Striking the Balance: Giving Advice while Respecting Privacy
Genetic counselors tend to be very attuned to the details in the ‘big picture.’ We take very detailed family histories when we meet with patients because we look for patterns which may suggest a hereditary component to a family’s medical concerns. We are trained to think critically and to not just accept things as chance.
This method of thinking is a skill we need in the workplace, but I find that it is difficult for me to separate my ‘work brain’ from my ‘real life brain.’ When I identify a situation where I believe that a genetics evaluation or genetic testing may be appropriate for an individual or a family, it’s hard to “turn off” the instinct, even if the situation is in my personal life where the person or family involved is not my patient.
On occasion, I will see a mother with her kids at the supermarket or on the subway platform and something about the child’s appearance or behavior will make me wonder if there is something genetic going on in the family. Other times, I will hear about a young woman in the community who is struggling with cancer and whose mother had died young. Other people post on social media about praying for her, about helping the family by providing meals and childcare, and there will be comments about how sad it is that this family is going through so much. But my first thought will be: Hmmm, I wonder if there is a genetic basis to this family’s cancer. And even strangers who learn that I am a genetic counselor will tell me their stories about seeing a counselor years ago for their child’s developmental delays and how it was a waste of time since all the genetic testing was normal and nothing was solved.
It is times like these when I struggle to decide whether or not I should speak up and recommend a consultation with a genetic counselor (sometimes, a second visit is warranted since newer technologies have been developed and testing may be different). Close friends or family members who know that I work in the field of genetics would probably welcome my advice, but what do I do when I don’t know the person at all or I may know “of the” person, but we have no relationship? Am I overstepping my boundaries?
The answer is, perhaps. But as genetics professional, I feel that I have a responsibility to help families and my community by sharing my expertise. How to best approach it? That, I don’t know. I find that the solution is very case-by-case, and I need to try to determine how my advice will be received. I remember when my son was 6 months old, a friend of mine who is an occupational therapist mentioned to me that he tilts his head too much and I should consider a physical therapy evaluation. I thanked her for her gratuitous advice and got an appointment for him later that day (he’s doing fine now!). But would I want a stranger telling me to do something?
One good way to approach this, especially with a stranger or an acquaintance, would be to try to find an intermediary who may be better suited to reach out to the person. If I can find someone I trust who knows the person, perhaps he or she can broach the topic and tell them they know someone (me or another genetics professional) who can help them. Only if I am feeling very bold would I actually say something to a stranger. But I would just hate myself for walking away knowing that I had the opportunity to help someone. I hope that people do not see such advice as me trying to be nosy, but that they accept and appreciate that there are those people who may be able to help them, and that we genuinely want to be there for them as they struggle through a hard time.
I recognize that there will be situations where I can’t find an intermediary, and I can’t work up the courage to make recommendations to a complete stranger. That’s why publicizing the availability and importance of genetic counselors may help that family or other families in the future. The more that people recognize the utility of a genetic counseling visit, the more likely it will be that even if I can’t make the recommendation, perhaps someone else will.