Transcription:

Scott Webb (Host): Knowing our family history can help us to be screened, diagnosed and treated early for things that may have been passed down to us from our family members. And joining me today to help us understand how to gather our family medical history and the importance of sharing that information with our primary care providers, is Dr. Linda Hamrich. She's a Primary Care and Family Medicine doctor with Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So Doctor, thanks so much for your time today. We were just discussing, before we got rolling here, how our, you know, family history is something that we can't really outrun. You know, it, it is what it is and we try all of us, to the best we can through behavior and lifestyle to do our best to be healthy. But our family history is something that's kind of always there kind of always looming in the background. So this is a great conversation. And as we get rolling here, I want to ask you why is it so important that we understand our family history, our family health history.

Lynn Hamrich, M.D. (Guest): Yeah, well, you've probably heard the phrase that past is prologue, and that's particularly true for family history and not in a fatalistic way, but it's the only really crystal ball we have in medicine to kind of try and predict the future of a given patient or a family from the past. And, it allows us to intervene in a preventative way, an opportunity that we wouldn't normally have if we didn't have that information. So if if you have a family history of any given disease and it tends to follow a genetic pattern, we might be able to start screening earlier.

Host: Yeah. I see what you mean. And, you know, and I think that that's especially, as we both know and you, especially as, as a doctor, you know, that early screening, early diagnosis are so key. And so really knowing our family history is important, but that can be a bit of a struggle, a bit of a battle because these things weren't necessarily documented electronically.

You know, they could be passed forward through generations. So there's often a family member who's sort of like the keeper of the family medical records. So how do we do that? How do we build our family history? How do we sort of take that on?

Dr. Hamrich: Yeah. Well, the first step is just to kind of start somewhere. Even if it's just with your immediate family, if that's all that you have available to you. When I was in medical school and things were, we'll just say a little less technologically advanced, I started to realize how important family history was. And so we were learning about how to do a family tree from a medical standpoint. And so I just pulled out a piece of paper and sat down with grandma and said, hey, what's going on here? Tell me about, you know, great uncle, great aunt. Cause there was no other way for me to get that information. Now, of course, there are all sorts of available opportunities online to create an electronic document in a way that's shareable with others in your family, or even perhaps with your healthcare provider, to have inputted all that information. There's a great one from the CDC, called my Family Health Portrait and I looked at it in preparation for this, and it's a really pretty easy, straightforward way of documenting what your history is.

So you really just want to start with who you have available to you and get what information you have. And even if it's not perfect, it's still better than nothing. So you look at your parents, brothers, sisters, children, grandparents, sometimes great aunts and uncles, great grandparents, particularly if you have access to the information can really give you a lot of information you might not otherwise have had. Obviously once, some of the information passes, you know, into history, you know, when people pass away, you might not have access to that. So, but again, you know, just do your best, try and get that information. You don't have to know the fancy medical words for things.

You know, you just do the best you can. And sometimes we can interpret based on the circumstances, what that might have been, or what that disease process was or whatever. But, some information is better than zero.

Host: Yeah, I think you're so right. And when we think about types of things that are passed down, unfortunately through generations, when we talk about family health history, what are the sort of usual suspects are we talking about? Cancers, breast cancer, and so on, maybe you can just kind of give folks an overview of the things that you knew that, you know, your great grandparents had this or a great aunt had that, that those would be reasons for concern.

Dr. Hamrich: Yeah, there are definitely some biggies, so to speak, that you'd want to know about. So for example, you mentioned cancer. There are some really well known familial transmitted, so inherited genetic changes that can result in a predisposition to cancer. And a couple of the most notable ones are colon cancer, ovarian cancer, breast cancer, and sometimes uterine or stomach cancer can go in there as well.

Most people have heard of, you know, the BRCA gene or there's many different pronunciations, BRCA, et cetera. Those are particularly associated with breast cancer and other female cancers in women, and also potentially colon cancer in both sexes, so, when you have a pattern set up of multiple generations or several, you know, sisters, brothers, parent, child that have those, you are paying a lot closer attention to that information, and can start early screening in a number of ways.

Host: Yeah, let's talk about that a little bit, because I know the one of the concerns that many listeners will have is always about insurance. Right? What does insurance cover? Will my insurance cover this? So, for someone who is of a let's say in a low risk category, but they're able to document and prove that they have a family history of thing how does that work? Can you maybe take us through that? I know you're not an expert on insurance, but just generally speaking, we talk about that early, that extra early screening and looking for diagnosis and potentially treatment. How does that work with insurance, for folks who ended up with themselves are sort of normal risk, but they have this added risk because of their family history?

