Doc, why do you care so much about my family history?

There are times when patients will ask why I need so much information from them. This is a reasonable question, particularly when you likely have never met the person who is asking for detailed and often very personal information.

There can be several reasons why we are not willing to share with someone. We may think that they will judge us or our family. We may come from a culture that does not deem it appropriate to discuss family affairs, or we may not be used to communicating personal information directly. Whatever the reason might be, it is important to understand why this information is useful for the clinician you are seeing. The goal is to help with accurate diagnosis and treatment. We are here to help, not to judge the patient or their family history.

My first rotation in NP school was with a child and adolescent psychiatrist who had many years of experience. He was an incredibly sharp person, and it was one of my most valuable learning experiences. One of his key messages was: family history to a psychiatrist is what an MRI or X-ray is to an ED doc. I am paraphrasing slightly, but the message is clear. Family history can be a key component to help with an accurate diagnosis. It helps us get an idea of the genetic and environmental influences that may be present in a person’s life. It gives us guideposts on possible diagnoses or features to look out for.

This is supported in multiple psychiatric texts. Additionally, medications that work for one family member may work for another.

Many people know that family history is important and are willing to provide it, but perhaps they aren’t close with their family or have never heard anyone talk about these problems. Sometimes circumstances or observed behavior can be cues. An aunt that has a little too much to drink at every family gathering, or a dad that seems to be very moody and has a quick temper. We may not know the diagnosis, but oftentimes we can describe the behavior we have seen.

It can be difficult to have discussions about mental health, but it can be helpful to try and collect this information so that the next time your provider asks about it you’ll be able to provide some important details.

The goal with this post is to briefly outline the ‘why’ behind questions around family history and help encourage an open dialogue between patient and clinician.