LFMH for Clinicians
Learn more:
Family medical history—the history of health conditions affecting close biological relatives—has long been a standard feature of medical evaluations, providing valuable insights into a person's genetic risks. Understanding family medical history can help people make informed lifestyle choices, engage in enhanced screening to detect potential health issues early, and implement evidence-based preventative measures.
However, millions of people in the United States do not have the degree of access to their family medical history than is described by a standard patient or taught int he medical curriculum.
Explore our clinician's guide for navigating limited family medical history (LFMH).
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Page overview:
Inclusive Medical Interviewing:
Limited Family Medical History & Adoption
In this section, we'll give an overview of the general principles to keep in mind when discussing adoption status and/or limited family medical history with a patient. Keep reading for our recommendations for inclusive family medical history-taking and how to respond to adoption and LFMH disclosures, including suggested phrasing and a flowchart.
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These recommendations were developed from a literature review of adopted patient narratives and utilizing insights from a qualitative study of primary care physicians around their approach to adopted patients with limited family medical history.
Recommendations
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Use open-ended questions with universal phrasing.
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Reflect your patient’s terminology.
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Acknowledge LFMH and/or adoption disclosures nonjudgmentally and neutrally.
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Disclosures can be emotionally difficult and triggering for adopted patients.
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Avoid making patients restate their adoption & LFMH.
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Ask permission before delving into adoption and LFMH.
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Clarify the degree of LFMH
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Recognize adoption and LFMH as often related, but distinct.
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Recognize that patients often have limited access to FMH involuntarily.
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Normalize adoption, LFMH, and any associated complex feelings.
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Offer to discuss the health implications of adoption and LFMH.
Click to reveal examples of phrasing and possible answers you may encounter.
Click to advance the medical interview.
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From there you’ll try to categorize your patient into 3 possibilities:
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Known FMH (green)
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Limited FMH (red)
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Unclear (yellow): You should watch out for patients with varying amounts of health literacy or might not understand what you’re asking here
Family medical history
Limited family medical history
Unknown
Proceed with medical interview as usual.
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Acknowledge disclosures
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Confirm interpretation
Clarify
Why acknowledge and confirm the interpretation?
“That's right."
“I don’t have contact with my dad. He left when I was young…”
Recognize as LFMH
3. Ask permission
Why ask for permission?
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Acknowledge disclosures
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Confirm interpretation
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Normalize LFMH
“I'd rather not talk about it now."
“Sure, it's fine to talk about now."
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Respect decision
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Offer to discuss in the future.
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Ask about FMH of biological parents, siblings or children.
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If some FMH is reported, clarify source.
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Consider educating on FMH role and LFMH implications
Medical History-Taking Interactive Flowchart: New Patient
Medical History-Taking Interactive Flowchart:
Existing Patient
Click to reveal examples of phrasing and possible answers you may encounter.
Click to advance the medical interview.
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Ask about any updates to LFMH annually.
“Actually, I found my biological mom so I have a lot of information now..."
“I took a DNA test and it said..."
“No updates."
Proceed as usual with the rest of medical interview.