The family history may be an important part of the initial interview. It will obviously help to identify genetic diseases, such as neurofibromatosis or cystic fibrosis. It is also useful, however, in identifying environmental diseases such as tuberculosis. There are also some important diseases which fall between being strictly genetic or environmental. Diabetes is a good example of such a disease with a familial tendency. The tendency to develop diabetes is often inherited, but the appearance and the course of the disease is strongly influenced by environmental factors, such as diet.

In obtaining the family history, you will want to focus on the patient's chief complaint, if there is one. However, there are some familial diseases which are sufficiently common and serious that they are worth investigating in almost any new patient. These would include high blood pressure, diabetes and cancers.

The family history should include both parents and any siblings. If there appears to be a positive history of familial disease, you should also try to obtain information about grandparents, uncles and aunts. In your clinical courses, you will learn how to record the family history in a chart form which helps you to quickly identify patterns of inheritance.

If your interest is in a disorder with a strong environmental influence, such as an infectious or allergic disease, you should also ask about the patient's spouse and children.

Different people will have different responses to questions about their family history. For some it is a very natural and important part of the diagnostic process. For others it may seem invasive. You should be sensitive to the fact that some people might experience shame or embarrassment about having a disease run in their family. This may result in the patient being somewhat reluctant to answer questions. They may even give misleading answers. Be sensitive to their concerns. It may take several visits to develop the trust that is needed to gather a complete family history.

Situation 1: A new patient is receiving a check-up. He has no particular complaint, but has not had a health check recently.

Nurse: Mr. Smith, I'd like to ask you a few questions about your family's health. Is that alright?

Mr. Smith: Sure, go right ahead.

Nurse: Mr. Smith, are both of your parents still alive?

Mr. Smith: Yes, they retired to Florida a couple of years ago.

Nurse: And how old are they?

Mr. Smith: Let me think. My father is 79 and my mother is 74, I think.

Nurse: Are they both well?

Mr. Smith: Mum's okay. She has high blood pressure, but it seems to be controlled with medication.

Nurse: Does she have any other health problems?

Mr. Smith: She has allergies, but they seem better since she moved to Florida.

Nurse: Did she have any other major health problems in the past?

Mr. Smith: She had a TIA, like a minor stroke, several years ago, but she seems to have recovered completely.

Nurse: And how about your father? Is he well?

Mr. Smith: He's very well. They both enjoy their retirement.

Nurse: Has he ever had any major health problems?

Mr. Smith: Actually, he had bowel cancer a couple of years ago, but they seem to have gotten it in time.

Nurse: Has anyone else on your father's side had a problem with cancer?

Mr. Smith: Now that you mention it, I think my father's older brother had cancer as well.

Nurse: As far as you know, has anyone else in the family had cancer?

Patterns:

*Are
... both of your parents still alive
... they both well

* Is ... he well

* She has ... high blood pressure
... allergies

*It seems / They seem / She seems
... to be controlled with medication
... better since she moved to Florida
... to have recovered

* Does she have / Did she have ...
... any other health problems
... any other major health problems in the past

* She had / He had / My father's older brother had ...
... a TIA
... bowel cancer

* Has he ever had
....any major health problems
* Has anyone else on your father's side
,,,,had a problem with cancer
* Has anyone else in the family
... had cancer

Situation 2: A doctor is interviewing the parents of a three year old boy who has been discovered to have a cataract in one eye.

Doctor: Your son is generally quite healthy, but he seems to be developing a cataract in his right eye.

Mother: How did this start? He has never been ill before.

Doctor: Has anyone else in the family been effected with cataracts?

Mother: Not as far as I know.

Doctor: It is probably congenital.

Father: Do you mean its genetic? There has never been anything like this in my family.

Doctor: No, its probably not genetic. You can think of it as just an unlucky accident.

Father: You mean its not hereditary?

Doctor: It's not likely to be inherited.

Mother: Is there a chance that our other children could be effected?

Doctor: That's highly unlikely. There is no reason to think that any of your other children would develop the same problem.

Father: Do you mean to say that there is no danger at all to our other children.

Doctor: There is no reason to be concerned. There is no more danger to your children than there is to any other family. Please don't worry.

Mother: Well, suppose he has children of his own when he grows up. Could they be effected with the same problem?

Doctor: That's not likely. This sort of problem usually doesn't run in families.

Father: But how did this happen? There has never been anything wrong with him before.

Patterns:

* How did this ... start
... happen

* He has never been
... ill before

* There has never been
... anything like this in my family

... anything wrong with him before

* It is /It's
... probably / probably not / not likely to be