Forgetting, fabricating, and telescoping: the instability of the medical history.

Full Abstract

Patients' recollections of their past symptoms, illnesses, and episodes of care are often inconsistent from one inquiry to the next. Patients frequently fail to recall (and therefore underreport) the incidence of previous symptoms and events; tend to combine separate, similar occurrences into a single, generic memory; and falsely recall medical events and symptoms that did not in fact occur. This unreliability of recall is affected by personality characteristics and by the patient's current state at the time of recall. Thus, current anxiety or depression and pain or bodily distress foster the recall of symptoms and events that are not recalled when the patient is more comfortable. Finally, current beliefs about one's health and the nature and causes of one's illness also affect the recall of past symptoms and illness. Physicians can maximize the reliability of the clinical history by (1) noting and taking into account the patient's current physical and emotional state; (2) first establishing historical "anchor points" or memorable milestones; (3) decomposing generic memories by finding features that distinguish them from each other; and (4) recalling the clinical history in retrograde fashion, beginning with the most recent event and working backward.

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Author information

Author/s: Barsky, Arthur J (AJ);

Affiliation: Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.

Journal and publication information

Publication Type: Journal Article

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2002-May; vol 162 (issue 9) : pp 981-4

Dates: Created 2002/05/08; Completed 2002/05/31; Revised 2004/11/17;

PMID: 11996606, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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