DISCREPANCIES BETWEEN PATIENT RECALL AND THE MEDICAL RECORD - POTENTIAL IMPACT ON DIAGNOSIS AND CLINICAL-ASSESSMENT OF CHRONIC DISEASE

Background: During a case-control study, data necessary for fulfilling diagnostic and classification criteria for spondyloarthropathy were c ollected from 121 patients. Objective: To study the potential impact o f differences between patient recall and the medical record on diagnos is and clinical characterization of spondyloarthropathy as a model of chronic disease. Methods: The study was conducted among four Alaskan E skimo populations served by the Alaska Native Health Service. Two sets of historical data were compiled for each subject, one acquired durin g the interview and the other derived from the medical record. Paired items from the interview and the medical record were analyzed to deter mine discrepancies and consequent effects on diagnosis, classification , and disease characterization. Results: Significant differences were observed in the reporting of genitourinary or diarrheal illnesses prec eding or associated with arthritis, the occurrence of eye inflammation in association with joint pain, the occurrence of joint pain and back pain together, and the age at onset of back pain, all of which are im portant to the diagnosis and classification of spondyloarthropathy. In contrast, for information needed to establish the probable inflammato ry nature of back pain, patient interview was more helpful than the me dical records, which did not provide adequate details to differentiate inflammatory from mechanical back pain. Conclusions: Patient recall b ias can substantially affect diagnosis and clinical assessment of chro nic disease, as exemplified by spondyloarthropathy. Reliance on record s alone, however, may lead to underestimation of features that require subjective appraisal by the patient.