by Katherine Ngo
Taking a family history - Katherine Ngo
In an earlier post, I wrote about parents. But are
brothers and sisters important? Sounds like a
rhetorical question, but family relationships get
short shrift in a typical medical history. Of course we
ask about family history. Does the patient's
parents, brothers or sisters have a suspect diagnosis? Or
any illnesses that run in the family? But the
current relationship with family members only plays a part
in the discharge planning (based on a hospital
perspective).
In any history, we want to answer three
questions:
1. Why does the patient have this problem? (Any
reversible factors?)
2. How bad is it?
3. What can we do about it?
I think that sibling relationships can shed some
light.
Why? Every relationship has its ups and downs. The
relationships with our brothers/ sisters are
probably the longest ones in our life (apart from
with our parents). Conflicts are limitless, particularly
through the rollercoaster of growing pains, peer
pressure at school, first loves, managing finances, etc.
So it can be a window into the patient's current
thinking patterns.
An example - my friend's mother favoured sons over
daughters. Her mother would take things from my
friend (birthday presents, home furniture, money,
etc) to give to her brother, even when her brother did
not necessarily need or want those things. This was
a cause of persistent sadness in her life - "why does
she take things from me for him?" "why does she
love my brother more?"
Severity. Family relationships are a litmus test
for how the patient may relate to others in life now.
There is a great analogy. If a family was like a
human body, the siblings would be like the limbs and the
parents - the head. If the right hand is itchy,
does the left hand think twice about scratching it? Most of
the time, probably not. It's a reflex and a
no-brainer. They help out each other for the common good.
Management. Far from being just friends, older and
younger siblings can learn a lot from each
other. Patience and forgiveness being just some of
those things. Although the effect of birth order on
personality is debatable, siblings do enable us to
strengthen our skills in sustaining a positive long-term
friendship. And relationships with siblings can be
something the patient may be able to work on first, at
times when other social relationships are difficult
to develop.
I'm no psychologist or counselor but my friend
would always call me and tell me about her sadness/
anger. Although voicing these feelings did not
change her mother's attitude, it affected my friend's
health. Over the years when she started earning
more, she learnt to let go and if her mother asked for
things, she would feel sympathy for her mother
instead of anger. She learnt to understand and accept
her mother's one-sidedness. At the end of the day,
that's all that you can ask for sometim
In an earlier post, I wrote about parents. But are brothers and
sisters important? Sounds like a rhetorical question, but
family relationships get short shrift in a typical medical history.
Of course we ask about family history. Does the patient's
parents, brothers or sisters have a suspect diagnosis? Or any
illnesses that run in the family? But the current relationship with
family members only plays a part
in the discharge planning (based on a hospital perspective).
In any history, we want to answer three questions:
1. Why does the patient have this problem? (Any reversible
factors?)
2. How bad is it?
3. What can we do about it?
I think that sibling relationships can shed some light.
Why? Every relationship has its ups and downs.
The relationships with our brothers/ sisters are probably the
longest ones in our life (apart from with our parents). Conflicts
are limitless, particularly through the rollercoaster of
growing pains, peer pressure at school, first loves, managing
finances, etc. So it can be a window into the patient's
current thinking patterns.
An example - my friend's mother favoured sons
over daughters. Her mother would take things from my friend
(birthday presents, home furniture, money, etc) to give to her
brother, even when her brother did not necessarily need or
want those things. This was a cause of persistent sadness in her
life - "why does she take things from me for him?" "why does
she love my brother more?"
Severity. Family relationships are a litmus
test for how the patient may relate to others in life
now. There is a great analogy: If a family was like a human
body, the siblings would be like the limbs and the parents -
the head. If the right hand is itchy, does the left hand think
twice about scratching it? Most of the time, probably not.
It's a reflex and a no-brainer. They help out each other for the
common good.
Management. Far from being just friends, older
and younger siblings can learn a lot from each other. Patience
and forgiveness being just some of those things. Although the
effect of birth order on personality is debatable, siblings do
enable us to strengthen our skills in sustaining a positive
long-term friendship. And relationships with siblings can be
something the patient may be able to work on first, at times
when other social relationships are difficult to develop.
I'm no psychologist or counselor but my friend would always call
me and tell me about her sadness/ anger. Although voicing
these feelings did not change her mother's attitude, it affected my
friend's health. Over the years when she started earning more,
she learnt to let go and if her mother asked for things, she
would feel sympathy for her mother instead of anger. She learnt to
understand and accept her mother's one-sidedness.
At the end of the day, that's all that you can ask for
sometimes.