In contrast to remembering the ages of their parents or spouse or knowing which jobs they have held, patients are very specific as to day, date, time and minute circumstances of not only the injury but what preceded and what followed.
This can be quite striking. They minimize the importance of education, training or health problems (outside injury), but they are meticulous in detailing who was at fault, how poorly things were managed, and from where their distrust arose.
Quite often, this is because their case has been mismanaged from reporting and documenting the injury to timeliness and structure of care.
However, these distortions and alterations of reality may also arise from attempts to manipulate and deceive.
This can be a central point in case management since it extends to what they report they were told about their diagnostic findings as well as distorts what they either believe and/or recount is the planned course of care.
As part of a psychological exam, I review all medical records. It is surprising or perhaps alarming that different versions of the injury and its aftermath have been recounted to each individual seen since the date of injury.
