Knowing Your Family Health History, Part 1
This is part 1 of a three-part series on the importance of understanding your family history of disease. Please see Part 2 and Part 3 to continue the discussion.
Until DNA sequencing technology becomes routine in every doctor’s office, doctors will have to rely on family history to assess the risk of inherited diseases – some of which are due to genes, some due to shared behavior, and most due to both genes and behavior. In the August issue of American Family Physician, recommendations are given for collecting family history information from all patients.
Why collect family history information?
Both genes and environmental risk factors, like lifestyle and exposures, affect a person’s risk of disease. Understanding your family history will help detect if you are at increased risk for diseases that can be prevented through a change in lifestyle.
Also, if physicians know that several members of your family have been affected by cancer, heart disease, or a disease with a clearly identifiable genetic cause, they will be on heightened alert and pay closer attention to any signs that you might be susceptible too. Early diagnosis usually leads to better outcome.
What kind of family history information is important?
Knowing the kinds of health problems your relatives have experienced is just one piece of the information that can be used to improve your health. If you know about family members’ lifestyles or behaviors, such as smoking, it will be easier to detect those which might be heritable.
You should also tell your physician about your ancestry and which countries your relatives are from. Some genetic diseases are more common in certain ethnic groups and knowing this information may help your physician interpret any signs and symptoms you’re experiencing.
To get the best medical care, try not to worry if you don’t know all of your family’s medical information; any amount of information is useful. Try also to think of the big picture and remember that what you tell your doctor is confidential and should not lead to any discrimination against you by your employer or insurance companies.
How do physicians collect family information?
The best and most thorough way to collect family information would be a 15-30 minute interview during which your physician will sketch out a family pedigree/diagram showing the relationships between family members and their health status. Unfortunately, most doctor’s visits last only 16 minutes on average and family history discussions last less than three minutes. Be assertive and tell your doctor if there’s more information he or she needs to know.
Alternatively, you may receive a questionnaire that you can fill out at home and discuss at a later date.
The American Medical Association also has family history tools online that can help you to compile your family history. Software developed as part of the U.S. Surgeon General’s Family History Initiative 17 is also available online.
What will your physician do with the information?
The goal of discussing your family health history with your physician is to obtain the best medical care you can.
Patient-physician confidentiality applies to anything you tell your doctor about your family history of disease. Unless you have signed a waiver for that information to be included in research or for other purposes, your family history should remain private.
Some people may be concerned about notifying relatives and it’s not clear if your physician is responsible for any part of this. In the process of discussing your family history, if your physician suggests that you let your relatives know that there is a higher risk of a particular disease in your family, let him or her know that you will think about it and decide whether you’d like to enlist his or her help.
Part 2 of the Knowing Your Family Health History series will discuss some of the diseases that can be prevented or more effectively managed if your family history is better understood.
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