Collection of Psychosocial Data

In family practice settings, the most common and natural approach to gathering psychosocial data is interviewing the patient over time. Freud suggested that the major achievements of healthy development were the abilities "to work and to love," and this is often a good place to start, even in the first contact with a physician. Where does this patient work, and how does he or she feel about the job, school, or household responsibilities? Who is "family" for this patient, and what is the nature of the support system? Detailed inquiries about work and love made in the context of the ongoing physician-patient relationship result in significant accretion of knowledge over time and make it easy to flag stressful changes in these important arenas.

Other important areas of inquiry include the patient's physical and social environment. Factors such as the quality of housing, neighborhood, food, and financial resources all affect patient safety, health care use, family stress, and physical health. Understanding the ethnic, religious, and political culture of a patient and family is important for guiding culturally appropriate care. Personal and family history, usually gathered gradually over time, can alert the physician to important family coping patterns, strengths, and liabilities. Of special importance is information on major personal family "dislocations," including losses, illness, and trauma. Knowledge of traumatic patient encounters with previous medical care may alert the physician to anticipate and manage potential crisis situations.

Information from patient dialogue can be supplemented by standard measures such as health questionnaires (e.g., SF 36), screening inventories (e.g., Beck Depression Inventory), and stress, coping, and social support tools. Other areas include interviews with family members, including structured assessments (e.g., family APGAR); review of existing records (e.g., school records); consultation with mul-tidisciplinary colleagues (e.g., psychologist, occupational therapist); observation of the patient's environment through home visits; and consultation with cultural informants and translators when needed.

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