family  His being as a moral fault  His disease speaks against his whole family ◦ Financial burden  Class C family  HMOs do not cover this risqué lifestyle disease  Cannot proceed to church’s hospital for confidentiality

18. Psychosocial Issues The Family Profile ◦ DNR and INC doctrines about life  No clear practice on remembering those who died  No doctrine on the issue of DNR ◦ Bereavement and Acceptance of loss  No clear understanding of how this came about  Difficult to communicate to family members the reason for BJ’s confinement  The issue of communicating his testimony to their community

19. FAMILY WELLNESS PLAN

20. Family Wellness Plan Acceptance of Grief DNR

21. LEARNING ISSUES