What are the components of a History of Present Illness (HPI)?

Components of a History of Present Illness (HPI)

The History of Present Illness (HPI) should include the nature of presenting symptoms, onset and chronology, symptom characteristics, impact on daily function, and relevant risk factors, integrating information from both patient and informants when appropriate. 1

Core Components of an HPI

1. Chief Complaint and Symptom Characterization

• Begin with open-ended questions to allow patients to describe their main concern
• Document specific symptom characteristics:
  • Location/distribution
  • Quality/character
  • Severity/intensity
  • Timing (onset, duration, frequency)
  • Context in which symptoms occur
  • Aggravating and alleviating factors
  • Associated symptoms

2. Chronology and Time Course

• Sequential order of symptom onset
• Frequency and pattern of symptoms
• Tempo and nature of changes over time
• Relationship between symptoms and pertinent events 1

3. Impact Assessment

• Effects on activities of daily living (ADLs)
• Impact on work/school performance
• Effects on interpersonal relationships
• Safety concerns related to symptoms
• Need for assistance or care partner support 1

4. Contextual Factors

• Potential triggers or precipitating events
• Environmental or exposure factors
• Plausible relationships between events and symptoms
• Previous similar episodes and outcomes
• Patient's understanding and concerns about their condition 1

Special Considerations for Specific Patient Populations

For Cognitive/Behavioral Concerns

• Obtain information from reliable informants/care partners
• Document changes in cognition, activities of daily living, mood, and sensorimotor function
• Assess impact on daily function and relationships 2

For Pediatric Patients

• Include perinatal history when relevant
• Document nutritional history
• Assess physical activity patterns
• Include psychosocial factors 2

For Suspected Infectious Diseases

• Document travel history
• Note exposure risks
• Record immunization status 1

Best Practices for Documentation

• Present information in chronological order
• Use clear, concise language avoiding medical jargon
• Include pertinent positives and negatives
• Document medications (including over-the-counter and complementary therapies)
• Note previous history of allergies or similar reactions 1

Common Pitfalls to Avoid

• Interrupting the patient's narrative prematurely
• Relying solely on closed-ended questions
• Failing to integrate information from informants when needed
• Neglecting to assess the impact of symptoms on daily function
• Attributing symptoms to "normal aging" without proper evaluation
• Framing history solely around a major event that patient believes is causal 1

Approach to HPI Documentation

1. Begin with open-ended questions to establish rapport and allow patient narrative
2. Follow with focused questions to clarify specific aspects
3. Integrate information from both patient and informants when appropriate
4. Use structured assessment tools when appropriate for specific conditions
5. Document in chronological order using clear, concise language
6. Include impact assessment on daily functioning and quality of life

By following this structured approach to obtaining and documenting the HPI, clinicians can improve diagnostic accuracy, develop effective treatment plans, and provide comprehensive patient care.