Discussion
To our knowledge, this is the first study to assess the effect of different approaches to family care on patient outcomes and time use during patient visits. Our study indicates that different styles of family focus have implications for the process and outcomes of patient care. Furthermore, physicians with the 2 different family practice styles tend to differ in physician characteristics and to see different patient populations. It is interesting to note that patients of family-oriented physicians whose practice style included greater emphasis on certain familial psychosocial aspects of care tended to report better overall health status (P <.10). This is of practice experience? One hypothesis about the possible etiology of these styles is that new residency graduates use their training to gather family histories as a context for screening and health habit advice for the individual patient. However, as they gain more practice experience they tend to become more relationship centered—pay more attention to family problems and less to screening and preventive services delivery. This process could be part of the developmental life cycle of a family physician; it may also be fueled by the complementary attitudes of patients. Younger patients often choose younger physicians, while older, patients and those with family problems may go to older more experienced physicians. In addition, our findings indicate that physicians who practice with a family-history stylemay benefit from a lower threshold for referring patients for family counseling. Alternatively, these physicians might work to hone their own skills to meet these needs while they perform preventive and physical examination procedures.16 In contrast, physicians who use a family-orientation style need to make certain that they or someone in the health care team will monitor and maintain the appropriate preventive services delivery.
Limitations
One limitation of our study was that the 2 family focus styles were developed on the basis of a small number of items related to family focus. There may be other styles that could be captured with a broader assessment. In addition, the sample represents only one geographical area (northeast Ohio). Our study, however, clearly benefited from the intensive multimethod examination of the process and outcome of care. Our findings advance previous work1 that reported a high level of family care and identified 2 distinct styles of family care in real world community practices.