1 Brs community medicine
Family Medicine
- Medical specialty which provides
continuing and comprehensive health
care for the individual and family.
- Integrates the biological, clinical and
behavioral sciences
- Practice encompasses all ages, both
sexes, each organ system and every
disease entity.
Three- dimensional Specialty
1. Knowledge
2. Skill
3. Process
Patient-Physician relationship with the patient
viewed in the context of family
Relationship is valued, developed, nurtured and
maintained.
Basic Principles of Patient Care in Family
Practice = Characteristics of Specialist
Patient- Centered or Biopsychosocial Model –
how doctors attend to patients
Approach patients with sensitivity and
responsiveness to culture, age, gender and
disabilities
Develops their ability to collect and incorporate
appropriate psychosocial, cultural and family
data into patient-centered management plans.
Comprehensive Care or Whole Person Care–
not focus on treatment but focus on prevention
Emphasizes the importance of caring for the
whole person
In longitudinal, integrated, preventive services
and treatment of common acute and chronic
medical problems for patients and families in all
phases of the life cycle.
Continuity of Care or Continuous Healing
Relationships – home visits, physician does not
end in hospital service only
Values and promotes continuous healing
relationships by
- Providing a personal medical home for
patients and their families
- Maintaining ongoing responsibility for
the health care of patients and families
- Facilitating transitions between the
primary care provider, referral agencies
and consultants
Context of Care – preventive aspect, on
treatment aspect
Coordination of Care or Integration – patient
should be referred to other doctors, when patient
need referrals
Functions as the integrator of complex care and
collaborates as a health care team member in
disease management, health promotion and
patient education.
Family Physician: Coordinator – inputs should
be coordinated
Attribute Description
A deep Consider all the influences
understanding of on a person’s health
the dynamics of the
whole person Integrate rather than
fragment care, involving
people in the prevention of
illness and the care of their
problems, diseases and
injuries

A generative Participate in the birth,
impact on patients’ growth and death of their
lives patients and want to make a
difference in their lives.
Family physicians foster
personal growth in
individuals and help with
behavior change that may
lead to better health and a
greater sense of well-being
A talent for Intimate relationships over
humanizing the time enable family
health care physicians to connect with
experience people
Explain complex medical
issues in ways that their
patients can understand
Take into account the
culture and values of their
patients while helping them
get the best care possible.
A natural Comfortable with
command of uncertainty and complexity
complexity
Trained to be inclusive, to
consider all the factors that
lead to health and well-
being - not just pills and
procedures
A commitment to Not only physically
multidimensional accessible to patients and
accessibility their families and friends,
able to maintain open,
honest and sharing
communications with all
who are involved in the
care process
Roles of a family physician
 Educator/ Health Advocate – when patient
wants to understand
 Researcher – cannot give management
2
 Manager – similar to coordinator, manage
needs of patients
 Community Organizer – evaluate
community
 Care-giver
Characteristics of the New Model of Family
Medicine
Patient-centered care – all factors involved in
the illness are taken into consideration
Patients are active participants in their health
and health care.
The practice has a patient-cared relationship-
oriented culture that emphasizes the importance
of meeting patients’ needs, reaffirming that the
fundamental basis for health care is people
taking care of people.
Personal Medical Home – home visits
The practice serves as a personal medical home
for each patient, ensuring access to
comprehensive integrated care through an
ongoing relationship.
Team approach- considering work with team
Health care is not delivered by an individual, but
rather by a multidisciplinary team approach for
delivering and continually improving care for an
identified population.
Elimination of barriers to access – more ways of
communicating with patients
Through implementation of open scheduling,
expanded office hours and additional,
convenient options for communication between
patients and practice staff.
3 Brs community medicine
Advanced information systems
Use an information system to deliver and
improve care, to provide effective practice
administration, to communicate with patients, to
network with other practices and to monitor the
health of the community
A standardized electronic health record adapted
to the specific needs of the family physicians,
constitutes the central nervous system of the
practice.
Redesigned offices – accommodate more people
Offices should be redesigned to meet changing
patient needs and expectations, to accommodate
innovative work processes and to ensure
convenience, comfort and efficiency for patients
and clinicians
Whole-person orientation – integrated, whole
person care
Developing cooperative alliances with services
or organizations that extend beyond the practice
setting, but which are essential for meeting the
complete range of needs for a given patient
population.
The practice has the ability to help guide a
patient through the health care system by
integrating care – not simply coordinating it.
Care provided within a community context
A culturally sensitive, community-oriented,
population-perspective focus
Emphasis on quality and safety
Systems are in place for the ongoing assessment
of performance and outcomes and for
implementation of appropriate changes to
enhance quality and safety
Commitment to provide family medicine’s basket
of services
Either directly or indirectly through established
relationships with other clinicians
Specialist – when you pass the diplomate exam,
3 to 6 years in fellowship training
Practice in any kind of hospital (Primary,
Secondary and Tertiary) – Diplomate or Fellow
Certified Family Physician (Primary,
Secondary)
Diplomate (DAFP)
Fellowship (FAFP)
Basket of Services in the new model of Family
Medicine
 Health care provided to children and adults
 Integration of personal health care
(coordinate and facilitate care)
 Health assessment (evaluate health and risk
status)
 Disease prevention (early detection of
asymptomatic disease)
 Health promotion (Primary prevention and
health behavior/Lifestyle modification)
 Patient education and support for self-care
 Diagnosis and management of acute injuries
and illness
 Diagnosis and management of chronic
diseases
 Supportive care, including end-of-life care
 Maternity care; hospital care
 Primary mental health care
 Consultation and referral services as
necessary
 4

