What questions should be asked during a patient's History of Present Illness (HPI)?

Essential Components of the History of Present Illness (HPI)

The History of Present Illness (HPI) should include a structured, comprehensive assessment of the patient's symptoms and concerns, focusing on the chronology of events, characteristics of symptoms, and relevant contextual factors that impact diagnosis and treatment decisions.

Core Elements of the HPI

• Onset and chronology: Document when symptoms began, their progression over time, and any patterns or changes in intensity 1, 2
• Location: Identify where symptoms are experienced and if they radiate or move 1
• Quality: Record the patient's description of how symptoms feel (e.g., sharp, dull, burning) 1
• Severity: Assess intensity using scales or by asking how symptoms impact daily activities 1, 3
• Duration: Document how long symptoms last when they occur 1
• Context: Note activities or situations when symptoms occur or worsen 1, 3
• Modifying factors: Identify what makes symptoms better or worse, including medications or interventions 1
• Associated symptoms: Record other symptoms that occur simultaneously 1

Medication and Treatment History

• Current medications: Document all prescription drugs, over-the-counter medications, supplements, and herbal remedies 1, 4
• Medication allergies: Ask about hypersensitivity reactions to medications 1
• Previous treatments: Inquire about prior treatments for the current condition and their effectiveness 1, 3
• Medication adherence: Assess medication-taking behavior and potential barriers to adherence 4

Past Medical History

• Chronic conditions: Document history of conditions like heart failure, renal insufficiency, diabetes, or lung disease 1
• Previous hospitalizations: Ask about past hospitalizations related to the current complaint 1
• Surgical history: Record relevant surgical procedures 1, 3
• Immunization status: Document vaccination history, particularly for influenza and pneumococcal vaccines 1

Social and Environmental Factors

• Substance use: Ask about tobacco, alcohol, and recreational drug use 1, 4
• Occupational exposures: Inquire about work-related exposures that may contribute to symptoms 1, 3
• Home environment: Assess living conditions that might impact health 1, 4
• Social support: Identify support systems and resources available to the patient 4, 3
• Sexual history: When relevant, ask about sexual practices and partners in a non-judgmental manner 1

Family History

• Relevant hereditary conditions: Ask about family history of conditions related to the presenting complaint 1, 4
• Age of onset: Document the age at which family members developed relevant conditions 1, 4

Interview Techniques to Enhance Information Gathering

• Begin with open-ended questions: Start with questions like "Tell me about your symptoms" to allow patients to express concerns freely 5
• Follow with focused questions: Use targeted questions to clarify specific aspects of symptoms 3, 5
• Use timeline-based format: Structure the interview chronologically to improve understanding of symptom progression 2
• Avoid interruptions: Allow patients to complete their thoughts before asking follow-up questions 5
• Validate concerns: Acknowledge the patient's experience to build rapport 3, 6

Special Considerations for Specific Populations

• Elderly patients: Pay particular attention to functional status, cognitive function, and fall risk 4, 3
• Patients with chronic conditions: Focus on changes from baseline and disease-specific symptoms 1
• Patients with communication barriers: Use appropriate communication aids or interpreters as needed 4, 3

Documentation Best Practices

• Organize information chronologically: Present information in a timeline format to improve clarity 2
• Use patient's own words: Include direct quotes when they provide insight into the patient's experience 6
• Document pertinent negatives: Record important symptoms that are absent 1, 3
• Avoid medical jargon: Use clear language that can be understood by other providers 7, 2

By systematically addressing these components during the HPI, clinicians can gather comprehensive information that facilitates accurate diagnosis, appropriate treatment planning, and effective communication with patients and other healthcare providers.