The History Hiders

Medical history is different from usual history. Apathy to the latter in student life is widespread, probably due to students hating the need to remember whatever happened exactly whenever. That cannot be said about medical history. Usually patients remember something about their past medical problems, though very few produce documents related to their treatment. Some of them leave their old papers at native place when they come to us for treatment of a new condition. Some of them leave the papers home, which is somewhat better since they can get them at the time of the next visit. Some of them get angry with the diagnosis of their condition and tear up all papers. After they repent, they go to a new doctor, and the whole diagnostic process has to be started again, including all tests that they had got done and had lost by tearing up the reports. Some women have some medical condition before marriage, and they hide it from the groom and in-laws fearing that the marriage will not take place if they know about it. They hide it from their doctors after marriage fearing that the husband and in-laws will learn about it from the doctor and the marriage may end in a divorce. Recently we had a patient who had undergone a major abdominal operation about four years ago, long before she married. She was pregnant when she came to us. She had no papers of her past operation, because her mother had torn up all of them. The mother did this because the daughter eloped with her boyfriend and got married to him without her parents' wish. Now we were stuck, not knowing what had happened inside her abdomen, and how it would affect her current pregnancy.

I have seen a new trend in the last 15 days. We had three patients, who hid their past medical history from us.

1. The first patient had high blood pressure, for which she was taking treatment from a private practitioner. She came to us with toxemia of pregnancy. She hid the history of this treatment from us and kept taking her pills on her own. She had seriously high blood pressure during childbirth, which we managed somehow. When she was ready to go home, she was seen taking her own pills, and when asked, she said nonchalantly, 'that is as per my other doctor's advise. I am managing that part on my own. So I did not tell you.' She obviously did not know about interactions of medicines, and possible serious effects of her condition on her pregnancy.
2. The second patient was a diabetic. She hid the history that she had convulsions in past. We managed her diabetes during pregnancy and delivered her successfully at term. She had tonic and clonic convulsions immediately after delivery, which could not be explained by her medical condition, and the doctors on duty were alarmed because the convulsions could be due to any of a large list of conditions, most of them serious, and they were prepared for none of them in this patient. It was discovered afterwards that she had this condition in the past. It was lucky the baby did not have any problem and both the mother and the child went home fine.
3. A resident doctor from another specialty brought his mother for uterine leiomyomas. We advised her to undergo surgical removal of the uterus. They hid the history of angina from us, from the anesthesia outpatient clinic doctors, and our OT anesthetists. She revealed it when she was on the operation table and was being administered a regional block. We all almost went into shock, thinking of all the bad things that could happen to her if we operated without diagnosing if she had ischemic heart disease. There was dispute among the son, husband, daughter, and patient on whether she had undergone a stress test. Finally it emerged that she had not run on a treadmill for the test. I had to take her out of the OT, get a cardiology opinion urgently (*which the son managed well, including a stress test) and then operate on her. Luckily she did not have ischemic heart disease, or we could not have operated on her without getting it treated first.

I am quite worried by this new trend. I appeal to all my readers to spread the word that patients should not hide their past medical and surgical history from their doctors, for any reason.