Table Of ContentUrban Family Medicine
Richard B. Birrer, M.D., M.P.H.
Department of Family Practice
SUNY-Downstate Medical Center
Brooklyn, New York 11203, U.S.A.
Library of Congress Cataloging in Publication Data
Urban family medicine
Includes bibliographies and index.
I. Family Medicine. 2. Urban health. I. Birrer,
Richard B. [DNLM: I. Family Practice. 2. Physicians,
Family. 3. Urban Population. W 89 U72]
R729.5.G4U73 1986 610 85-1855
© 1987 by Springer-Verlag New York Inc.
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ISBN-13: 978-1-4612-9088-9 e-ISBN-13: 978-1-4612-4624-4
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Urban Family Medicine
Edited by
Richard B. Birrer
With 33 Figures
Springer-Verlag
New York Berlin Heidelberg
London Paris Tokyo
To
Christina
Richie
Chrissie
and
Danielle
Acknowledgment
The editor wishes to gratefully acknowledge Robert B. Taylor, M.D. for his guidance and sup
port, Ms. Gloria lichetti for her unselfish secretarial assistance, and the indefatigable and
devoted staff of Springer-Verlag.
Foreword
Now, more than ever, Family Medicine is alive and well in the United States. The base of this
medical specialty has traditionally been in the smaller cities, suburban communities, and rural
areas of this country. Over the past decade, however, there has been a resurgence of interest in
primary care in our major metropolitan areas as a solution to the high tech subspecialty pace of
the tertiary care environment. A rebirth of urban family medicine has accompanied these
pioneering efforts. To date, the accomplishments are substantial and the prospects are bright.
There is still a long way to go and there are a significant number of hurdles to cross.
Although diseases are generally the same wherever you are, their effects as illness on the
individual and the family are strongly influenced by the environment and social milieu. Urban
families have distinctive and diverse problems-cultural, economic, and ethnic. Training pro
grams situated in the large cities must recognize these issues and include special emphasis on the
situations that the family physician is likely to encounter during and after his training. There is
very little research literature on the background and nature of special urban problems and these
areas are the subject of several chapters of this long overdue volume devoted specifically to urban
family medicine. Dr. Birrer has persuaded true experts to share their knowledge with the reader.
The emphasis of the text is the family and the provision of wise humane health care characteristic
of family medicine. Urban family medicine is not a subcategory or subspecialty of family medi
cine. Rather, it is a logical extension and application of the precepts and philosophies of family
medicine to the vital and challenging issues of our metropolitan living areas. The result should
be not only better care for the urban family but also a better understanding by all physicians of
the special needs of a major portion of our population and what family practice has to offer them.
Charles M. Plotz,M.D.
Professor of Medicine
Chairman, Department of Family Practice
Downstate Medical Center
State University of New York
Brooklyn, New York
Contents
I The Urban Family Physician
Urban Family Medicine: An Historical Overview ...................... .
Steven K. Rothschild
2 Urban Family Practice: Breadth and Scope. . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Richard Sadovsky
IT The Urban Family
3 Family Structure and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Janice L. Benson
4 Family Organization and Dynamics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Alvin H. Slrelnick and Margaret Gilpin
5 The Family Life Cycle in the Urban Context. . . . . . . . . . . . . . . . . . . . . . . . . .. 27
Alvin H. Slrelnick and Margaret Gilpin
m Physician-Patient Interaction
6 Doctor-Patient Communication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 42
Sim S. Galazka and George Drake
7 Working with Family Systems and Biopsychosocial Problems
in Family Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 51
Emilie Lowerre-Jambois
8 Compliance: An Urban Nightmare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 58
David B. Brecher and Ross L. Egger
9 The Urban High-Risk Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 62
Sleven Marc Simons
IV Medical Records
10 Urban Family Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 72
Joseph Kertesz
x Contents
V Urban Preventive Medicine
11 Screening and Choice of Diagnostic Tests . . . . . . . . . . . . . . .. . . . . . . . . . . . .. 82
Richard C. Kf!nder and Donald Balaban
VI Common Medical Problems in the Urban Sector
12 Issues in the Health Care of the Urban Adolescent. . . . . . . . . . . . . . . . . . . . .. 92
D. Clare Fried and S. Kenneth Schonberg
13 Alcohol and Drug Abuse in an Urban Environment . . . . . . . . . . . . . . . . . . . .. 98