 Advocacy for the patient within the health Family as a unit of care
care system
Definitions:
 Quality improvement and practice-based
research In terms of affinity: Group of people related by
blood, marriage or adoption, who live together
Traditional Model New Model of Practice in one household (united nations)
Systems often disrupt Systems support
the patient-physician continuous healing Household: a group of persons living under one
relationship relationships
roof and sharing the same kitchen and
Care is provided to both Care is provided to both
sexes and all ages; sexes and all ages; housekeeping arrangements
includes all stages of the includes all stages of the
individual and family individual and family life It involves delineation of family structure,
life cycles in continuous, cycles in continuous, functions, composition and affectionalities.
healing relationships healing relationships
Physician is center stage Patient is center stage Family as a special unit
Unnecessary barriers to Open access by patients
access by patients 1. Family membership is a lifelong involvement.
Care is mostly reactive Care is both responsive
and prospective 2. Shared attributes
Care is often fragmented Care is integrated
Paper medical record Electronic health record 3. Sense of belonging
Unpredictable package Commitment to providing
of services is offered directly and/or 4. Social expectations
coordinating a defined
basket of services 5. Built- in problems
Individual patient Individual and
6. Family endures despite conflicts and built-in
oriented community oriented
Communication with Communication with the problems
practice is synchronous practice is both
(in person or by synchronous and
telephone) asynchronous (e-mail, Why study the family?
web portal, voice mail)
Quality and safety of Processes are in place for  Psychosocial stress can occur within the
care are assumed ongoing measurement family
and improvement of
quality and safety  Source of social support
Physician is the main Multidisciplinary team is  Transmission of infectious disease
source of care the source of care  Health behavior is acquired from the family
Individual physician- Individual and group
 Define health and illness
patient visits visits involving several
patients and members of  Makes health decisions
the health care team
Consumes knowledge Generates new
knowledge through Why family as a unit of care?
practice-based research
Experience based Evidence based 1. Family is the social context for health care.

2. Patient’s problem is the family’s problem.

3. Family is the greatest ally in treatment.

5 Brs community medicine

4. Patient’s family is present in patient Classification of families according to structure

interview.
 Nuclear family

What is family care?
1. Taking care of all individuals in the family
one by one.
2. Dealing with family as object of management.
Married man and woman with their offspring
(biological/adopted)
Occupy a separate dwelling not shared with
members of the family of orientation of either
spouse

3. Influencing family members to change factors Economically independent

affecting an individual’s health.
 Extended family
What family physicians need to know about
families? Includes 3 generations

1. Understanding family structure and function. Shared responsibilities

2. Awareness of how families communicate. Maintenance of expressive and emotional

relations beyond the nuclear family
3. Skills in observing how families operate.
Unmarried adult daughters and sons typically
4. Ability to relate family/individual. remain in their parents’ home and contribute to
family support.
5. Reinforce central function of family.
Additional extended family members such as
grandparents, aunts, uncles or cousins also may
The Filipino family
live in the same house and assume vital roles.
 Reliance on the family for love, support and
 Polygamous family
refuge has historically been as much an
economic necessity as it is a cultural
 Single-parent family
tradition.
 The relationship to family is not just a The loss of the spouse from death, divorce,
practical trade off of autonomy for social separation or desertion
security.
 Transcends socioeconomic, educational and From the out of wedlock birth of a child
regional differences and is part of a
From the adoption of a child
collectivistic cultural orientation or way of
perceiving the place of the individual in the  Blended family
social context.
 Is the source of one’s personal identity and Includes step parents and stepchildren
of emotional and material support; it also is
May be caused by separation, divorce,
the focus of one’s primary duty and
remarriage
commitment. Dependence on, loyalty to and
solidarity with the family and kin group are
of the highest priority.
 6

