Figure 3.

Example of an integrated clinic schedule, with a genetic counselor and medical geneticist seeing patients together. The genetic counselor starts with new patients, taking the personal medical and family history and reviewing prior genetic testing (approximately 30 minutes). At the same time, the medical geneticist sees a follow-up patient for discussion of genetic tests results, medical management, or other. After 30 minutes, the genetic counselor and medical geneticist meet to briefly discuss patient 1, then go into the exam room together, for the physician to perform the physical exam and to develop a differential diagnosis. Then genetic counselor and physician together with the family discuss genetic testing options and plans. After a total of 60 minutes, a new patient assessment and a follow-up patient assessment have been completed, and the next set of patients can be evaluated. Time frames are based on the personal experience of the author during his tenure at Texas Children’s Hospital (Houston, TX), with additional staff available to take vital signs, for rooming patients, and for phlebotomy services.