In the course of your family research you may have already found much
or all of the information needed for a family health history. A lot of
the general data required is virtually identical to that used in a
family genealogy. Also, like the genealogies with which we are more
familiar, a typical family health history will include fairly complete
information for the more recent, contemporary members and less, more
spotty data for the older, distant generations.
An important part of compiling a medical family tree is to find out
as much as possible about family members throughout their lives. Don’t
just look for diseases and ailments. How they looked physically, what
they did for recreation or hobbies, and where they lived or traveled can
also have an important impact.
When searching for the medical history, gather as many specific
details as possible about each person, illness, and condition. For
example, if someone in the family has or had cancer, find out the type
of cancer and the history of the illness. Some cancers are more
genetically linked or related to family patterns than others. Or, if a
relative survived a heart attack at an early age, find out how old the
person was at that time, the treatment or surgical regimen employed, and
the aftermath of the episode.
The general personal information that should be gathered for each
person in a family health history includes the items listed below. A few
of the questions will not have specific answers for every person. For
example, some family members may not have served in the military or may
still be living. In those cases, an indication of “no military service”
or “living” will be sufficient. The idea is to create as complete a
picture of each family member as possible.
The specific medical
information that should be gathered for each person in a family health
history includes the items listed below. Some questions may have no
answer for many family members since not everyone will have had surgery,
a blood transfusion, or an accident, for example. Some information is
better than none, but try to be as complete as possible when describing a
medical or dental problem or disorder. If a specific date is unknown,
try to provide the year. Since the health history is constantly updated,
it may be possible to provide more data or verified information at a
The sample genogram was created
for the person represented in the first generation by the double lines.
Males are shown as squares and females as circles. There are four
generations represented in this genogram. Each generation line includes
all the siblings on that level of the family tree. The diagonal line
crossing through a circle or square indicates the person is deceased.
The age at death is given inside the person’s symbol. The numbers below
the symbol represent a medical condition, illness or disease experienced
by the family member. For example, the root person was a female who
died at age 96. Looking at the disease legend, we see that number 1859
was pneumonia, likely her cause of death. She also had Alzheimer’s
Norma Storrs Keating, RN, BSN
Now that all the health data has been accumulated into a master file
with each person’s medical questionnaire (the above listed questions and
answers), the next step is to put it into a format that can easily be
used by family members and their medical advisors. The best way to do
that is to create a medical genogram that uses symbols and lines
representing people and relationships to display family health
information graphically and facilitate recognition of disease patterns
recurring across several generations. It is a “road map” that allows you
and your medical advisor to see your family in a bigger picture, both
historically and currently.
The genogram concept was developed in the 1970s by Dr. Murray Bowen, a
family therapist, as a tool to help unravel relationships between
family members. Clinical psychologists and others working with family
dynamics have used genograms since then. The standardized symbols
represent specific information and allow traits, diseases, disorders,
and other health details to be incorporated into the genogram. In the
1980s, the North American Primary Care Research Group organized a
committee of leading proponents of genograms from family therapy and
family medicine to define the most practical genogram symbols and agree
on a standardized format. The National Society of Genetic Counselors
created standardized symbols for genograms.
The medical community began to use genograms to present and analyze
family health and genetic relationships, and they have found them to be a
reliable and efficient method. The summary provided by the genogram
allows a physician to quickly understand a large amount of data.
Genograms appeal to doctors because they are tangible and graphic
representations of complex patterns within a family. While notes written
in a chart or questionnaire may become lost within a record, genogram
information is easily recognized and can be added to as more is learned
about a family.
Genograms can view information both horizontally across the family
context and vertically through the generations revealing
cross-generational patterns not previously recognized. Illnesses and
diseases in different parts of the family can be seen not as random
happenings but as occurrences that may be connected. The best person to
analyze and interpret the genogram is a family physician, who can use
the knowledge to develop an individualized diagnostic and therapeutic
plan. It is important for family members not to infer too much from
isolated facts since they may not see or interpret every pattern in the
genogram the way a doctor would.
A medical genogram has some special characteristics to keep in mind.
It includes all siblings in each of three or four generations and only
blood relatives are included. Family members who have not contributed to
the family genetic pool are unimportant. It focuses on illness,
usually displaying the primary illnesses for living persons as well as
primary and secondary causes of death for deceased family members. A
specific disease or illness, such as glaucoma, can easily be highlighted
within a genogram.
Genograms have traditionally been created using a pencil, ruler and
special template containing some of the symbols. In the past few years
several computer programs that make this task quicker and easier have
become available. Some are very complicated and expensive, while others
are both easier to use and more reasonably priced. Please refer to the
bibliography following this article to locate books or articles with
detailed instructions about how to go about drawing a genogram, as well
as computer programs that will create a genogram based on information
The author is the president of Genes & Things, Inc., creators
of GeneWeaver®, new computer software for creating and maintaining
family health histories. Please visit their website for
Bell, Sherilyn L. and Constandina N. Arvanitis. The Genes in Your
Genealogy. Heritage Book Series: #10. Toronto, Canada: Heritage
Bennett, Robin et al., “Recommendations for Standardized Human
Pedigree Nomenclature,” American Journal of Human Genetics 56:3
(March 1995): 745-752.
Keating, Norma Storrs, RN, BSN and Richard F. Robinson with Elizabeth
Kelley Kerstens, CGRS, CGL. Geneweaver®: Family Health History Made
Easy. Plymouth, Michigan: Genes & Things, Inc., 2001.
Krasner-Khait, Barbara. “Family Health Histories on the Web,” Genealogical
Computing 21 (Summer 2001): 7-10.
Krasner-Khait, Barbara. “Focusing Beneath the Surface: Genograms Add
Insight to Family Research,” Ancestry 18 (Jan-Feb 2000): 28-31.
McGoldrick, Monica et al. Genograms: Assessment and Intervention.
2d edition. New York, New York: W.W. Norton & Co., 1999.
Nelson-Anderson, Danette et al. Genetic Connection: A Guide to
Documenting Your Individual and Family Health History. Washington,
Missouri: Sonters Publishing, 1997.