In Christian Filipinos, the family is Divorce No divorce, Prostitution Divorce

simple for legal available; No obtainable on
monogamous (one couple at a given time) while husband; separation divorce. Legal many grounds
polygamous (multiple wives) in Muslim Filipino available with right separation but subject to
for cause of without right legal restrictions
families is allowed. Nowadays, Muslims for wife remarriage. or remarriage and financial
Consensual burdensome.
generally practice monogamy. marriage
common.
Extended Extended Extended Small family
family often family ties family weaker includes only 2
Filipino family (Mag-anak) live strong but than in rural generations and
together. separate areas. Birth not collateral
Type of relationship emphasized High birth dwellings. between that relatives. Low
rate. High High birth of Muslim and birth rate and low
infant rate. Low Western infant infant mortality
Conjugal – marital bond mortality infant mortality low. rate.
rate. mortality
rate.
Consanguinal – blood ties

Personal virtues and failings

Descent System: Affiliation of an individual
Choice of marital partner, friends, godparents with a particular group of relatives.

Weakness/immortality/defects  Bilateral – every biological ancestor and

descendant is a socially recognized relative,
Muslim Rural Urban Western a system of family lineage in which the
Filipino Filipino
Paternal Paternal Paternal Trend toward relatives on the mother’s side and father’s
dominance dominance Dominance complete equality side are equally important for emotional ties
with with maternal between
maternal decision husbands and or for transfer of property or wealth.
decision making in wives
making in some areas
some areas
Family is Family is Important in Economic role
the proper the property property; less minor except as
holder and holder and effective in unit of
source of source of labor unit. consumption
labor labor
 Bilineal – an individual is both a member of
Strong Moderate Combination Trend toward the
discipline of strong of discipline equality in his mother’s matrilineage and his father’s
children discipline and parent-child
of children indulgence of relationship
patrilineage. Also known as double descent
treatment of
children
Family Romantic Individual Romantic love all
choice of love exalted marital choice important with
mate subordinate with parental parental approval
to parental approval playing minor
approval role
No free Chaperone Chaperone Little and no
association or group giving way of chaperonage and
with dating dating no taboos
opposite sex
except for
college Naming: (last name or surname)
educated
Double Double Double Tendency to a  Patronymic
standard of standard of standard with single standard
morality morality queridas or for both sexes for  Matronymic
mistresses fewer taboos for
being both. Prostitution
challenge by available,
wives mistresses rare
7 Brs community medicine
Rules of residence:
 Neolocal – new environment, not near the
family of mother and father
 Bilocal
 Matrilocal – family living near the mother’s
house
 Patrilocal – family living near the father’s
house
 Matri-patrilocal
Family set-up
1. Democratic set-up
Parents respect their child’s decisions and ideas.
Tolerance, understanding and permissiveness
prevail.
2. Authoritarian set-up
Conformity to parental guidance.
More punishments than praises.
Authority Patterns:
 Patriarchal
 Matriarchal
 Equalitarian – Traditional: Basis Age
Traditional families and other social systems are
highly authoritarian. Age, power, prestige and
wealth are the chief sources of authority.
Within the family, age determines a hierarchical
system of authority that flows from oldest to
youngest.
Outside the family, other factors such as social
class, professional status or official government
affiliation and ecclesiastical positions may
supersede age as determining factors in the locus
of authority.
Egalitarian roles and relationships between men
and women are further reflected in family
decision making processes.
Family authority is based on respect of age,
regardless of sex.
Family decisions are made only after a
consensus has been reached to ensure that the
ultimate decision will be representative of and
acted on by all family members.
Family disagreements are avoided, if possible;
when disagreements do occur, they are kept
strictly within the family.
Although the father may be perceived as the
main authority figure in the nuclear family, the
mother has considerable authority and influence.
She generally controls the finances, may work
full time (even with many children at home) and
earns as much as or more than half the family
income.
Women enjoy high status in the family and in
the society at large. Bilateral lineage attests to
this higher status of Filipinas compared with
women in more patriarchal Asian countries.
The long accepted phenomenon of the working
mother in the Philippines thus does not pose a
drastic role change as it does for other recent
Asian immigrant families in the United States.
Basic areas of family function
1. Biologic
2. Economic
3. Educational
4. Psychological
5. Socio-cultural or socialization
Family relationship and interaction
Children are the center of parent’s concerns.
They are viewed as an extension of the family
and recipients of the family’s good fortune.
Parents are expected to persuade a child to
accept their point of view, rather than impose
their authority on the child without consideration
for the child’s preferences or wishes.

