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I am a newly graduated nurse now working in a large trauma center. The social workers tell me not to believe what patients say during the intake interview. They say that when it comes to car accidents, if it wasn't the patient's fault, they will report much higher pain levels and deny a previous history of neck or back pain. Is there any truth to this that you know of?

The accuracy of health histories after car accidents has long been under suspicion. Ever since a pilot study showed that what patients reported about their past medical history and what the medical records already on file showed were two different stories. Since that time, another, larger study was conducted at Stanford University. 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. It is extremely important to obtain an accurate history after a motor accident. 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.

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