People say history repeats itself, but it's important to challenge this belief when you're evaluating a new patient with a family history of medical problems.
Research into genetics has unlocked a trove of information about the role inheritance plays in our health. It's easy to ask a new patient about the types of diseases they've heard about from aunts, uncles, parents, and grandparents. Heart disease, certain types of cancer, and diabetes are commonly associated with inheritance.
You might hear a patient say, "Well, I just have bad genes. That's just the hand I've been dealt," or something to that effect.
As their physician, it's important to help patients understand the role genetics will play in your recommended course of action, as well as the impact their lifestyle choices, like diet and exercise, have on the symptoms that brought them to your clinic.
Let's briefly examine the two most common factors influencing chronic and inherited illnesses.
Two ways of looking at family history
Your patient’s habits
Whether it's fast food every Friday night or watching TV during dinner-time, we tend to pick up most of our habits from our parents. This habit formation is the less examined side of patient history and it's often ignored in favor of genetic testing. The latter is still important, however, it provides a limited view into what might be contributing to your patient's health concerns.
How often do they eat fast food?
How often do they exercise?
What types of exercise do they do?
What types of food does their diet consist of?
Are they consuming alcohol on a regular basis?
Have they attempted and failed at multiple diets?
Is this their first time looking into an alternative approach?
We ask these questions to try to glean what lifestyle choices could be causing the presenting symptoms. Jumping right into what diseases their relatives have had can be a bit of a red herring—a relative with diabetes may have had a genetic predisposition to it, but it could be that they ate ice cream every night for dessert and a soda every afternoon with their lunch.
Isolating how your patient is living currently from what they might have inherited is an important way to check your bias during an evaluation. This allows you to help them holistically, rather than working from assumptions.
Unlike traditional doctors, physicians who practice functional medicine know it's important not to limit the scope of testing you conduct for a patient's blood work. This is where it's important to keep a patient's family history in the back of your mind. There are certain diseases inextricably linked with the genes we inherit, but the likelihood of them presenting is increased by lifestyle choices. Therefore, it’s important to rely on an understanding of both factors when deciding on a plan with your patient.
Lifestyle adjustments and patient compliance
"I'm going to change everybody's diet unless they're already eating in a healthy manner," says Dr. Pescatore.
For many doctors practicing functional medicine, addressing a patient's diet is often the first course of action. As we noted previously, a patient’s eating habits are often inherited via imitation of their parents. If Dad put extra salt and butter on his popcorn at the movies, chances are your patient does, too.
Once you’ve collected information on both the patient’s genetic and behavioral inheritance, you can use your understanding of the bigger picture to promote patient compliance. Most people you'll see in your clinic don't have a good understanding of why they feel the way they do. If the patient is overweight and so are their parents, your patient may assume they’re just predisposed to weight gain or that their metabolism is inherently deficient.
This is a defeatist mindset that can present even more hurdles as your patient tries to adhere to your plan for them. If you feel like you're working against fate, it's easy to lose hope that change or progress can ever be realized.
Putting it another way - a seed will grow when it falls on fertile ground, not cement. The same principles apply when it comes to preconceived notions about the role genetics play in your patient’s long-term health. They may present minor challenges, but they can be overcome. Your patient needs to understand this in order to buy-in to the process of creating their own path to wellness.
By dispelling the idea that history is doomed to repeat itself, and revealing to your patients how much of their current symptoms are linked to behaviors and habits rather than genes, you will move their locus of control inward so they can begin to take ownership of their health.
They will feel better physically, but more importantly – they will gain peace of mind as well. When people feel a real sense of control over a health-related challenge, it’s much easier to visualize success. And that makes all the difference.
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