The New England Journal of MedicineFamily History: Unknown

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A medical student’s personal account highlights the challenges faced by adoptees and others with unknown family histories in receiving comprehensive medical care. The article explores how the lack of family medical information impacts diagnostic processes, treatment decisions, and preventive care strategies. It calls for reforms in medical education, documentation practices, and screening guidelines to better serve patients with limited access to their genetic backgrounds.

Key Points:

• Patients with unknown family histories, including adoptees, may face disparities in healthcare delivery due to lack of information about genetic risks.
• Current medical practices often fail to distinguish between patients with known negative family histories and those with unknown histories.
• The author’s personal experience reveals how unknown family history led to additional testing and complex decision-making regarding growth hormone treatment.
• Inconsistent documentation of adoption status in medical records can lead to false negative findings for family history.
• Early screening and genetic testing for adoptees could provide valuable health information and guide preventive care strategies.
• Medical education should include training on how to approach patients with limited family history information.
• The author suggests reforms such as adding “unknown” or “not available” options in family history sections of patient charts and developing evidence-based guidelines for earlier screenings in these cases.

“The more I learn about my own health, the more I learn about my birth family. But ideally, it would be the other way around. Better access to genetic testing and earlier screenings could help adoptees like me reclaim a valuable tool for our health care.”
– Annie R. Abruzzo, BA, Harvard Medical School

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