Eliciting Medical History

Current genetic counseling job tasks were determined by the American Board of Genetic Counseling as the outcome of a Genetic Counseling Practice Analysis Hampel et al., 2009).

1. The following is a list of the Eliciting Medical History tasks:
   
   
   • Elicit/Review General History
     
     
   • Specific Health Problems and Age of Onset
     
     
   • Hospitalizations and Surgeries
     
     
     • Congenital Anomalies/Birth Defects
       
       
     • Current Medications (i.e., indication, dosage, duration)
       
       
2. Elicit/Review Pregnancy History
   
   
   • Maternal Age at delivery
   • Serum screening
     
     
   • Ultrasound findings
     
     
   • Number of outcome of pregnancies
     
     
   • Maternal illnesses/conditions
     
     
3. Elicit/Review Gynecological History: Infertility
   
   
4.  Elicit/Review Cancer History
   
   
   • Date of/age of diagnosis
     
     
   • Anatomic location
     
     
5.  Elicit/Review Exposure History
   
   
   • Type (e.g., carcinogens, teratogens, occupational, environmental)
     
     
   • Dose, duration, and timing

Several components of Bianca's medical history were documented in her prison chart prior to the genetic counseling appointment. But, much can be learned from eliciting medical history directly from Bianca, without making inferences or assumptions. The following is an overview of what you know about Bianca, the assumptions you may have made, and what is not known:

What you know about Bianca:

• Bianca has several convictions for forging bad checks, and has been arrested for parole violation.

• Bianca's ultrasound detected fetal heart abnormalities.

• The ultrasound showed 21.5 weeks of gestation with delayed fetal growth and large ventricular heart defect.

• Bianca has a history of drug abuse.

• Rinaldo is her boyfriend.

Assumptions you made:

• Bianca has additional convictions.

• Fetal alcohol exposure is responsible for the fetal anomalies.

• Rinaldo is the father of the baby.

What you do not know:

• Rinaldo is not the father of the baby.

• The actual father of the baby was born with a congenital heart defect of the ventricular septum.

• The actual father of the baby is involved with illegal activities; Bianca fears the negative consequences associated with discussing him.

• Bianca is serving time as a result of attempting to keep the father of her baby out of trouble.

Your emotional biases:

• You have seen a few other pregnant women referred for genetic counseling from this correctional facility.

• You feel extremely uncomfortable every time you have to see such patients.

• You don't feel scared, but whenever you counsel inmates you tend to focus on your discomfort and not on the client's agenda. These cases have never gone well for you.

• You notice that you use haste as an excuse to get out of uncomfortable situations.

• You tend to do this whenever drug or alcohol abuse is relevant.

• You have heartfelt sadness for Bianca and other women who face so many personal and medical challenges, including the additional new challenge of the abnormal fetal ultrasound.

• You were unsure about discussing psychosocial matters, since Bianca is supposed to be an inmate at Greenville for another year.

• Maybe Greenville has good mental health counseling resources to help Bianca sort out her challenges.

• You were glad when Bianca left.

   

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