IMPACT OF

ILLNESS
ON THE FAMILY
(dampak sakit thd kelg)

Tim FOME
Fakultas Kedokteran Universitas Andalas

1/9
The good physician treats the
disease; the great physician
treats the patient who has the
disease (mngobati peny><mngobati org yg sakit)

Sir William Osler

 Subjective Features of Practice
(gmbarn suby dlm paraktek)

• Health Beliefs (kyakinan kes)

• Somatisation
• The ‘Meaning of Illness’(arti penyakit)
• Ritualistic Chronic Care (tata cara prawtn
peny kronik)
• Fear of Disease (ktakutn akn peny)
• Autonomy & Empowerment
Michael Boland, 2000
(pmbrdyaan)
 Importance Of Studying
The Impact Of Illness
(pnting memplajari dampak dr sakit)

• Causes suffering for the family

• (msebabkn pnderitaan thd kelg)
• Can be disruptive to family life and
hazardous to health (mggu khdupn kelg dn
brbhaya thd kes)
• Embedded in a whole matrix of difficult
family problems (tertanam dlm ksluruhan
matrix dr maslah kelg yg sulit)
Major Illnesses:
(peny utama)
Involving loss of : (mliputi
hlgnya):
 body parts (bgn tubuh)
 ability to carry out normal
functions (kmampuan u
mnjalnkn fgsi normal)
 sense of self-esteem (rsa hrga
diri)
 dreams and plans for future
(mimpi dn rncna u msa dpan)
 sense of invulnerability (rasa
kebal/rasa tdk brdaya)
 Investigate illness
• Health belief model of
patient (model
keyakinan sehat dr
px)
• Broad set of
experience and
concerns of patients
(brbagai pngalamn dn
kekhawatrn px)
• Meaning of illness for
the family (makna
sakit u kelg tsb)
Ecological-transactional model of health, sickness and
family-physician care
Individual
Environment
Microsystems Biologic factors
Psycho-cultural
Exosystem factors
MD-Patient Adaptive capacity
Macro system
transaction
Routine
Ceremony
Drama

Health seeking process

Symptom definition
Role shift
Consultation
Healing action Miller, 1990s
Adaptation
Stages in family illness trajectory
(Tahapan rx thd perjalanan peny dlm keluarga)

• Onset of symptoms
• Reaction to diagnosis
• Major therapeutic efforts (upaya th/utama)
• Early adjustment to outcome
(pnyesuaian awal thd sakit)
• Adjustment to permanency of the
outcome (pnyesuaian thd hsil akhir)
 Stage 1: Onset of symptoms
• Experience prior to Lessons for MD:
contact with MD • Explore explanatory
• Issues on acute vs model and fear of patients
(yg ditakutkan px)
chronic onset
• Acknowledge and explore
• Characteristics of possible conflict (kenali
experience dn cari kmungkinan
• Impact on family konflik)
• Explore aspects of
prediagnosis phase
(aspek preD/)
 Stage 2: Impact phase, reaction to
diagnosis
Emotional Plane Cognitive plane
• Onset • Phase 1: Tension/
• Emotional upheaval Confusion
(prgolakn emosi)
• Phase 2: Increased
• Accommodation
tension/ depression
(pnyesuaian)
• Phase 3: Acceptance
Stage 2: Impact phase, reaction to diagnosis

• Clinical judgement on • Acknowledge feelings

(akui prasaan)
disclosure of
• Appropriate treatment
diagnosis (pnilaian klinis
thd pngungkapn D/) explained (jlskan
• Explain diagnosis pngobatn yg tpat)

• Reassurance, support • Help family

and encouragement understand and cope
(kpstian, dukungan, with illness (bntu kelg
dorongan/smangat) memahami dn mngatasi
peny)
 Major therapeutic efforts
(Upaya terapi utama)

Clinical issues on planning:

• Psychologic states (kead
psikologis)
• Assumption of
responsibilities (prkiraan sso
yg brtanggung jwab)
• Economy
• Lifestyle and cultural
characteristics
• Effects of incapacitation
(efek dr ktdmampuan)
 Stage 3: Major therapeutic efforts
Lessons for MD
Logistic problem of • Remain open to
hospitalization family (tetap trbuka u kelg)
• Deal with variables
(tangani tiap var)
• Father
• Work with patient/
• Mother
family
• Children • Coordinate
• Geriatric • Anticipate
 Stage 4: Recovery, early adjustment
to outcome

Type of outcome Lessons for MD

• Deal with immediate
effects of trauma
• Simplest • Alleviate anxiety, assure
(kurangi kcmasan dn
nyamankn)
• Partial recovery • Psychologic support
• Explore level of
understanding
• Permanent
Stage 5: Adjustment to permanency of
the outcome

Second crisis
• Acceptance of
outcome

For MD:
• Help family cope
 Economic Impact of Illness
(dampak/beban ekonomi peny)

• Emotional trauma
• Social dislocation
(sosial tggu)
• Economic catastrophe
(bencna/tggu ekonomi)
 Categorization of chronic illness

• Onset: Acute, gradual

• Course of chronic diseases:
progressive, constant, relapsing
• Outcome--> fatal?
• Incapacitation: cognition, sensation,
movement, energy production,
disfiguring (cacat), social stigma

Roland
Time phases of chronic illness

• Crisis phase
• Chronic phase
• Terminal
phase
 Health seeking process
Role shift

Symptom Consultation Healing Adaptation

Definition Action
Self care Self
Physiologic Lay referral Family
consequences network Adherence
Folk Healer
Conceptual
consequences
Professional
healer
Chrisman, modified
  

“Caring without science is

well-intentioned kindness,
but not medicine. On the
other hand, science without
caring empties medicine of
healing and negates the
great potential of an ancient
profession. The two
• Peduli tanpa dilandasi ilmu adalah “sekedar” kebaikan/
niat baik, bukan mengobati/memberi pengobatan. Di sisi
lain, ilmu tanpa disertai kepedulian mengurangi aspek
penyembuhan dan meniadakan potensi besar profesi
luhur (kedokteran). Keduanya saling melengkapi dan
penting dalam seni merawat. "

Roland