It's the first thing you do at a doctor's visit after producing your proof of insurance -- fill out a family medical history. Many doctors ask detailed questions or require patients to complete long forms, and patients sometimes worry about not knowing or forgetting something important.
But does a medical history collection actually do any good? A new study casts some doubt about its value. Researchers funded by the Agency for Healthcare Research and Quality reviewed 137 studies on various aspects of family history-taking. The studies were performed between 1995 and March of this year. Researchers set out to examine three aspects of the issue: the pros and cons of collecting a family medical history; how well the history predicts an individual's risk of disease and how accurate patients report it.
They found that there were few studies that actually examined these questions thoroughly. Overall, there was not enough evidence to say how history collection affects patients' outcomes. The analysis found that patients tend to report the absence of disease in relatives better than the presence of disease.
"We understand the absolute importance of family history in assessing the risk of genetic conditions," said the lead author of the study, Dr. Brenda J. Wilson, an associate professor of epidemiology at the University of Ottawa. "But when you are looking at complex diseases, such as heart attacks, strokes, diabetes and so forth, we wouldn't expect the family history to tell us everything we need to know. Family history plays into it, but it's one of many factors."
Family history has been thought to serve two purposes. One is to assist doctors in assessing a patient's risk. The other is to motivate the patient to make changes that might lower risk. But the authors concluded that more research should be done to pinpoint what is helpful about a family history and how much it matters along with other risk factors. For example, Wilson says, a doctor looking at the risk of heart disease will take a patient's blood pressure, weight and will perform cholesterol and perhaps other tests.
"What we don't know is how useful family history is along with this other risk information," Wilson said. "For complex disorders, we need to develop the evidence for how to use it -- so physicians know how it factors in."
Methods for collecting family medical history should be simpler, she added. Electronic medical records and other information-gathering tools should be helpful.
"I think we are going to have to take family history more seriously," Wilson said. "We may want to put this in the hands of family members and have them gather it and be the custodians of it."
The study was published Monday in the Annals of Internal Medicine.
-- Shari Roan
Photo credit: Christopher Nielsen / For The Times