The family as patient in family medicine. Rhetoric or reality?

Considerable attention has been paid to the role of the family as a system in its own right, rather than the individual patient, as the fundamental unit of health care delivery. Despite the apparent validity of this concept, many important questions remain unanswered. Among these are: (1) Is there sufficient understanding of family pathophysiology, of the sensitivity and specificity of diagnostic techniques and of the safety and efficacy of therapeutic modalities to make true family health care possible? (2) If this type of care is possible, how are the needs of the family and its individual members met, or value judgements made about their relative importance? and (3) What are the consequences for the health care delivery system of this type of care? An extensive literature review is used in an attempt to answer these queries, from which questions for further study are posed.