Family Frameworks

Should Marriage be talked about in the the Medical Office?

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Jul 2013

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If you know me you know how passionate I feel about marriage and how it effects our children.  We are seeing more and more research that demonstrates this.  Several colleagues have questioned my desire to check with a family about how their marriage is doing.  They have expressed that this is not part of the anticipatory guidance that is needed for a child or that this is getting too personal and it’s really none of a healthcare provider’s business to ask these questions.  A healthcare provider should focus only on the patient’s health and it’s inappropriate to ask anything else.  Well, I am proposing that this is one of the MOST important ways to determine how the child is doing.  

Twenty years ago I started using a form that was provided by the government as a good check off list for anticipatory guidance.  It did include a question about the marriage relationships and how the family is doing as well as summer safety, bicycle helmets and many other issues that are important for children’s safety.  In the past twenty years we have done further research and found that when there is increased conflict that leads to violence there is a greater chance that the children will be effected emotionally.  So much so that this has been determined as one factor that allows the Children and Family Services to remove a child from the home. Why aren’t we asking these questions?  Dr. John Gottman has found that when there is increased violence in the home the child has many more illnesses.  So why don’t we ask before we get into this situation?  Could it not be helpful to get them resources before violence occurs?  Could we prevent some problems such as non-compliance, depression, neglect, and many other stress related illnesses? We are more comfortable giving them summer safety advice and helmet safety rather than talking about relationships and how they effect a child’s health.   If we do not talk about this or ask the questions do you think the patient might bring it up? 
To be honest many years ago when I was going through my tough divorce, I felt like my medical

provider would be a good resource for finding help for the children emotionally.  Unfortunately, my provider had no clue.  Most medical providers a very much trusted by their clients, so much so that they will reveal very intimate information that may not be revealed to anyone else.  If they are trusted this much don’t you think it’s pretty important to encourage them to get good information or to refer to good resources to prevent the problems that troubled relationships can have.  

I remember when I was young there were so many physicians that smoked, it was not even considered

a medical problem.  There were just a very few that were willing to challenge their patients on their smoking habits.  Other colleagues would scoff and seem to think it wasn’t a problem. But look what we have now.  There are tobacco quit lines, all kinds of stop smoking classes and devices, because we found out it does effect our heath and life expectancy and the money we pay out for our medical insurance.  

Another recent example is the weight problem that we see.  Many 

would not address the weight of their  patients.  I remember a friend of mine being so offended because her physician labeled her as obese.  But it needed to be said.  We as healthcare providers need to be pointing out where people can improve their health.  We are not doing what we are expected to do if we don’t address the issues.  But the majority of providers will not ask the question, “How’s your marriage doing?” or “Are you two married?  why not?”  That might be too uncomfortable, it might offend someone, it might make them leave the practice.  I believe that most people want to know what they can do to improve their health.  But you have to say it in a way that it can be accepted.  Just as saying your fat can prove to be ineffective, you can’t ask any personal question without being upfront and honest but doing it in love.  

I would love to know what you think.  Do you think this should be talked about?  Who do you ask these kind of questions.  Over the next couple of weeks I’m going to be looking at the health of your marriage and how it effects your health.  Let me know if this is helpful, ok?  Thanks for reading. 

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