The Value of the Past Medical History

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Some time ago, a young man came to see me in the office accompanied by his mother.  I cannot recall a single detail of what led him to see me.  But I remember very clearly a medical intervention that he had as an infant that bore no relevance to the forgotten reason for his visit. 

One of the tasks that physicians perform on patients we see is to review the past medical history (PMH).  We do this to assemble a medical portrait of the individual who is before us.  Oftentimes, the historical medical events are not directly relevant to the issues at hand.  But often they are.  For example, if a patient has been experiencing chest discomfort, and the PMH includes a heart bypass operation, the physician will be on heightened alert to consider a cardiac explanation. 

When I am reviewing the PMH, I do so in a routine manner, not really acknowledging how many of these items were major life experiences for the patient and his family. It’s likely that your doctor also regards the PMH as a data assembly and review process. At times, I will express myself on a major life event, but usually this process is a pass-through.  Usually, the PMH is already listed by the electronic medical record, which I can quickly scan.  In the olden days, we physicians would complete the PMH ourselves by hand.  My main focus during office visits is on the active issues that brought the patient to my office. This is where I prioritize my time.   Below is a hypothetical but typical PMH.

• Prostate cancer with radiation treatments.
• Rotator cuff surgery
• Stroke
• Fibromyalgia
• Migraine headaches
• Rheumatoid arthritis
• Spinal stenosis
• Diabetes       

Some of the above illnesses were likely major and frightening events in the patient’s life.  Some of them, such as rotator cuff surgery, may have resulted in complete healing but only after months of therapy and rehab.  Other chronic illnesses, such as chronic back pain or fibromyalgia, may cause ongoing suffering.  While the PMH deserves our attention, we physicians tend to casually and efficiently review it. Do I pause to consider what these events must have been like when I running through the PMH list?  Sometimes I do, but not as often as I should.   I’m not being overly self-critical here; this is simply how the system generally works

Chronic back pain and other items on the PMH list may be major life events.

I learned that the young man who was in my office with his mom had undergone pyloric stenosis surgery as a newborn.  In this condition, the outlet from his stomach was very narrow at birth, and his feedings were blocked at this point.  Surgery corrected this, and the patient was cured.  This event was barely a medical footnote to the patient, who has no memory of the incident.  But his mom remembered it quite well.  I decided to share some brief thoughts on this with both of them. I expressed marvel that a surgical team could perform an operation on a newborn to correct an intestinal defect with perfect success.  Leaving aside that I am in the medical business, this seemed to me to be an amazing demonstration of medical skill.  And then, facing the mom I remarked that this must have been a scary time for her and her family, which of course it was.  I can’t explain what motivated me to be so reflective on this event that had long been forgotten.  It just seemed to merit at least an honorable mention.  There are lessons here for me that I will try to carry forward.