The Richness of Family: Expanding the Family History

Abstract

14 Family history is a powerful predictor of the development of diseases in fi rst-degree family members. A family history increases risk for many common conditions such as cancer and cardiovascular disease (CVD) and is so strongly clustered in families with CVD, for example, that about 15% of families account for more than 70% of all cases of CVD occurring before age 60. Tragically, more than half of unaffected relatives who have CVD risk factors are not aware of their own risk factors. The family history should include not only the age, gender, and cause of death but also the age of onset of the diseases of the family member and all the disease risk factors of that family member. It is vital to include not only genetic risk factors (eg, cholesterol disorders, diabetes, hypertension) but also other critical family variables—for example, the behaviors in a family such as (secondhand) smoking, sedentary lifestyle, nutrition, and more. These are vital because not only does family history of disease cluster in families, but chronic disease risk factors, behaviors, environmental factors, and important social and cultural variables are also available through the history. Attention to family history and effi cient methods to collect these crucial data are necessary and have been encouraged for many years. But science and practice, like a democracy, are slow to change. Time has always been a limiting factor. In this issue of the journal, Dr Michael Crouch provides an elegant and important method for obtaining a complete family history that would benefi t medical practice—the genogram. Although the genogram has been available as a tool for some time, Crouch presents the utility of the genogram in practice and methods to effi ciently use the genogram in practice, including the electronic medical record. Crouch demonstrates that the genogram provides important information that can improve and promote health and prevent disease, and it is vital for comprehensive patient care. The genogram demonstrates that there are methods to gain much more information from families than just the age