Taking A Family History Is A Way To Establish Client Rapport And Facilitate Patient Decisionmaking

Your patients are more likely to comply with your medical advice if they trust you and have a relationship with you. The process of taking a medical-family history provides an excellent opportunity to establish rapport with a client. A clear picture of family dynamics and the patient's life experiences usually unfolds while taking a patient's medical-family history. These family relationships and life experiences will have an impact on a patient's decisions about medical care and genetic testing. Compare Amanda, a healthy 37-year-old pregnant woman who has experienced 10 years of infertility, with Beth, who is also 37 years old but has two healthy children. Both women have the same age-related risk to have a child with a chromosome anomaly, yet each woman may make different choices about genetic testing during her pregnancy. Or consider two 45-year-old women who each has a mother who died of breast cancer at age 38 years. Their genetic risk assessments (drawn from factual empiric risk tables) are the same, but the emotional feelings each woman has about medical screening and genetic testing are likely to differ based on each woman's individual experience with her mother's illness.

The symbols of a pedigree represent more than the geometric pieces of a biological crossword puzzle, as described by Robert Resta (1993) in the introductory quote to this chapter. I view a pedigree like a quilt, stitching together the intimate and colorful scraps of medical and family information from a person's life (Fig. 1.3). Familiar pedigree patterns are the clinician's matrix for providing pedigree risk assessment, as well as clinical and diagnostic recommendations. Yet just as the quil-ter takes artistic liberty with tried-and-true patterns to make each quilt a unique work of art, each pedigree has a unique human story behind it. It is from the interwoven fabric of a patient's family, cultural, and life experiences that the patient pieces together his or her decision-making framework.

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