On reflection Postgrad Med J: first published as 10.1136/postgradmedj-2017-135241 on 21 August 2017. Downloaded from

information into a small diagram than Why doctors should draw genograms– through writing and, as a visual aid, it is far easier to use than reading including their own through prose. If necessary, you can jot down some core details in less than a John Launer minute on the first occasion you meet someone, and then extend the diagram during subsequent conversations by Virtually every doctor will have learnt at might need to be mobilised to support adding one or two more generations medical school how to draw a genogram. a frail elderly person returning to the and further annotation. Genograms (sometimes spelled geneo- community. In specialised areas like child An even more unhelpful misconcep- grams but always pronounced ‘gene-o- psychiatry and family therapy, there are tion is that genograms are just about grams’) are basically family trees, but a variety of other recognised symbols recording facts. Although in many annotated with further relevant informa- for marking such details as conflictual instances this is a necessary function tion according to the clinical context. In relationships, but these should probably – for example, to record that a child’s some specialties like clinical genetics or be used sparingly, since they may only parents are divorced, or that an elderly haematology, they are used routinely to represent one person’s perspective, and person’s only child lives far away – in record which members of a patient’s they could be seen as intrusive or judge- most situations taking down a geno- family carry a particular gene or suffer mental. gram is more of a shared creative act. from an expressed inherited disorder. In This is especially the case if you draw specialties like family medicine,1 paediat- Quick and efficient method it sitting alongside the patient, rather rics,2 palliative care3 or psychiatry,4 they There is a common perception that than opposite them. When patients are usually taken in order to gain a more drawing genograms is time-consuming. narrate the objective facts of their informed understanding of a patient’s In reality, setting down essential infor- lives, they have an opportunity to share personal circumstances and the back- mation in the form of symbols is actu- ally a quicker and more efficient than their emotions too, perhaps when they ground to their presentations. Indeed, using words, especially if you do it are speaking about transitions such as some practitioners in these fields regard regularly. You can also pack more births and bereavements, relocations or genograms as an indispensable tool for understanding family systems and dynamics, or even for just remembering or details like everyone’s names and ages. b 1940 d 1995 Over many years as a general practitioner male female main patient birth date/death date (GP) I kept folders containing the geno- grams of most of the patients I looked after. I shared a belief with many of my colleagues that drawing a genogram is not 1 2 only one of the best ways of gathering

essential personal information, but also a http://pmj.bmj.com/ good way to demonstrate human curiosity, marriage first and second (or lasting relationship) marriages build a relationship of trust, and enter more fully into people’s personal and illness narratives.5 There is a simple system of notation in genograms to show such things as gender, m 1994 m 1994 and whether a relative is alive or has on October 2, 2021 by guest. Protected copyright. died. There is also a straightforward way sep 1999 div 2001 of linking different individuals together seperation divorce to show their relationships as parents and children, along with first or subse- quent marriages, divorces and so forth (see figure 1). Additional information can then be added according to the needs of the clinical situation. This can include the years of births and deaths, and other brief biographical information that seems important – like occupations, place of residence, languages spoken, or role as a carer. Such details can be important, for instance. in understanding who Children (including a miscarriage and opposite-sex twins) Correspondence to Dr John Launer, Health Education England, Stewart House, 32 Russell Square, London Figure 1 How to draw a genogram Taken from Launer, J. Narrative-based primary care: a WC1H 5DN, UK; johnlauner@​ ​aol.com​ practical guide. Oxford: Radcliffe, 2002.

Launer J. Postgrad Med J September 2017 Vol 93 No 1103 575 On reflection Postgrad Med J: first published as 10.1136/postgradmedj-2017-135241 on 21 August 2017. Downloaded from migrations, and other causes for cele- teachers might want to teach and model Twitter Follow John Launer @JohnLauner bration or grief. While doing so, they it as a key skill for the clinic or ward. Competing interests None declared. may well make new connections in their Finally, I can highly recommend Provenance and peer review Commissioned; minds – for example, when they see a compiling your own genogram. It can be internally peer reviewed. pattern of illness, separation, social one of the most enlightening exercises in © Article author(s) (or their employer(s) unless mobility or mutual support emerge personal learning that you ever carry out. otherwise stated in the text of the article) 2017. All among many individuals or more than Although you can easily do this on your rights reserved. No commercial use is permitted unless one generation. Your own sense of own, it is more powerful if you do it in the otherwise expressly granted. affiliation with them as a professional presence of a friend or colleague who can is likely to increase. If done sensitively afterwards repeat the exercise the other way and with clear consent and the right around, with yourself as interlocutor. (Even timing, drawing a genogram brings if you have done this before, you will almost practitioner and patient closer to each certainly recall new details or establish new To cite Launer J. Postgrad Med J 2017;93:575–576. other, and creates mutual respect. understanding each time.) If you start out Postgrad Med J 2017;93:575–576. Some physicians and surgeons still with just the details of your immediate doi:10.1136/postgradmedj-2017-135241 appear to think that genograms are a family – parents, siblings, plus partner and specialised form of intervention, best children if you have them –you will find References reserved for complex psychosocial how easy genograms are to draw, merely 1 Waters I, Watson W, Wetzel W. Genograms. Practical problems and only done by mental by using the basic symbols and people’s tools for family physicians. Can Fam Physician health professionals with special names. Then, by adding in more relatives or 1994;40:282–7. 2 Nottingham City and Nottinghamshire Safeguarding training or resources to deal with these. generations and further information of your Children Board. Guidance for practitioners completing In reality, it is hard to think of any choice as you go along you will see how chronologies and genograms. Nottingham: NCSCB/ medical or surgical cases, except the much crucial information can be included NSCB, 2014. http://www.proceduresonline.​ ​com/​ most trivial ones, where it would not on a single page. If you want to make the nottinghamshire/scb/​ ​user_controlled_​ ​lcms_area/​ ​ be useful to have a sketch of someone’s exercise more imaginative, try looking at uploaded_files/​ ​guide_pract_​ ​chronol_geno.​ ​pdf (accessed 1 Aug 2017). immediate support network to hand. patterns like the first names people in your 3 North West Coast Strategic Clinical Networks and Just as I found it beneficial to have family were given in each generation and Senate. Guidelines for the use of genograms in palliative folders of genograms readily acces- why, where people lived as adults in relation care. Liverpool: NWCSCNS. http://www.nwcscnsenate​ .​ sible in my own GP practice, there are to where they were brought up, and what nhs.uk/​ ​files/8114/​ ​3394/6194/​ ​Genograms.pdf​ (accessed 1 Aug 2017). obvious advantages to having these jobs they did compared with their parents. 4 McGoldrick M, Gerson R, Petry S. Genograms: available in a regular format, and in a You may experience exactly the same kind assessment and intervention. 3rd edition. New York: predictable place, in people’s hospital of insights that your patients will often WW Norton, 2008. records. I would certainly encourage do in these circumstances – and you may 5 Asen E, Tomson D, Young V, et al. Ten minutes for the any junior doctor to consider doing discover that sharing a genogram, or even a family: systemic interventions in primary care. London: Routledge, 2004. this as a routine, and hope that many small part of it, is a profoundly humanising activity for everyone involved. http://pmj.bmj.com/ on October 2, 2021 by guest. Protected copyright.

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