Taking Family History

In the article titled “Genes Will Someday Help Select Depression Treatment” in the July 2 issue, Dr. Charles Nemeroff said, “Ten or 20 years from now, we will be sending our patients to the laboratory to characterize them in terms of genetic polymorphisms and/or to an imaging laboratory.” However, we don't need to wait a decade or more for such information if the managed care industry would recognize that taking a thorough family history will reveal these genetic patterns and then reimburse for the time involved in gathering this information. It is very time consuming to ask a patient about three or more generations of family history concerning mental illness and, if such illness was present in a relative, what, if any, medication helped that person recover.

In the modern era of fragmented family structure, the task is even more time consuming than it once was. But the information gained is cost-effective in the long run; for example, “They had my cousin Aurora, who is older than me, on half a dozen drugs, had her in the hospital several times, until they gave her drug X, and then it was like a miracle, and she hasn't been ill for years.”

In situations in which patients do not know the information about their relative's psychiatric history, when the importance of the information is explained to them, they will often attempt to gather the information. Or in psychoeducation sessions with patients' relatives or significant others—another time-consuming process that managed care will eschew—this vital information can be obtained by the physician.