Medical genogram

Any family has dozens of health events across three generations, so record the ones a reader can learn the most from:

• Conditions that appear more than once. The same condition in a father and his sister, or in three generations of one side, is the strongest pattern a reader can see on a medical genogram.
• Conditions diagnosed unusually young. Breast cancer diagnosed at 38 is a very different finding from the same diagnosis at 75, so write the age with every diagnosis.
• Conditions related to the reason for the genogram. If the genogram is drawn because the index person has chest pain, a father's heart attack at 50 is worth more space than three relatives with arthritis.
• Genetic conditions, even in one relative. A single relative with Huntington's disease, cystic fibrosis or a known BRCA variant is worth recording when no one else is affected.
• Uncertain diagnoses, marked as uncertain. Write "possible stroke" or "reported bipolar disorder" when the family is not sure, rather than recording a guess as a diagnosis.

Most of the conditions recorded on a medical genogram belong to one of these groups:

• Cardiovascular disease, such as heart disease, high blood pressure, stroke and high cholesterol
• Cancer, with the type written out, such as breast, colon, lung, prostate or ovarian cancer
• Metabolic conditions, such as type 1 and type 2 diabetes, thyroid disorders and obesity
• Neurological conditions, such as Alzheimer's disease, Parkinson's disease, epilepsy and multiple sclerosis
• Mental health conditions, such as depression, anxiety, bipolar disorder and schizophrenia, which have their own page on mental health symbols
• Substance use, such as alcohol or drug dependence
• Genetic disorders, such as sickle cell disease, cystic fibrosis, Huntington's disease and Down syndrome

The editor's default list has sixteen conditions, among them Cardiovascular, Cancer, Diabetes, Depression and PTSD, and you can rename them, move them up or down, or add your own.

The health questions to ask relatives, with the fill drawn for each answer, are listed with the other genogram questions.

In Genogram Pro, each of a person's conditions is drawn as a quarter of the symbol in that condition's color, clockwise from the top left in the order of the editor's condition list. With five or more conditions, the symbol is divided into equal slices from the center instead.

The order in which you select conditions does not matter, so with the default list Cardiovascular is always drawn in the top-left quarter, and moving a condition past another of the person's conditions in the list swaps their quarters. Every condition you use is added to the key with its color.

Standard genogram notation also has fills for a kind of problem rather than a named condition, with the left half of the symbol filled for a physical or psychological illness and the bottom half for substance abuse, and other fills for suspected substance abuse, remission and recovery. In Genogram Pro, these fills are drawn in red, and both kinds are shown side by side in the guide to mental health symbols.

Draw the family first, following the steps in how to make a genogram, and then add the health history:

• Choose the conditions to track. Pick the conditions that recur in the family or relate to the reason for the genogram, rather than every diagnosis anyone remembers.
• Fill in each person's conditions. In the editor, select a person, open Medical conditions and click each condition they have. For one that is not in the list, click Add condition, name it and then click it. On paper, choose a color or pattern for each condition and draw it in a key.
• Write ages and causes of death. The editor has an Onset date for each selected condition and a Cause of death field for anyone who has died, but neither is drawn on the diagram. Open Other information, click Add property, name it Health, turn on Available on all people and Show in diagram, and type each diagnosis with its age, as in "Angina at 58" under Howard. Add a second property named Cause of death the same way, as in "Heart attack" under Howard.
• Look for patterns. Check whether a condition appears in more than one generation, whether it was diagnosed younger in each generation and whether it is on one side of the family, as diabetes is on the Ogden side.

Genetic counselors draw a pedigree, a family diagram in the notation of the National Society of Genetic Counselors with partners, biological relationships and inherited conditions. A medical genogram has the same health history in genogram notation and can also have lines for how people relate.

In the hereditary cancer genogram example, each age at diagnosis and each genetic test result is written under the symbol, as it would be on a pedigree.