Significant presentations of family dysfunction

The following presentations may be indicators that all is not well in the family, and so the doctor needs to 'think family':

• marital or sexual difficulties

• multiple presentations of a family member— 'the thick file syndrome'

• multiple presentations by multiple family members

• abnormal behaviour in a child

• the 'difficult patient'

• inappropriate behaviour in the antenatal and/or postpartum period

• drug or alcohol abuse in a family member

• evidence of physical or sexual abuse in wife or child

• psychiatric disorders

• susceptibility to illness

• increased stress/anxiety

• complaints of chronic fatigue or insomnia

It is important that the family doctor remains alert to the diversity of presentations and takes the responsibility for identifying an underlying family-based problem.

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