Family Medicine

This article is based loosely on Erik Erikson’s theory of psycho-social development wherein human life progresses through eight stages. Each has developmental questions that need an answer and some have postulated that we cannot progress to the next stage until we have satisfactorily answered the previous one.

The first years see rapid development, language is acquired, toilet training happens, emotional regulation (or not) is commenced, we turn over, crawl and walk. As parents, we also learn to cope with our own emotions and the responsibility of guiding this life and growing skill set. In this reciprocity are the answers to the first two Erikson questions: Firstly: “Am I safe?”

If I cry, will I be comforted. If I am hungry, will I be fed? Positive answers to this most fundamental question leads children to establish trust in those closest to them. Without this, the infant will not only be mistrustful of others but also less hopeful in outlook in general and unconfident at attempting new things.

Secondly: “Can I make my own decisions?”

Will the child be encouraged when attempting new skills like walking, toileting, speaking? If so, the child develops and expresses preferences for favourite toys, foods, clothes – we sometimes see gum boots and shorts worn together. Toddlers increase their vocabulary and start crawling and walking, they learn to feed and dress themselves. Children also begin to make friends, direct their social sphere and show initiative as they plan play and express imaginings. Encouragement, even following mistakes and mishaps, builds resilience whereas negative re-enforcement can lead to a sense of inadequacy or shame.

At Pro Health Care, when assessing a child’s development, we consider the physical parameters like height, weight, head circumference, but also the development of language, social interactions plus gross motor and fine motor skills. It is here that our wonderful allied health practitioners offer their experience and observations to correct and encourage as needed. 

Primary school sees children spend more time out of the home, interact with peers and other adults regularly and they begin to experience success in more formal domains. They show aptitude at some things and initiative is reflected in play and socialisation.

The question to be answered is: “Am I useful?”

Is the child’s industry seen as creative or stifled as basic? Are their many questions seen as thirst for knowledge or a nuisance?

The fourth stage follows naturally, as the child’s skill set develops further. During this time, in later primary school, peers’ opinions become as important as parents. The question answered is: “Are my efforts valued by others or am I inferior?” 

A classic example of encouraged talent was a boy who would compulsively draw in the margins of his schoolbooks. His teacher acknowledged his creativity but encouraged him to complete the class activities as well. Imagine children’s entertainment today had the young Walt Disney not been so supported…

Mark Twain suggested placing children in a barrel when they are born and communicating with them via the bung hole. When they become teenagers, he said, stop up the hole! Your scribe could describe cringe-worthy accounts from his teenaged years. Language, dress, attempts at impressing others, frequent faux pas as I projected the latest and coolest version of myself onto the world. This forming, sorting, discarding of opinions, mannerisms and habits characterise the establishment of an identity. The drive for peer acceptance influences these actions both for the positive and detrimentally to answer the question: “Who am I?” Can I be trusted with intimate relationships? Will my vocation contribute to the world around me?

GP’s are asked to consult on issues of body image, self belief, school stressors, peers, family disputes, sexuality, contraception, pregnancy. Accidents and misadventure can take on more severe forms as teenagers’ prowess and influence grows. Their thinking moves from simple recall and expressions of the concrete to the understanding of the conceptual and adolescent brain development mirrors the shift. Young people synthesize their own beliefs and some choose to become medically differentiated from their parents. The GP may ask if they can speak to the young person alone during part or all of a consult. It can be a delicate task for the GP to balance the teenager’s request for privacy with the parent’s desire to ensure their child’s continuing well being. We will ask if parties agree to information being shared and are bound by the answers to this question.

The growing desire for intimacy leads us to seek out long term relationships We may start a family and choose a life direction. We ask, and receive, answers to the next 2 questions:

“Will I love and be loved?”

Careers, long term relationships, families can be all encompassing (Where did our 30’s go?) and offer many challenges and rewards. Many of these can impact our mental health, especially when setbacks or grief occur. Support from your GP can come in the form of listening, counselling, medication, referrals to psychologists and psychiatrists.

“Am I building something which will outlast me?”

A family, a business, a legacy. Success can be very rewarding, perceptions of failure crippling.

For most of us this time is middle age. Children are independent, the body is holding up. There is often more time to focus on diet and exercise. But chronic diseases, particularly those associated with western diet and sedentary lifestyle, can become apparent. Regular blood tests and screening for breast, cervical, and bowel cancers are proven to benefit those undertaking them, detecting small changes early and referring appropriately. Management is available for declining fertility, virility and the questions arising from these changes.

Growing old is mandatory, growing up is desirable…

We retire, the realisation of our own mortality grows and we reflect on the final question: “Has my life been worthwhile?” The answer to this can lead to satisfaction or regret.

The body isn’t what it was with features like immunity and bone density, metabolic reserves lessening. Yet lifestyle, including nutrition, exercise, social interaction all continue to be important, enhancing quality of life. Immunisations for influenza, pneumonia, shingles are all available for
free to older Australians and regular check ups and monitoring remain as important
as ever.

We observe folks as they discover answers to their life questions. I have the privilege of treating four generations of the same family. Your Pro Health Care Clinic is glad and grateful to be part of your journey.

 Pro Medical SA, Dr Robert Laakmann, GP

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