2008/5/3 STFM 41st Ann Spring Conference : Lecture-Discussion A Family Chart in the Electronic Age

Points for discussion

 Is it a “MUST” for us to implement “family chart/genogram”

system in our care (even with limited evidence) ? Then, how ?
Who?

 Practice structure promotes physicians thinking process. How

do you structure your practice to make “family oriented”?

 How do you structure your care process so you can see “family
tree behind the patient in front of you?

 How do you define “the family” ? By living address? By same

last name? Pets included?

 What are the features the EHR has to have to promote family
orientation in our care? What are the ‘MUST’ features? What
are the desirables?

 Is HIPAA or other confidentiality law/regulation in a way for

us to promote family orientation? Can they be overcome?
How?

 What are the barriers for us to use genogram/family oriented

system in daily practice?

Suggestions, Questions, Collaborations ?

Why hesitate for international friendship? Give us a mail!

Akira Matsushita, MD
Nagi Family Clinic, Okayama. Japan
akimat@mb.infoweb.ne.jp

Tadao Okada, MD, MPH

Kameda Family Clinic Tateyama, Japan
KFCT Family Medicine Residency Program
familymedicine@kameda.jp

Akira Matsushita, MD, Tadao Okada, MD, MPH by creative commons

2008/5/3 STFM 41st Ann Spring Conference : Lecture-Discussion A Family Chart in the Electronic Age

Reference
1. Campbell TL, McDaniel SH. Family Interviewing: A Review of the Literature
in Primary Care. Family Medicine 2002; 34(5): 312-318
Comprehensive review!
Most family physicians collect a family history, but few of them record it
as a genogram. The genogram can be obtained reliably and accurately in a
brief interview.
Genograms obtained by the physician are likely to have more influence on
physician behavior and health outcomes than those completed by the
patient or a health assistant and placed into the chart.
This argues for the use of a genogram as a way to record information and
convey interest in a patient s social context.
However, the use of the genogram as a screening instrument and the
benefit of obtaining a genogram on patient perceptions and physician
behaviors is uncertain, since the existing studies are too small to make any
firm conclusions.

2. Madalie JH, et al. Two Physician Styles of Focusing on the Family. J Fam
Pract 2000; 49(2): 209-15 (DOPC study)
Other family members were present 32% of visits.
Family history obtained in 51% of new patients, 22% of established patients.
Genograms present on 11% of charts and family folders were seldom used.
1) Family-history style: recent graduate →Higher on preventive service
delivery
2) Family-orientation style: experienced →Higher on in-depth knowledge of
the patient and family

3. Doescher, MP et al. Is Family Care Associated with Reduced Health Care

Expenditures? J of Fam Prac 1999, 49(8): 608-614
Family Care and Reduced Health Care Expenditures
Family care provided by FP and GP was associated with 14% lower
expenditures for adults.
Although not statistically significant, family care was associated with 9%
lower expenditure for children.

Akira Matsushita, MD, Tadao Okada, MD, MPH by creative commons