Prescribing dings is one matter, taking them is another. About 50% of patients are non-compliant. However, many doctors assume compliance unless the contrary is obvious. Sometimes non-compliance can be established by absent plasma concentrations of drugs or suspected by the lack of common adverse effects such as a dry mouth with tricyclic antidepressants. Inquiring about compliance requires tact

Normal male Normal female Mating

Cosanguineous mating

Parents with son and daughter (in order of birth)

Female with children by two males

Dizygotic twins Monozygotic twins Zygosity uncertain

Sex unspecified

Number of children of sex indicated

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Affected male Affected female Propositus

Heterozygotes for autosomal genes

Carrier X-linked recessive gene


Abortion or stillbirth of unspecified sex

Identification of person in pedigree from the generation (Roman numerals) and the location in I the generation. Proposita is lll4

Fig. 1.7 Symbols used in pedigree charts. Drawing up a family tree begins with the affected person first found to have the Irait (propositus if male, proposita if female). Thereafter, relevant information regarding siblings and all material and palernal relatives is included. (Reproduced with permission from Emery A E H, Mueller R F 1992 Elements of medical genetics, 8th edn. Churchill Livingstone. Edinburgh.)

and rapport. Poor compliance may not be wilful and many patients may be unaware of the extent of their noncompliance and embarrassed when questioned.

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