Frederick B. Cooley
14 Care of the Urban Elderly .......................................... 106
James D. Lomax
15 Psychiatry and the Urban Family Practitioner. . . . . . . . . . . . . . . . . . . . . . . . .. 117
Manin Kesselman, Cornelius W. Sullivan, and Carll. Cohen
16 Epidemiologic Concerns of Urban Family Practice. . . . . . . . . . . . . . . . . . . . .. 125
Alan B. Steinbach
VII The Primary Care Team
17 Primary Care Team ....................... . . . . . . . . . . . . . . . . . . . . . . .. 135
Ludlow Creary and Ernes~ ~n
18 Physical Therapy and Urban Family Medicine ......................... 139
Linda Rascetti-Danon and Connie Brignole
19 Community Resources ............................................. 147
Jacquelynn K. Otte -
20 Home Visits ..................................................... 154
Raben L. Perkel
21 Urban Community Diagnosis: A Tool for Community-Oriented
Family Practice .............................................. . . .. 163
Thomas M. Mettee
22 The Periodic Health Examination in Adults . . . . . . . . . . . . . . . . . . . . . . . . . . .. 171
Patrick T. Dowling
23 Periodic Health Screening in Children: Urban Implications. . . . . . . . . . . . . .. 192
Richard B. Birrer, Howard Kf!instein, and Laney McHarry
24 Medical Ethics in Urban Family Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 200
Donnie J. Self
VIII Systems and Subsystems of Urban Medical Care
25 Practice Options in Urban Family Practice . . . . . . . . . . . . . . . . . . . . . . . . . . .. 208
Joshua Freeman and John C. Payne (with contributions
from L. Creary and E. ~n)
IX Cross-Cultural Medicine
26 Cross-Cultural Medicine: Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 220
Patrick T. Dowling
27 Traditional Medicine Among Mexican-Americans . . . . . . . . . . . . . . . . . . . . .. 222
Patrick T. Dowling and Glenn Lopez
28 Families of Mexican Descent: A Contextual Approach. . . . . . . . . . . . . . . . . .. 228
Betty M. Karrer
Contents xi
29 Traditional Medicine and the Urban Black American Patient ............. 233
Stanley T. Harper
30 Medical Practice Among Haitians ......... . . . . . . . . . . . . . . . . . . . . . . . . .. 235
Gertrude Novak
31 The Indochinese Patient 238
Van Hong Duong
X Training for Inner-City Family Practice
32 Graduate Training for Urban Family Practice .......................... 243
Peter S. Sommers and Robert J. Massad
33 Training for Inner-City Family Practice: Experience of the
Montefiore Medical Center. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 248
Robert J. Massad
XI Important Issues in Family Practice
34 Managing Your Practice in the 1980s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 255
Robert R. Moore and Greg B. Gates
35 Legal Aspects of Family Practice .................................... 264
Nancy Neveloff Dubler
36 Issues in Family Medicine Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 272
Donald J. Balaban and Neill. Goldfarb
37 The Future of Urban Family Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 281
mn.
MacMillan Rodney
Index .............................................................. 285
Contributors
DofUlld J. Balaban, M.D., M.P.H., Department of Family Medicine, The Greenfield Research
Center, Thomas Jefferson University, Philadelphia, PA 19107
Janice L. Benson, M.D., Faculty Development Program, Cook County Hospital, Chicago, IL
60613
Richard B. Birrer, M.D., M.P.H., Department of Family Practice, SUNY-Downstate Medical
Center, Brooklyn, NY 11203
David B. Brecher, M.D., Department of Family Practice, SUNY-Downstate Medical Center,
Brooklyn, NY 11203
Connie Brignole, P.I, Formerly, Department of Physical Therapy, SUNY-Downstate Medical
Center, Brooklyn, NY 11203
earl I. Cohen, M.D., Department of Psychology, SUNY-Downstate Medical Center, Brooklyn,
NY 11203
Frederick B. Cooley, Ph.D., Department of Family Medicine, SUNY at Buffalo, Buffalo, NY
14208
Ludlow Creary, M.D., Department of Family Medicine, Charles R. Drew Medical School and
Martin Luther King Hospital, Los Angeles, CA 90059
Patrick I Dowling, M.D., Department of Family Practice, Cook County Hospital, Chicago, IL
60612
George Drake, M.D., Department of Family Practice, Cleveland Metropolitan General/Highland
View Hospital, and Department of Family Medicine, Case Western Reserve University School
of Medicine, Cleveland, OH 44109
Nancy Neveloff Dubler, U.B., Department of Social Medicine, Montefiore Medical Center,
Bronx, NY 10467
Mm Hong Duong, M.D., Department of Family Practice, Cook County Hospital, Chicago, IL
60612
Ross L. Egger, M.D., Department of Family Practice, Ball Hospital, Muncie, IN 47303
Joshua Freeman, M.D., Department of Family Practice, Cook County Hospital, Chicago, IL
60612
D. Clare Fried, M.D., Department of Pediatrics, New York Medical College, Valhalla, NY 10595
Sim S. Ga/azka, M.D., Family Practice Residency Program, Cleveland Metropolitan General
Hospital, Cleveland, OH 44109
