Medical Staff Neglect Family History of Acutely Ill Patients

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.

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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 Langlands said.

“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 familial disease.”

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In two accompanying editorials in the MJA, Dr 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.

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“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 admissions.”

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.

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“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 is a publication of the Australian Medical Association.

Source-MJA