Case Example

Annie greets Tom and the woman and asks them to come back to her office.  On the way to the office, Tom introduces his sister, Mary.  He says that she has come to provide support.  Mary explains that she also wants to know if her children are at risk even if she does not have the condition. 

After sitting down, Annie first asks Tom what is his understanding of today’s visit.  Tom explains that he has recently received a clinical diagnosis of HHT and when he told his PCP this, the PCP said that there was testing available for HHT and referred Tom to genetics. 

Annie confirms that there is testing available for HHT and that they will be discussing that during today’s session.  She tells Tom what her plan for the session is, namely to take a medical and family history, talk about the inheritance and findings that can be associated with HHT, and finally discuss available testing.  Annie asks Tom if that is alright with him and Tom says that that’s fine.

Laying out the plan for the session and confirming this plan with the patient is called ‘contracting’.  Why is this an important part of any genetic counseling session?  What might happen if contracting did not take place?

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