A Call for an End to “Past Medical History”

Abstract

To the Editor: The redundant expression past medical history (PMH), a staple of medical communication, appears often in conferences, admission notes, and presentations on teaching rounds. As someone who spent 6 years studying history, I found the introduction to this term in my second-year physical diagnosis course jarring. At my previous institution, even hospital forms included PMH. Although scholarly journals rarely, if ever, use the term past medical history, it has become entrenched in the lexicon of students, house staff, and practicing physicians. Physicians use PMH to distinguish between a patient's long-standing medical conditions and more recent events, the history of present illness. Although that distinction is sometimes artificial, I agree that it is useful to identify the patient's established diagnoses and hospitalizations separately from the events of the patient's present illness. The term medical history is no less helpful, and use of this term avoids the perpetuation of redundancy seen in such often-cited transgressions as future plans or past regrets. All of us have rolled our eyes when subjected to pomposity, a quality that academic institutions rarely lack. As someone who is starting a career in academic medicine, I acknowledge that some may think my objection to PMH is mere pedantry. However, our acceptance of sloppy word usage reflects our overall indifference to thoughtful speech. As physicians, we strive to use precise and appropriate language when communicating with patients and with each other. Precise language is a by-product of careful thought. Although an extreme example, I do not think any of us would find it acceptable if our students used the words heparin and warfarin as synonyms because both are anticoagulants. Long hours in medical school and residency are spent cultivating the art and practice of systematic thought, precision that is undone, if very slightly, by use of PMH. Although perhaps trivial in many respects, use of PMH reflects an indifference to language and usage that we should strive to avoid. Historians such as Marc Bloch (1886–1944) stressed the importance of careful, rigorous, systematic thought as a way of understanding history as a living thing. Similarly, creating a thorough medical history is central to our care of the living patient. I believe we should acknowledge the importance of this endeavor with a more precise and thoughtful term. The Editor welcomes letters and comments, particularly pertaining to recently published articles in Mayo Clinic Proceedings, as well as letters reporting original observations and research. Letters pertaining to a recently published Proceedings article should be received no later than 1 month after the article's publication. A letter should be no longer than 500 words, contain no more than 5 references and 1 table or figure, be limited to no more than 3 authors, and not be published or submitted elsewhere. It is assumed that appropriate letters submitted to the Editor will be published, at the Editor's discretion, unless the writer indicates otherwise. Priority is given for the importance of the message, novelty of thought, and clarity of presentation. The Editor reserves the right to edit letters in accordance with Proceedings style and to abridge them if necessary.