Geneticist and Genetic Counselor—the Odd Couple

by Kate Gardiner (illustrations by Leichelle Little)

According to Genetics Home Reference (http://ghr.nlm.nih.gov) and the Merriam-Webster dictionary: geneticist (noun): a specialist or expert in genetics genetic counseling (noun): guidance provided by a medical professional typically to individuals with an increased risk of having offspring with a specific genetic disorder and that includes providing information and advice concerning the probability of producing offspring with the disorder, prenatal diagnostic tests, and available treatments.

With those definitions in mind, it is easy to see why as a student interviewing for a Masters program specializing in genetic counseling would find it so difficult to answer the questions “What’s the difference between geneticists and genetic counselors?” and “Why is a genetic counselor important?”

Examining the similarities, geneticists and genetic counselors are part of a multidisciplinary team known as genetic professionals. Together, these professionals share the responsibility of examining the etiology and pathology of genetic conditions, while empowering the patient with support and knowledge. They act as patient advocates and liaisons to additional resources.

There is health care creed of do no harm and an obvious overlap in their roles.

From my clinical experiences, I have noted that one can typically expect a geneticist to be responsible for approximately one to five genetic counselors. A geneticist acts as a manager of and mentor for the genetic counselors, as clinical decisions must meet the geneticist’s approval for legal and billing purposes. On the National Human Genome Research Institute website www.genome.gov, the medical geneticist’s role is differentiated from the role of the genetic counselor: “many genetic diseases are so rare that only a geneticist can provide the most complete and current information about your condition.” Geneticists have specialized knowledge that is critical in complicated patient assessments.

Medical Geneticists Dr. Siobhan Dolan and Dr. Joy Samanich discussed the genetic counselor’s role in the clinic. Both agree that genetic counselors do much more than see only routine, uncomplicated cases to decrease physician’s workload. In both of their settings, the genetic counselor usually sees the patient or family first to make an initial clinical assessment. According to Dr. Dolan, “the geneticist [then] reviews the case with the counselor and patient, reinforcing any tricky issues and answering any questions. This gives the patient two opportunities to hear critical information and ask questions.” Dr. Samanich adds that subsequent to a genetic counselor’s review, the geneticist meets with the family for “exam and further discussion.” An examination by a geneticist is condition-specific but typically includes physical assessment as well as cognitive evaluation with various questions concerning learning and functioning capabilities. Although both geneticists agree that all clinical decisions made by genetic counselors must be approved by them to account for legal liability, Dr. Dolan makes a valid point regarding the geneticist genetic counselor relationship in saying “I personally see this more of a team approach with everyone working together.”

The roles and independence of a genetic counselor may vary from center to center. In some situations, a genetic counselor may see patients with a geneticist and act more as an assistant with patient triage, documentation and patient-doctor support. In others, a genetic counselor could carry out a patient session without the geneticist present, and complete the assessment, coordinate testing options, present test results and so on. There is a lot of room for a genetic counselor to diversity her/his role. As Dr. Dolan states, “counselors of varying training and experience desire and require different levels of oversight—and that varies with each person” making the roles of a genetic counselor site specific but also unique to the individual.

Although the goals for each profession are quite similar, the educational preparation for these professions is quite different. Perhaps it is not so unusual that the standout difference between the two roles lies in the educational preparation, since their professional goals have a lot in common. However, it is in the definition of their relationship that one begins to uncover the differences. It is a relationship in which these professionals work together to assess and support the clinical and psychosocial needs of patients referred for a genetic consult. Their roles can vary in the degree of patient evaluation, legal burden and specialized knowledge, but the roles manage to complement each other’s strengths. With the geneticist acting as an advisor, manager, mentor, and insurance guarantor, the genetic counselor benefits from the clinical expertise and wisdom of a geneticist. Conversely, a geneticist benefits from a genetic counselor’s ability to offer psychosocial support and expertise. In summary, in the health care field, they are a perfect match! They go together like peanut butter and jelly—sure you can have one on it’s own, but together they are great.