A Patient's History: Forgetfulness
Blog - A Patient's History: Forgetfulness
The challenge we face is that a person’s recollection of their health problems is not reliable.
I’ll use back pain as an example.
Studies of large groups of people tell us that back pain is common. 20% or more of the population has a long term back complaint, where they experience some level of back discomfort or soreness on most days. More than 30% of people experience intermittent episodes of back pain. Only about 30% of the working age population have never experienced back pain.
New and better quality studies suggest that people can move from one of these groups to the next group. They may go from intermittent pain to constant pain, or from no pain to intermittent pain, or from intermittent pain to no pain.
It is rare, however, for people to move from experiencing no pain to experiencing constant pain, yet we see this history very commonly in workers compensation.
“I hurt my back lifting that 20 kg box two years ago and have had back pain ever since. And “No, I’ve never had any back pain before,” is a familiar story. Of the patients I see with a work related back problem, around 10% tell me they’ve had some prior back soreness. How does this equate with studies which tell us that around 70% of the population have had back pain?
Should we simply accept this history? Are the studies wrong? Is there something we’re missing? Does a significant proportion of this group lie about their history?
What might be contributing to this scenario?
A number of different types of studies tell us that people’s memory of their previous health problems is not reliable. I will address a few of these in turn.
A study in the United States looked at people who had experienced neck pain after being involved in a car accident. People attending a clinical review were asked if they had any prior neck problems. Of those who said they had not had any neck complaints prior to the accident, 50% were found to have a significant history of neck problems when their earlier clinical records were reviewed.
Another study followed people over time. People were asked in 2002, for example, “Have you had any soreness in your back over the last 12 months?” In 2004, 2006 and 2008 they were asked “Have you had any soreness in your back in the last 12 months?” and “Have you had any previous soreness in your back at any time in your life?”
The answers showed that over time people forgot earlier problems. Many people who said they’d experienced pain in 2002 had forgotten about it by 2004. Even more had forgotten about it by 2006 and 2008. This study had nothing to do with a compensation system.
When there’s a specific incident, followed by multiple retellings for medical and compensation purposes, then you are more likely to get into a pattern of repeating the same history.
In everyday practice we know that people naturally forget their earlier health problems. In general practice, patients often return to the same clinic for many years therefore practitioners have the opportunity to look back over earlier notes. As a doctor seeing a patient for hay fever, you ask “Have you ever had any hay fever before?” The patient might answer “No,” but as you flip back through the notes you might find two, three or four records where they had previously attended for hay fever treatment.
The same trend applies with all sorts of health conditions and is worth remembering when assessing patients.