In the latest installment of our conversations with Fort Worth newsmakers, Dr. Justin Ezell, a family medicine physician with Texas Health Family Care, discusses why collecting your family medical history matters — and how to do it as people gather for the holidays.
This conversation has been edited for length and clarity. For a longer version, please listen to the audio file attached to this article.
Alexis Allison: Dr. Ezell, let’s start with some basics. What is a person’s family medical history?
Dr. Justin Ezell: Well, a family medical history is essentially looking at a person’s first-generation family members and what specific diseases tend to run in those families. So for example, when I’m asking those questions, I’m primarily going to be concerned about mother, father, brothers, sisters, people with direct genetic lineage to you. Also, when we start to deal with people that are a little bit older and have already had children, we want to know those diseases that have popped up in children as well, because sometimes things will declare themselves in children.
We’re a little less concerned about distant family members. But, for example, sometimes with things like breast cancer history, (if) mom had breast cancer and the patient’s aunt had breast cancer, we’re looking at that a little bit more closely. But we’re not necessarily worried too much about cousins or people that have a little bit more distant genetic lineage.
Not sure where to start?
The U.S. Surgeon General has a tool that helps you collect your family medical history: My Family Health Portrait. The tool helps you know which information to seek and provides a space to document your relatives’ answers.
Allison: You mentioned breast cancer — can you tell us about some of the other diseases or conditions that, as a physician, you’re looking for?
Ezell: In family medicine, there’s a big push for things not only like breast cancer, but also for colorectal cancer screening. And other things I’m looking for, too, are things that would suggest higher risk for cardiovascular disease — like heart attacks and strokes.
A classic one that comes to mind is, oftentimes we’ll get asked to do sports physicals as the school year begins. On that questionnaire, one of the things that you’ll see is: ‘Has anyone unexpectedly died in your family?’ Certain genetic conditions can cause abnormal heart rhythms. And if you have a family member who suddenly dies for no apparent cause under the age of 50, oftentimes, the person receiving the sports physical won’t necessarily know that, but mom or dad would. And that’s very important to me to know as well, because in those cases, we might elect to do a little bit more screening, or keep a closer watch, or, in some cases, actually do full workups on those people, depending on the severity of the condition.
And then, what I call the top three: high blood pressure, high cholesterol and diabetes. The reason why we worry about those three things so much is, in America, the biggest thing that’s causing early death is going to be the result of a heart attack or stroke. Blood pressure, blood sugars and blood cholesterol really do increase those risks earlier in life.
Allison: You’ve mentioned genetic lineage. Are each of these diseases directly tied to genetics? Or are you looking toward a family’s environment or something else?
Ezell: Yes, so that’s the whole nature versus nurture question. There is often difficulty trying to distinguish between those two. What we can see is that, oftentimes, if there is a genetic component, despite the environment, yes, we’re going to see things pop up. However, a person’s social environment is very important as well. For example, one of the things that you’re hearing in the medical circles now is getting histories of something called social determinants of health.
For example, if a person has a low income and has difficulty affording food, it’s very easy to say, ‘I want you to exercise and I want you to change your diet.’ However, if the person is struggling to afford some of the healthier food options, and all they can afford is what they they can purchase, which oftentimes may be meals that are full of carbohydrates, very processed foods, prepackaged foods that are stripped of some of their nutritive value, that’s going to make that a little bit more challenging for that person to achieve those goals.
So, when we’re looking at how these things all link together, it’s always a struggle to say which one is directly related versus not. But what we can say is, things tend to cluster together. Whether that’s a socially induced thing because of your environment, or it’s a direct relation to your genetics, from my perspective, I’m not really concerned about identifying what that particular cause is. I’m much more concerned about identifying it early and making meaningful interventions that can improve that person’s health.
Allison: I’m thinking that as we enter the holiday season, families may be gathering — people who don’t necessarily live together anymore. And I’m wondering, how can a person collect their family medical history? Do you have strategies or tips?
Ezell: Sometimes it might seem a little bit awkward, because you don’t want to walk in and say, ‘Hi, mom, now tell me your past medical history.’ That’s not organic, right? However, oftentimes, when families are sitting around and the meal’s over and people are just kind of catching up, sometimes these conversations will start where, ‘Hey, did you hear what happened to your cousin?’ Or, ‘Did you hear what happened to so and so?’ And those are wonderful, spontaneous moments to really just start to ask those questions.
