Thursday, September 29, 2016

Family History

I find the family history to be the most useless part of my history.

For some doctors, I'm sure it's really useful. If you are evaluating a patient with chest pain, it's useful to know that their father had a heart attack at age 42. But considering every patient I've seen has already had a diagnosis, it ends up being completely useless to me.

Unfortunately, I don't get to decide what is useful or not. If I write a 30-page history and physical, I can only bill at the very lowest level unless I include a family history.  So you can bet I'm asking about it.


  1. I find the family history so very useful(*NOT*) on my 93 year old patients with dehydration and UTI.
    ANd lets be honest, if you are 42 and have classic chest pain, I really don't care if your dad had a heart attack or not. You're going to be treated like you are until proven otherwise so even there it is of limited utility.
    About the only time I find family history useful is in cancer discussions and clotting disorders though I am sure there are a few exceptions.

  2. I have been imagining notes written by and FOR doctors and other medical providers, rather than for billing purposes, for federal regulators, etc. It's a wonderful fantasy. I feel worse for the doctors who lived through that period and now have to have all this gobbled-dy gook in their notes that is of no use. ... I will say that I do appreciate full notes from primary care providers. I go to these with any big questions about my patients. I really like when their notes carry this forward even for one-off visits.

  3. I'm adopted, and have Zero information about my biological parents, despite making requests through the system as soon as I was old enough to do so. The fact that I might have a genetically relevant disease (I.e. BCRA) causes me a great deal of stress. So although my SIL can get a mammogram at 40 because my MIL had breast cancer, I can't get one until 50, because I don't know my family history (currently 44 and wishing I could be screened!)

    1. Your wish should be granted:

  4. It can be useful in rheumatic disease

  5. I am a Clinical Geneticist. Family history is the most important part of my hystory. To each it's own, I suppose. ;)

  6. I just ask a limited one related to whatever condition I'm seeing them for. Patient coming in for diabetes? I ask them whether anyone in their family had DM and document that one line.