I went with my sister to the hospital after we had a bad car accident together. I don’t know why, but it was clear to me that she wasn’t telling everything she knew. For instance, they asked if she had ever been treated for neck or back pain before. She said no even though I know she is currently seeing a chiropractor and a physical therapist. Why don’t people tell the truth about these things?

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. Why do patients give inaccurate histories? 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, exaggerating, or malingering because they have a mental health history.

We don’t really know why this happens. But we know it happens a lot. But what they actually found was that patients frequently (about half the time) underreport previous bouts of neck and back pain. And they deny 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 left out the entire history.

Studies 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 couldn’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.

We don’t yet know all the reasons for this type of behavior. Researchers have just confirmed that the underreporting occurs when self-reported tools are used to gather the information. There may be other (more accurate) ways to collect the data. More research is needed in this area.