A note on the medical history

The medical history is something that is only important when it is important. By that I meant that the vast majority of people we encounter will have no medical conditions that will significantly affect the way we do our work but when we have a patient with significant comorbidities it is vital that we identify these so we can plan accordingly. This may involves modifying our treatment plan, omitting certain procedures or consulting with our medical colleagues for advice or to arrange multidisciplinary treatment. Some patients who are significantly ill are not suitable to be treated in the general practice setting and may have to be referred onto colleagues with experience treating medically compromised patients or have to be treated in a hospital setting.

A common mistake we make in private practice is that the medical history is often left to the patient to fill out and there is often not enough emphasis from the practitioner on the importance of this legal document. The issue with the patient filling out the history is that they can forget things and don't always understand the implications of certain medical conditions to dental treatment. Often times patients may discount diagnoses of osteoporosis, heart valve disease amongst others as they think it isn't relevant to us as dental practitioners. It is our job to tunnel down and investigate the matter further and not stop asking questions until we are satisfied we have covered every relevant detail. If the patient fills out their own medical history, it is pertinent on meeting them that you double check the details with them and confirm nothing has been missed. I find it useful to be able to look into their eyes and see their body language as we do this as you can often tell when there is hesitation or they are hiding something. Often, the response to a question will be "not really", to which my response is always "not really, or no?"

Details such as allergies should not be taken at face value. Patients don't speak the same language as us and we wouldn't have much luck asking if they have had any hypersensitivity reactions in the past. Allergies we are interested in are hypersensitivity reactions especially type 1 hypersensitivity reactions and to patients, adverse reactions often get chucked into the mix. Common adverse reactions to penicillins will be reported as allergy e.g "I had a stomach ache from penicillin 15 years ago." This patient would never have had a penicillin antibiotic since even if it was the drug of choice for their condition. It is dangerous to make assumptions that the patient is fully aware of their condition or the implications of their words and assumptions can lead to substandard treatment or even dangerous adverse outcomes of treatment. 

Adverse effects of medication are predictable and manageable and should be part of the consent process. For example it is well known that a certain population of people can't metabolise codeine to the active morphine form and so they can take a codeine based medication with no analgesic benefit with all of the side effects. A common side effect of opiate analgesics is constipation as the drug will affect gastric motility so laxatives are routinely co-prescribed by our medical colleagues. The point here is that there is always more to the picture than we are first told and the point of a medical history is not to tick a legal box so we can get down to the important aspects of treatment. The point of a medical history is to ensure that we leave no stone unturned and can ensure we have a solid foundation to allow us to carry out our treatment in a safe and predictable manner.