Dr. Hamrich: So you'd want to check with your insurance company to make sure what and how much of any genetic testing is covered, but a lot of insurance companies now are realizing that prevention is always better than treatment. And that's particularly true of cancer. Cancer is very expensive to treat and understandably so. Genetic testing is in a manner of speaking, the ultimate preventative treatment. If you can find out if you're a carrier of a genetic abnormality that is likely or highly likely to result in a specific cancer and you have a definitive treatment or definitive preventative or screening method for that is way cheaper, than it is to wait until someone gets that disease and then have to treat it.

And so I think insurance, not all insurance, but I think they get that to a certain extent. And so in my personal experience, I found that there's starting to be increasing awareness in coverage, not always, but increasing coverage for some of this testing.

Host: That's good to hear. And you're so right. That obviously prevention is much cheaper. I hate to talk about medicine and talk about money, but let's be honest. Medicine is big business and insurance has a vested interest in trying to make sure that they keep their costs down, right? So, prevention is much cheaper than treatment.

And when it comes to cancer, the prognosis and outcomes are much better if something is diagnosed early, treated early. So good to hear that in many cases, at least, that insurance is understanding that and playing ball and so, okay, we get our family history together. We get it documented. Now, doctor, what do we do with it?

Dr. Hamrich: Well, there's many ways to bring that forward to your healthcare provider and so I mentioned that there's an online portal through the CDC, but even if it's just handwritten or, you know, carried verbally, to your provider, just sharing that information, making sure you set aside a time to go and see that health care provider is probably the first step, right?

So you have this information, you bring it to them. And we generally do that during an annual wellness visit. If you're a Medicare, and, or a just a yearly visit for non-Medicare patients. And that's one of the things that sometimes people don't understand and understandably so, is like, well, I'm fine. Why do I need to go every year to the doctor and what are they gonna do? You know, I try and eat healthy. I exercise, or I know I need to eat healthier and I know I need to exercise. So they're not going to tell me anything I don't already know. Well, there are multiple opportunities during those visits to educate patients about their risk factors, to give them practical advice, to help them achieve their lifestyle goals. So it's never a worthless visit, because there are always tools that are available. So one of them is bringing that family history to us. So even if you were trying to do all the things that are right, or I feel like, you know what you need to do what's right. There's that added part that you may not have a frame of reference for.

So, you know, grandma had this and mom had this, so that means something for me that I, you know, wouldn't have known if I hadn't gone to my provider, doctor, nurse practitioner, whoever, and shared that information with them.

Host: You know, Doctor, as we wrap up here, which side are you on there Doctor? Are you on the side of, you know, well, just be frustrated because grandma had this or grandpa had that, or it's good to know what grandma and grandpa had, because it can help you to live a better life, a healthier life, and also be screened and diagnosed early.

Dr. Hamrich: Well, as you can imagine, I fall on the side of knowing that information, no surprise there. That really gets down to the question of modifiable risk factors or non-modifiable risk factors, right? So non-modifiable risk factors. So risk factors for disease or illness that cannot be changed. So that's your genetics. That's the sex you were born with. That's a number of other things that just your race, et cetera, that can't be changed. And then there are modifiable risk factors, and that's really where the key is. So you may be at increased risk for heart disease, stroke, or diabetes, but you have opportunities to really impact whether or not you develop that. Or how soon you develop that or how severe it is when it does develop. So that's where the lifestyle comes in, the diet, the exercise, maintaining an ideal weight, avoiding alcohol and tobacco. That's where that comes in. Is there things that you can do. And it's not inevitable that you will develop those problems if you know the specifics about that.

And so I see it as empowering people. So I'm on the other side of that, you know, I don't see this as fatalistic. I'm really optimistic about that. Knowing that information can really empower a patient to take that opportunity to not fall into that same circumstance that their family did, at least as much as possible.

Host: I think that's a perfect way to say it and a perfect way to end, you know, it is empowering. Knowledge is power and we can do our part, right? The modifiables, behavior, lifestyle, exercise, diet, all of that, but that family history, the genetics, if we know it, if that's been documented, if we provide that to our providers, it can really empower us. And as you say, it may allow us to prevent ever developing something or a less severe case, or push it off to a later age and so on. So that's great takeaway doctor, empowering. So, we hope listeners have the same reaction to this. Thank you, so much for your time today and you stay well.

Dr. Hamrich: Thank you, you too.

Host: Visit Summahealth.org/primarycare to find a primary care physician near you, or to schedule an appointment with one of our providers. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

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