A new study suggests family doctors may be missing valuable patient information when they only gather health histories during busy appointments.
Researchers found that Toronto doctors could get a dramatically better picture of patients’ family health histories if patients completed a digital questionnaire ahead of an appointment.
The findings highlight an opportunity to improve how one of medicine’s most important risk-assessment tools is collected.
“People who have a family history [of health problems] have [a] twice or greater chance of developing some diseases,” said Dr. June Carroll, a family physician and professor in the University of Toronto’s Department of Family and Community Medicine.
“[Knowing family history] enables a more personalized approach to screening and management.”
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Many conditions can run in families, including cardiovascular disease, diabetes and certain cancers, such as breast, ovarian and prostate.
Family health history remains one of the simplest and most powerful predictors of disease risk, helping guide preventative care.
“[Family history] provides those clues years before symptoms develop, so [we] would be on the lookout,” said Dr. Sarah Cook, a family physician based in Yellowknife, N.W.T.
For example, a patient with a strong family history of breast cancer might be advised to get a mammography and MRI, while someone with a family history of colorectal cancer might go for early stool testing.
In some cases, knowledge of inherited risk can encourage healthier lifestyle choices or inform reproductive planning.
“If a person has a family history of heart disease at an early age, I think the physician is more likely to stress avoiding excessive alcohol, getting more exercise,” Carroll said.
“Sometimes people are more willing to consent if it’s linked to family history.”
Traditionally, family history is gathered verbally during doctor’s appointments. But short appointment times can make it difficult to collect comprehensive information and ensure it is properly documented.
“Typically an appointment time in most places is 15 minutes,” said Cook. “Walk-in clinics are sometimes shorter than that.”
Longitudinal care
Collecting family history is only part of the equation, however. Physicians say its value depends on having someone update and act on that information over time.
“Family history isn’t static,” said Cook. “There may be new diagnoses that occur in their relatives throughout their life that change what that individual’s risk factors may be.”
“[B]est practice is to review what we call a cumulative patient profile,” Cook added. “That would include family history, past medical history, medications, allergies — all the components of your health.”
Carroll says having a regular family doctor is critical. A family physician can update family health histories, identify appropriate screening programs, and coordinate care.
The issue is particularly relevant as nearly six million Canadians are without a family doctor — a reality Carroll describes as “very upsetting.”
Without a regular physician, many patients rely on walk-in clinics and emergency departments, which often do not do preventative care or screening.
That can have consequences for early detection.
“If you’re not screened, it’s more likely that these diseases will appear at a later point in their development, when it’s harder to treat them,” said Carroll.
Patient input
The study, published in September, tested whether a patient-completed family health history questionnaire could improve documentation in primary care.
Researchers compared patients who completed the online questionnaire ahead of an appointment with patients receiving usual care in family medicine practices affiliated with the University of Toronto.
Clinicians documented the new or updated family history in the patient’s electronic medical record for about 16 per cent of patients, compared with just 0.2 per cent of patients receiving usual care.
Researchers also found significant improvements in the documentation of cancer-related family history, as well as evidence that the information was being used during appointments.
“[The advance questionnaire] also gives [patients the] chance to ask the family members if they’re not sure,” said Carroll, who was the lead author of the study.
Carroll noted, however, that this approach does nothing to help patients who are without a primary care provider.
“This is not a solution for those without a family doctor,” she said.
Cook said the Northwest Territories offers a different model because the territory uses a single electronic medical record system across communities, clinics, hospitals and specialist services.
“We were the first jurisdiction in the country to have that,” she said. “Every single small community in the Northwest Territories, and the larger clinics in Yellowknife, specialists and our allied health providers — we are all on the same electronic medical record.”
But Cook still believes the study’s recommendations could further improve how the territory manages patients’ health information.
“It definitely would be helpful to have patient input into the electronic medical record,” she said.
Cook also believes patients should have greater ability to review and correct their own health records.
“I think the [ideal scenario] is that you have a patient portal where the patient can actually flag what is missing and what is incorrect,” she said.
“They can have some control over making sure that that information is completely accurate in collaboration with their health-care team.”
