Family Medical History Influences Patient Health

By Charis Eng, MD, PhD

Family members share a combination of genes, behaviors, lifestyles and environments. Collecting your patients’ family medical history and including it in their medical record is important in prevention, risk reduction and early detection of disease.

As the U.S. healthcare system transitions into more personalized medicine, the family medical history is an important starting point for physicians.

The American Medical Association cites a number of reasons why obtaining a family medical history on patients is beneficial:

• Identifies potential high-risk future health problems
• Targets services for patients with a strong family history of disease
• Customizes preventive treatments (lifestyle changes) and screening programs for treatable disorders
• Identifies single gene disorders or chromosomal abnormalities that are common or rare
• Identifies patients at high risk for diseases influenced by environmental conditions, (diabetes, hypertension)
• Promotes an increased awareness of disease risk in patients, encouraging actions to reduce risk

The family tree

The best way for patients to gather information about their family medical history is to ask questions—with the upcoming holidays, encourage them to talk at family gatherings or draw a family tree. The Office of the Surgeon General offers a Family Health Portrait tool, and the American Society of Human Genetics offers resources to guide the conversation.

Ask patients to collect medical histories on first-degree relatives (parents, siblings and children), then move on to extended family members (grandparents, aunts, uncles, cousins). Ideally, patients should collect health history information from as many family members as possible.

A detailed family tree can help physicians—and their patients—to easily visualize how medical conditions and traits are moving through generations. For each family member, the following information should be collected:

• Relationship to patient
• Gender
• Age
• Ethnicity
• Relevant medical conditions (chronic diseases, cancer, infertility) and age of onset
• For deceased family members, cause and age at death
• Medications taken regularly
• Surgeries or hospitalizations
• Lifestyle and dietary habits

Adoptees may have a more difficult time accessing their family health histories. Some adoption agencies collect medical information on birth relatives, but laws vary by state. Individuals can contact the health and social service agency in their state for information on how to access medical and legal records on biological family members. Child Welfare Information Gateway (formerly the Adoption Information Clearinghouse) offers information on adoption and obtaining records.

Knowledge is power

A family medical history can help practitioners create a unique road map to wellness and disease prevention. That knowledge also can help patients gain a diagnosis, plan a family, find the right treatment for a medical condition or improve their understanding of how genetics plays a role in their health.

Your patients may not be able to change their genes, but with a little information they can change behaviors or make lifestyle choices that have a lasting impact on their health.

Genetic counseling

Gathering a complete and accurate family medical history is becoming more important as genetic medicine explains more diseases. A strong family history of a genetic or inherited condition may require a referral for clinical genetic services.

Cleveland Clinic’s Center for Personalized Genetic Healthcare offers comprehensive clinical genetics services, education and support. Our geneticists and genetic counselors work closely with primary care providers and specialists to incorporate genetic information into a patient’s overall care plan.

The family medical history is a starting point to guide patients to explore the branches of their family tree to improve their overall health and quality of life.

Dr. Eng is Chair and Founding Director of Cleveland Clinic’s Genomic Medicine Institute and founding Director of its Center for Personalized Genetic Healthcare.