And they can be springboards into asking your more immediate loved ones, like, ‘Well, how is your health? And how are things going with you?’ Obviously, some people are going to be a lot more guarded with their medical history. I hear all the time, ‘I don’t want to worry my children.’ I have a significant population of older patients, and I will counsel them like, ‘Look, part of one of the things we want to do is your advanced medical directive, so we can respect your health care wishes, and we know who to call in the event that something happens.’
And sometimes they’ll get really hesitant, because they’ll say, ‘I’m not really sure what I want to do here.’ And I’ll use that as a moment to say, ‘This is a great opportunity for you to sit down with your children and talk about your medical history. And really tell them what your thoughts are about what you would want to do.’
The opposite of that is true, as well. When you’re coming in and having that dinner with your parents or some of your close relatives, a great starting point is like, ‘How are you doing? How’s your health been?’ And then as things come up organically, just asking more questions about it. Oftentimes, you’ll find out some very interesting things.
One of the things that happened in my life was, my father contacted me once and said, ‘Hey, I’m about to go in and have this procedure — I’ve had this fast heart rate. Just wanted to let you know because the doctors say it could be genetic.’ And that was wonderful for me, because then I was able to follow up with my physician and do some additional screening and find some things out that I need to be aware of personally.
Allison: Thank you for sharing that last example, because it sounds like your father gave you some information, and then you acted on it with your own physician. And I’m wondering, once someone has gathered family medical history, what can they do with it? How do they use it?
Ezell: Everyone has different ways that they like to learn and retain information. In this day and age of cell phones, I mean, everybody has the ability to jot down notes. Me, personally, I’m an old pen-and-book person. But when I start to hear important things, like, ‘Mom has high blood pressure,’ you want to know when that was diagnosed, you want to know if other people in the family have similar problems. And you just essentially want to keep that documented on something that you have handy.
I’m a big proponent of the annual wellness exam. So, say for example, you’re in your early 20s, you’re very healthy. You know, ‘Why would I need to go see the doctor if I’m doing fine?’ So part of that is, one, on the annual wellness exam, you can anticipate you’ll have some very basic screening labs, and again those are going to be looking for the top three things, so checking your vital signs and looking at your blood pressure and checking your cholesterol and checking your blood sugars to see if you have evidence of diabetes.
And then after that, sometimes with the newer electronic health care records, you can directly upload and put in those important family history things. So, for example, if you’re going back to the breast cancer example, I had a patient (whose) sister had a very rapid, aggressive form of breast cancer and passed away. And so, as she’s coming in on a regular visit, completely unrelated, she goes, ‘Oh, by the way, Hey, Dr. Ezell, this is something that happened in my life. And I said, ‘Whoa, that’s important.’ And so we wanted to go ahead and get her genetic risk assessed. And so we got her over with one of our breast surgeons, and they did a genetic map, they did genetic testing, and they have her engaged in their program so that they’re able to do a much more aggressive screening program on her with the hope and expectation that if she does develop breast cancer, they’ll be able to act on it early and save her life.
Allison: Thank you so much for sharing this morning. Is there anything else that you’d like us to know?
Ezell: Again, I’m a big advocate of the annual wellness exam — even though you may feel that absolutely nothing wrong is going on. Of course, I do this for a living. And I see this day in and day out: I’ll have people come in, people in their early 20s, and have extremely high (blood pressure).
There’s a lot of conditions that we’ll call ‘silent killers,’ because people can adapt to them and feel very fine and not have any symptoms until later in the course. And just by having those periodic check-ins and getting health screenings, that does a couple of things: One, it can give you reassurance that you’re doing well. Two, it’s establishing rapport with the physician. And what’s important about that rapport is, oftentimes, once I get to know people very well, I can see a big change in their behavior or their physical presentation just because I know them. And then, three, you want to create that data tracking of you’re doing well, you’re doing well, and then if you start to see something change from what we call a baseline level, it’s a lot easier to intervene.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her at email@example.com or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.