The child, in turn, is expected to show proper
respect and obedience, to compromise and to
maintain good relationships with all other family
members.
In the Filipino culture, the birth of children is an
expected and desired outcome of marriage. Most
couples prefer to have children of both sexes and
there is typically no special preferences for
males over females.
Children are considered a special gift from God
and a large family is proof of God’s favor and
blessing.
Ordinal position
1. First born – persevering, serious, more
responsive to adults, achievement oriented.
2. Middle child – optimistic, sociable, aggressive
and competitive
3. Youngest child – demanding, outgoing,
narcissistic, though by nature affectionate
Role of the children
May depend on the position of the family
 Eldest- takes charge in helping the mother in
taking care of siblings
 Middle- may assume the role of the eldest child
 Youngest – often the most loved although is also
expected to have own share in household chores,
gets special treatment from parents
Parent child interaction/Family relationship
1. Rejecting parent – insecure, aggressive,
sadistic, nervous, stubborn and uncooperative
child
2. Submissive parent – aggressive, careless,
disobedient and uncooperative child
3. Dominating parent – uncooperative, tense,
quarrelsome and disinterested child
8
4. Absent father or mother – aggressive,
neurotic, jealous, uncooperative, delinquent, less
confident in the future and less able to trust
adults
Social Class Pattern of Behavior
1. Upper class family – closely-knit greater
concern for maintaining the family name and
prestige
2. Middle class family – believes in hard work,
self-reliance, initiative, independence,
responsibility, economic security and self-
improvement through education
3. Lower class family - largely- unemployed,
sees life is a continuous process for survival and
gives the impression of being to a life of
frustration and defeat.
Filipinos view education as:
a "passport to good jobs, economic security,
social acceptance, and as a way out of a cycle of
poverty and lower class status, not only for their
children, but for the whole family”
A family concern
Considered to be an economic investment
toward which family members must contribute
significant effort and often personal sacrifice.
Once successfully graduated and employed, the
individual is expected to assume the
responsibility of helping his or her parents
finance the education of the next child.
Major strengths of the Filipino character
 Pakikipagkapwa tao- having regard for the
dignity and being of others (Philippine
Senate Commissioned Task Force in 1988)
9 Brs community medicine
Manifested among Filipinos in their basic sense
of justice and fairness and concern for other’s
well-being
Filipinos recognize the essential humanity of all
people and regard others with respect and
empathy.
Ex. a.) Mario was told by her mother to stay
inside the room because she would like to talk to
him alone. His mother observed that he got a
P100 bill from the pocket of his father. His
mother asked him if his father was aware of this.
When Mario said no, his mother told him not to
do it again because it is not proper to be getting
money from his father without permission.
 Pakikisama – value and goal that consists of
maintaining good feelings in all personal
interactions and getting along with others at
all costs.
To avoid open display of conflicts and stressful
confrontations, Filipinos may yield to:
 Group opinion (even if it contradicts their
own desires)
 Lavish extravagant praise on one another
 Use metaphorical language rather than frank
terms
 Hide negative feelings or depressed spirits
beneath a pleasant demeanor
 Smile when things go wrong
 Avoid saying no
 Refrain from expressing anger or losing
their temper
 Hiya - commonly translated as Shame
Feeling of inferiority, Embarassment, Shyness
and Alienation which is experienced as acutely
distressing
Integrally related to the concept of face and a
preoccupation with how one appears in the eyes
of others
Inculcated as necessary part of a child’s
development and used as a means to shape
approved or desired behaviors
An individual’s capacity for appropriate
behavior with authority figures is a reflection of
one’s family and upbringing and the fear of
losing face
Ex. My patient was asked by the endocrinologist
if he understood the explanation regarding the
intake of his medications for diabetes. He said
yes because he was afraid that the doctor would
feel that he was not intelligent enough to
understand what was told to him.
 Utang na loob
Integral aspect of maintaining group harmony
and relationships that require the balancing of
obligations and debts
Ex. I had to take care of his son when he was
here because my friend also took care of my son
when he was in the US.
Filipino values, Cultural Ideas
 Paggalang – respect for individual
 Pagbabahala – concern for work and other
people
 Pananagutan – accountability for action
taken
Ex. I decided for the group so I should be able to
defend my action.
 Pagbabalikatan – sharing the burden with
others
 Pagbabayanihan – cooperation with
teamwork
 Pagmamalasakit – solicitous concern for all
 10

