On every new patient intake form, whether electronic or paper, past medical history and family Medical history sections exist. This portion of the document seeks to obtain all types of important data, which may or may not impact the patient’s health. Having advanced notice of family history of diabetes, hypertension, high cholesterol, cancers and autoimmune diseases, for example, can help providers more accurately and efficiently interpret symptoms and laboratory abnormalities.
However, minority families lag far behind in providing such critical health history.
I liken this type of behavior to the patient’s reluctance in revealing remote histories of sexual abuse. I have patients that I have seen for years, yet they never shared with me their painful past experiences. Some of these patients have been holding on to such horrific memories for decades.
These same patients are also the ones who often suffer from chronic headaches, pain and struggle with interrupted sleep. Lacking all of the vital history essentially handicaps the provider and causes him or her to venture down multiple diagnostic paths when the cause of the problem is related to that past abuse.
Although, I am embarrassed to admit it, I am certain that I have contributed to healthcare waste by ordering unnecessary tests and procedures when I could not readily determine the cause of the patient’s myriad of symptoms. With appropriate history, that type of behavior could be curtailed. And I am certain that I am not the only physician for which this is true.
For instance, in honor of Lupus Awareness Month, let’s use this imposter disease as an example.
My own personal journey with lupus illustrates what a lack of family history can do in affecting how a patient is treated or not treated in my case.
Early in college, I noticed a reoccurring rash for which I was diagnosed as having eczema. I was prescribed a steroid cream, which seemed to help control the symptoms, but the rash and scarring never completely resolved. However, I was young and fairly healthy. I exercised regularly, had normal blood pressure and to my doctor at the time, no further investigation or treatment was necessary.
What I lacked at that time was a thorough paternal history. After some considerable probing into my father’s background, I uncovered that several of his siblings had rheumatoid arthritis and I had a cousin who had died from lupus.
If that significant history had been available, my obstetrician back in 1999 would have known the cause of my abnormal blood tests during pregnancy. But because she was unaware of my family history, lupus testing was not done at that time. So instead of being diagnosed with lupus in 1990 when I first showed signs of the skin manifestations of the disease in college, I was not diagnosed until 11 years later!
Systemic Lupus Erythematosus is an autoimmune disease where the body attacks itself. Every system of the body can be affected, including cardiovascular, respiratory, and renal. So you can see why doctors could be sent on a wild diagnostic extravaganza if crucial pieces of history were missing.
The takeaway message is simple: past medical history, including family medical history is important! Precious resources and time are wasted when such information is withheld.
Your family doctor,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
