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Patient History After Car Accident Doesn't Match Up With Medical Records

Posted on: 01/28/2009
An accurate patient history after motor vehicle accidents is important when planning the best and most appropriate treatment. Anyone with a prior history of neck or back pain may need a different approach. Social research confirms that anyone with a psychologic profile, history of alcohol or other drug use, or mental illness will likely need special attention.

But getting at that information can be tougher than it looks. Despite taking a thorough patient history, patients don't always reveal important facts from their past. In this study, researchers at Stanford University School of Medicine attempt to see how accurate patient self-report is after an accident.

They compared the information given by patients experiencing chronic neck or back pain following a car accident with data in their medical records on the same patients. They were expecting that the information would match up.

But what they actually found was that patients frequently (half the group) underreported previous bouts of neck and back pain. And they denied ever having treatment for these problems even when the medical records clearly showed they did have treatment at some time in the past.

Not only that, but the patients who were not at fault (the accident was caused by someone else) were much more likely to fail to report previous back and neck pain problems. Patients with a history of psychologic problems were seven times more likely to underreport information on those problems. These patients didn't just leave out a small portion of their history. Often, they omitted the entire history.

To make sure this wasn't just a general underreporting of all problems (including health conditions unrelated to an accident), the authors also included two control conditions: hypertension and diabetes. Consistent with the idea that the underreporting was conscious or deliberate, no one failed to tell the examiner about other health concerns of this type.

Why do patients give inaccurate histories? The authors suggest in the case of psychologic issues, the patients may have the feeling that it will be a strike against them. Everyone will think they are faking or exaggerating because they have a mental health history. Whether or not this is true was not tested or proven in this study.

Secondly, other studies done by these same authors have shown that underreporting occurs more often in cases where the patient was not at fault and who hired a lawyer. It's easy to assume the patient is out for secondary gain (i.e., get all they can from this one accident).

But there may be other explanations for this behavior. For example, maybe the people who underreported past history just couldn't think straight and didn't remember past injuries. Maybe they didn't have the emotional or psychologic strength to deal with all the questions, the finances, and all the paperwork.

Regardless of the reasons, it's clear that patient histories related to neck and back pain taken after motor vehicle accidents are not valid or accurate. Involvement in a compensation claim may be a key risk factor for this type of underreporting. Health care workers must keep this in mind when trying to interview or help patients who have recently been involved in a car accident.

Other studies show that patients with a previous history of treatment for neck or back pain are much more likely to have a poor prognosis. Management of the problem may be approached quite differently under these circumstances. Not knowing this information could compromise quality of care.

Angus S. Don, FRACS, and Eugene J. Carragee, MD. Is the Self-Reported History Accurate in Patients with Persistent Axial Pain After a Motor Vehicle Accident? In The Spine Journal. January 2009. Vol. 9. No. 1. Pp. 4-12.

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