The toughest questions a patient can ask a doctor

Are you ready for the toughest questions a patient can ask a doctor?

The Wall Street Journal and The New York Times reported on an article in today’s issue of The Lancet entitled “Identification of risk loci with shared effects on five psychiatric disorders: a genome-wide analysis”  (free, but registration required).  The article suggests that there is an apparent genetic relationship involving calcium-channel activity genes among the five major psychiatric disorders (autism spectrum disorder, attention deficit-hyperactivity disorder, bipolar disorder, major depressive disorder, and schizophrenia).

Within a few hours, the story had been picked up by many popular press outlets. Most that we have seen take a scholarly, cautious approach, but sooner or later, you can expect to see articles from less reputable venues suggesting that ‘if you’re mentally ill, there’s no hope for your kids.’

You will get some questions from your patients.  Perhaps they will ask whether they can have their children tested, or whether they should even have children (or more children) if there’s a chance that those children will inherit genes likely to cause these disorders.  Physicians in other specialties who routinely deal with disorders known to be genetic (Tay-Sachs, Huntington’s, cystic fibrosis, sickle cell anemia, muscular dystrophies, etc.) deal with these questions every day.

Of course, no one knows the answers to these questions in psychiatry, and it will be years before we have real clarity on this. But start thinking about how you will deal with these most difficult questions put to you by patients whose own suffering may now be compounded by the fear that their children are “doomed” to their parents’ fate.


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