Medical staff rarely consider family history when caring for acutely ill patients in hospital, according to research published in the Medical Journal of Australia.
Dr Andrew Langlands, from the Royal Perth Hospital, and
co-authors conducted an audit of the medical records of 300 randomly selected
patients who were admitted to the hospital's short-stay medical unit between
July and December 2007.
Their study showed that 73.7 per cent of patient records had
no family history documented, and just 16 per cent contained a family history
with specific details about the presence or absence of a medical condition in
at least one relative.
"This retrospective survey found that family history is
seldom documented by medical staff assessing acutely ill patients," Dr
"As family history offers an increasing range of
opportunities for improved health outcomes, any failure to routinely assess it
is a lost opportunity to improve the health of those at increased risk of
In two accompanying editorials in the MJA
Josephine Thomas, from the Royal Adelaide Hospital, Prof Campbell Thompson,
from the Department of General Medicine at the University of Adelaide, and Prof
Jon Emery, Chair of General Practice at the University of Western Australia,
and his co-authors write that it is unrealistic for clinicians to record a
patient's family history in acute hospital admissions because of increased
workload and time pressures.
"The acute admission is not an ideal setting for detailed
and accurate history taking; patients are usually unwell and access to their
family is compromised," Dr Thomas said.
"We would argue that, under present circumstances and with
doubt hanging over its sensitivity, specificity and effect on health outcomes,
the family history is a justifiable omission from many acute hospital
Prof Emery said that not all patients required detailed
assessment of their family history, and that simple, self-completed family
history screening questionnaires could assist time-poor clinicians in recording
patients' family history.
"Internationally, there is growing recognition that a family
medical history can support tailored disease prevention ... There is some
evidence that having knowledge of a family history of a specific condition is
associated with improved uptake of a range of disease-preventive activities for
breast, colorectal and skin cancer," Prof Emery said.
"It is time to reconsider the clinical benefits arising from
family history and start making better use of it in clinical practice."
The Medical Journal of Australia
publication of the Australian Medical Association.