The patient and family dynamics

Family doctors see many patients who present with physical symptoms that have primarily an emotional or psychosocial basis with either little or no organic pathology. As many as 50-75% of patients utilising primary care clinics have a psychosocial precipitant as opposed to biomedical problems as the main cause of their visit. 2

In order to understand the clinical manifestations of the sick role of patients, family doctors should first understand the individual's response to stress stimuli, which may come from external (family, work or sexual behaviour) or internal (personality trait or psychosocial) sources (Fig. 2.1 and Table 2.1).


Dysfunction of

G rowing , environment


behaviour (sick role]

values feelings expectations personality trail

Threshold t inlernal sources

Fig. 2.1 Family dynamics and psychosomatic illness iceberg

Table 2.1 Areas of possible biopsychosocial dysfunction
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