P.M.H.

As medical students, we’re taught to present patients starting with the history of present illness, followed directly by the patient’s past medical history. On internal medicine rotations, this past medical history typically includes a long list of chronic diseases and previous treatments that color the current disease manifestation. As we started to write up a few cases here, I realized that even the long intake notes completely lack a “past medical history” section for most patients, perhaps beyond comments of whether they have been previously treated for malaria or TB. Obviously, it’s not because these patients lack a past medical history. In most cases the only fully relevant piece of PMH is serostatus, and every patient is offered routine HIV counseling and testing on the wards. It’s in part the “peds phenomenon”: most patients (particularly those with HIV/AIDS) are relatively young and their bodies have not been ravaged by the diseases that accompany growing old in a wealthy country. But it’s also because I think there is an unspoken understanding that whatever disease has brought them all the way to Mulago is the big one, the one that matters, the one that will likely take their lives one day. Smaller complaints pale amid a sense that anything really major would have killed the patient before the present admission. There simply are not many patients at Mulago “status/post partial colectomy” or “s/p cardiac cath” or s/p any of a thousand other things.