Filipino Family Values  Changing roles of men and woman

 Double standard of morality
People get strength and stability from family. As
such, many children have several godparents. Filipino Families must prepare themselves
The more, the better for:

Concern for the extended family is seen in the
patronage provided to family members when
they seek employment.
It is common for members of the family to work
for the same company, more likely than not.
Jobs are hard to get and you can trust your
relatives almost always.
Filipino Family in Modern Society
Modernization is catching up with the Filipino
family
Change must occur if the family is to survive in
the changing world
 A serious reexamination of values and
practices.
 They will have to break with the past and
adjust to the future. There is enough
evidence of the viability of the Filipino
family to make this adjustment and to ensure
its survival.
 The function of the family is being more and
more absorbed by other social institutions
such as the church and the school, but the
family will remain as a great source of
emotional and psychological satisfaction.

Size of the family

States of marriage
In spite of family planning programs and
1. Honeymoon (0-2 years)
education efforts promoted
Emotional: commitment to marriage
In spite of the economic difficulties of bringing
up children, their birth is welcomed. Stage critical tasks: differentiation from family
origin, making room for spouse with family and
Gifts from God
friends, adjusting career demands
Sent to help their parents obtain a better life
through filial love, participation in home
2. Early marriage (2-10 years)
generating activities, insurance for their parents’
old age, sources of strengthening family bonds. Emotional: maturation of relationship

Typical family: 5 children. Stage critical tasks: keeping romance in the

Urban: 3 to 4 marriage, balancing separateness and
Rural: 4 to 5 togetherness, renewing marriage commitment
Considered as ideal family size.

 Economic Pressures on the Family 3. Middle marriage (10-25 years)

 Effects of Poverty on the Family Emotional: post-career planning
 The kinship system:
 The extended kinship Group: Changing
pattern:compadrazgo.
11 Brs community medicine
Stage critical tasks: adjusting to mid-life
changes, renegotiating relationship, renewing
marriage commitment
4. Long term marriage (25+ years)
Emotional: review and farewells
Stage-critical tasks: maintaining couple
functioning, closing or adapting family home,
coping with death of spouse
Basic areas of family function
1. Biologic – reproduction, care and rearing of
children, nutrition, maintenance of health
2. Economic – provide adequate financial
resources, determine allocation of resources,
ensure financial security of members
3. Educational – teach skills, attitudes and
knowledge relating to other functions
4. Psychologic Affection – promotes natural
development of personalities, offer optimum
psychologic protection and promotes ability to
form relationships with people outside family
circle.
5. Socio-cultural or Socialization – associated
with socialization of children, provision of social
status or legitimacy.
Nice to know
It is believed that young people should not
marry before they have completed some kind of
educational preparation for a career so that they
will be economically self-sufficient.
They also should be sufficiently mature to
assume the responsibilities of raising a family.
The typical age for marriage:
Men: 25-30 years old
Women: 20-25 years old
Once married, Filipinos are expected to start
their families within a year or so. The birth of a
child fixes the ties between the married couple’s
respective families. The bond of marriage also is
considered permanent. Catholicism and
Philippine law PROHIBIT DIVORCE except
among Muslims and some unassimilated groups.
Discipline in traditional Filipino homes depends
a great deal on appeals to duties and obligations
of family members based on their respective
roles. Children are disciplined by spanking,
hitting, scolding, embarrassment through teasing
or reprimanding for being walang hiya
(shameless, thoughtless or insensitive), bastos
(crude), walang utang na loob (ungrateful) or for
being a source of shame to the family.
Traditionally, the mother is the chief
disciplinarian because she typically spends more
time with the children and therefore finds more
occasions calling for punishment. The father
tends to punish the children less frequently in
part because of their recognition of his absolute
authority.
Concern for the welfare of the family is
expressed in the honor and respect bestowed on
parents and older relatives, the care provided to
children, and the individual sacrifices that are
made on behalf of family members. A primary
focus on the needs of immediate as well as
extended family members may translate into
behaviors such as considerable sharing of
material things. A Filipina, for example, can
walk into a store to buy a blouse for herself and
come out with one for her sister instead.
Filipinos living in the United States will
routinely send money, clothes, household goods
and other items as well as bring many gifts on

