Volume 193 - Issue 7
Family history: the neglected risk factor in disease prevention
Author: Simon E P Hauser
Med J Aust 2010; 193 (7): 429-430. || doi: 10.5694/j.1326-5377.2010.tb03985.x
Published online: 4 October 2010
Published online: 4 October 2010
To the Editor: I read the article by Langlands and colleagues1 with some dismay, and a sinking heart. Their report is further evidence of the dangers of moving away from the basic skills of comprehensive history taking and performing a detailed physical examination. Interestingly, in the United States, the debate regarding performing a physical examination has come full circle, from virtually ignoring its importance to now telling us how vital it is and how to perform it.2 But it is the taking of a comprehensive history that, as one of my mentors told me, “is where the money is”, and a detailed family history is an integral part of this.
Eliciting a detailed family history is arguably more important for paediatric patients, who have a longer potential life span and hence have more to gain from this information. In my paediatric practice, for example, I see numerous overweight children, some of whom have a strong family history of hypercholesterolaemia, vascular disease or type 2 diabetes mellitus, which places them at considerable risk of cardiovascular disease in their adult years. A detailed family history may also “unmask” the genetic contribution to a child’s history of deafness or learning disability.
Time constraint is the main impediment to taking a comprehensive family history, but it is worth keeping in mind that it is time well spent and that, in the paediatric population, it may make a significant contribution to the long-term health of the child. With the impending advent of personalised genomic screening, there will be an even greater imperative to formalise the gathering of family history details.3,4
References
- Langlands AR, Prentice DA, Ravine D. A retrospective audit of family history records in short-stay medical admissions. Med J Aust 2010; 192: 682-684.
- Verghese A, Horwitz RI. In praise of the physical examination [editorial]. BMJ 2009; 339: b5448. 0_pgfId-2119859
- Edelman E, Eng C. A practical guide to interpretation and clinical application of personal genomic screening. BMJ 2009; 339: b4253. 0_CBBDCAAF
- Collins FS. The language of life: DNA and the revolution in personalized medicine. New York: Harper, 2010. 0_i1095405