Persons who establish a relationship characterized by affinity, intimacy, reciprocity, and continuity may feel that they are a family. This feeling is not based on factors such as sharing a common household or being parents. Rather it is based on the process or the relationship itself which has the above four characteristics. Primary care physicians will note that these four elements are familiar and are often found in the relationships they develop with patients in their practice. If unappreciated by the physician while practicing, the overwhelming sense of loss one experiences when leaving practice confirms their existence. The existence of such relationships comes about because of the context of general medical practice. Only in a few of the encounters the physician has with a patient is there a progressive disorder in which the medical model is applicable. In the majority of encounters the physician and the patient are participants in a social function that is based on process rather than outcome. Success rides on the rights and duties of the participants rather than on utilitarian value judgments such as what is-the greatest good-for the greatest number. From FAMILY PRACTICE FORUM 1976 THE FAMILY IN MEDICINE,PROCESS OR ENTITY? By Lynn Carmichael References 1. Marinker,Marshall. The Family in Medicine. Proceedings of the Royal Society of Medicine 69:115-124,1976. 2. Ransom,D.C., and Vandervoort,H.E., The Development of Family Medicine: problematic trends. JAMA,225: 1098-1102,1973. 3. Carmichael,L.P. Competencies in the Relational Model. Presented at the Annual Meeting, Society of Teachers of Family Medicine, New Orleans, Louisiana, April 2,1976. From Lawrence Silverberg
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