personal visits to extend family members “left
behind” in the Philippines.
Reliance on the family for love, support and
refuge has historically been as much an
economic necessity as it is a cultural tradition.
However, the relationship to family is not just a
practical trade off of autonomy for social
security. It transcends socioeconomic,
educational and regional differences and is part
of a collevistic cultural orientation or way of
perceiving the place of the individual in the
social context.
For Filipinos, the family is the source of one’s
personal identity and of emotional and material
support. It is also the focus of one’s primary
duty and commitment. Dependence on, loyalty
to, and solidarity with the family and kin group
are of the highest priority.
Examples:
a.) Dr. Garcia is a busy practitioner. He has been
managing patients of all ages and of varied
complaints. He had 10 patients last week. He
was able to discharge all except for one. This
patient is Mrs. Santos. She has diabetes and Dr.
Garcia could not control her blood sugar with
her present medications. Yesterday, he called up
the Dietary Department and referred her to a
nutritionist for her diabetic diet. Moreover, he
also referred her to an orthopedic surgeon for
her lower extremity problem.
This morning, he visited Mr. Lopez in his
house to check whether he has been taking his
medications regularly. He also told him the
importance of rehabilitation. He discharged
him 4 days ago, after being confined for 2 weeks
in the hospital. Mr. Lopez has suffered from
stroke.
12
Dr. Garcia finished his residency training in
Family Medicine at PGH and has been
practicing in the same hospital for the last 10
years.
= Dr. Garcia is a specialist and family physician.
= The role performed by Dr. Garcia in the case
of Mrs. Santos is manager/coordinator
= The kind of care given to Mrs. Santos by Dr.
Garcia is continuous care. (Pero hindi ba dapat
with coordination of care din dahil sa referrals?)
= The role performed by Dr. Garcia in the case
of Mr. Lopez is educator.
= The kind of care given to Mr. Lopez by Dr.
Garcia is continuous care.
b.) Dr. Carlo Mencias just admitted a patient
from the emergency room of the De La Salle
Medical Center. Patient is an 18 year old male
suffering from fever of 4 days duration. She
ordered that the patient be given intravenous
fluids and NS1 blood examination to
determine if patient is suffering from dengue
fever. She read in one journal that this is the
newest technique to determine if a patient has
dengue. She also requested that the patient be
referred to an internist because patient also has
diabetes. She got her certification from the
Philippine Academy of Family Physicians
after her residency. Dr. Mencias took and
passed the diplomate examination given by
the same organization. Dr. Mencias has MD,
DPAFP, FPAFP after her name.
= Dr. Mencias is a diplomate, fellow, specialist.
= The roles performed by the Dr. Mencias are
health care provider and researcher.
= The kind of care given to Dr. Mencias are
coordination of care and comprehensive.
13 Brs community medicine

c.) Mr. Gutierrez is a 59 year old male, teacher, References

married for 15 years to his second wife, Mary.
They have two sons, Gino and Gary. Mr. Dr. Hipol’s ppt presentation
Gutierrez has a daughter with his first wife, Notes during lecture
who is living with them. His first wife died Batch 2017 Past-E
from a car accident 16 years ago. Presently, Mr.
Gutierrez and his family is staying near the
house of Edgar, his eldest brother who is single. “I can do all things through Christ who
The two sons and daughter of Mr. Gutierrez are strengthens me.” – Philippians 4:13
still in high school. He has been pushing them
to study very well so they will be professionals
in the future. When Gino met an accident 2
months ago and had to be operated for a fracture
which could be delayed for another 2 days, Mr.
Gutierrez called up Mary and told her that
they need to talk about it and come up with a
decision. Gino was so upset because being
operated for a lower extremity would mean that
he will not be able to go to school for more than
a month. Gino is very sociable, aggressive and
competitive. He has been working hard to get
into the top ten of his class.

= Mr. Gutierrez’s family is a blended family

according to structure.

= Mr. Gutierrez’s family is neolocal according

to location.

= Mr. Gutierrez’s family is egalitarian according

to decision making.

= The family of Mr. Gutierrez is composed of

Mr. Gutierrez, his wife, 2 sons and a daughter.

= The household of Mr. Gutierrez is composed

of Mr. Gutierrez, his wife, 2 sons and a
daughter.

= The family of Mr. Gutierrez most likely

belongs to a middle class family.

= Gino, most likely, is middle born.