PI Brief Update

What should an expert put into the Past Medical History section of a PI report? - Dr Mark Burgin

09/08/22. Dr. Mark Burgin BM BCh (oxon) MRCGP discusses the relevance of previous injuries, MSK symptoms and psychological problems.

Most people with aches and pains and stress do not attend their doctors to discuss their problems, many consider (rightly) that they are a normal part of life.

‘At any given time 15% to 20% of adults will report having back pain and 10% to 20% will report neck pain symptoms’.

Unsurprisingly a similar proportion will have ongoing neck and back pain at 6 months following a claim for personal injury following an RTA.

Many of these claimants will have sparse records of their previous problems, typically 2-3 entries over many years and may not have attended after the index accident.

Previous injuries

Most claimants can remember fractures better than other injuries so any history of fracture is material.

Some fractures are clearly directly relevant, for instance facial fractures due to being assaulted would have involved energy being transmitted to the neck.

Other fractures can indicate a more general history of injury for instance related to playing a contact sport or horse-riding.

Injuries related to previous claims can indicate if the claimant is unusual in their responses even if many years previously.

MSK symptoms

Disclosing a previous history of MSK symptoms is a test of honesty and reliability and is part of the critical assessment of the claimant.

Failure to include relevant negatives such as ‘no history of neck and back pain’ makes the expert appear to lack independence.

As most claimants will have had symptoms at some point, a completely negative history should give the expert concern that the claimant might have forgotten a detail.

Only the worsening following an accident is claimable and can be included in the prognosis so understanding any pre-existing MSK problems is essential.

Psychological symptoms.

In a similar way to MSK problems many claimants will have GP records of psychological attendances which may be sparse but still significant.

Claimants are often happier to admit to previous stress than psychiatric illness and will relate their symptoms to stressful psychosocial experiences.

When a claimant is making a claim for psychological injuries in the index accident the relevance of previous responses to stress is greater.

It may be that the claimant is more likely to be injured, more likely to suffer disability associated and less likely to recover because of previous problems.

Conclusions

It is the court to determine whether the previous history of injuries, MSK and psychological symptoms is relevant or significant.

The expert should give sufficient detail for the court to be able to determine the true nature of the claimant’s pre-existing conditions.

Past medical history is time consuming to assess and often creates inconsistencies that require careful reasoning.

An expert who deals properly with previous conditions can ensure that they are prepared for any challenge that the solicitors raise to their evidence.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

Sinnott Trends in diagnosis of painful neck and back conditions, 2002 to 2011 Medicine (Baltimore). 2017 May; 96(20): e6691.

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