What HPI Stands For
HPI stands for History of Present Illness, which is the cornerstone of medical diagnosis and represents the narrative account of a patient's principal symptoms and their impact on daily function. 1
Definition and Core Purpose
History of Present Illness (HPI) is the portion of the clinical evaluation that documents why the patient is seeking medical care, whether for an initial visit or follow-up after observation or intervention. 1
The HPI serves as:
- The foundation for medical diagnosis across all specialties, providing a comprehensive description of the patient's principal cognitive, behavioral, or physical symptoms and their impact on daily function, interpersonal relationships, and comportment. 1
- The driver of clinical decision-making, as the content and degree of documentation in this section determines the remainder of the examination, assessment, and decision-making process. 1
Key Components of an Effective HPI
The HPI should systematically capture:
- Characterization of symptoms about which there is concern, including their nature, location, quality, severity, and associated features. 1
- Temporal progression, establishing the sequential order of onset, frequency, tempo, and nature of change over time. 1
- Contextual relationships between events and presenting symptoms, exploring plausible triggers or contextual features. 1
- Functional impact on activities of daily living, interpersonal relationships, personal and public health and safety, and the need for care partner support. 1
Critical Clinical Considerations
The HPI requires integration of information from multiple sources, particularly in conditions where patient insight may be impaired (such as cognitive disorders), making informant interviews essential for accurate diagnosis. 1
Common pitfalls to avoid:
- In the era of electronic medical records with templates and checkboxes, the artful elicitation of the HPI remains an interactive exercise requiring spontaneity and nimble redirection rather than rigid adherence to forms. 1
- Approximately 80% of medical conditions can be diagnosed by taking a thorough HPI, making its quality critical to diagnostic accuracy. 2
- The HPI should be distinguished from other history components (past medical history, family history, social history) as it focuses specifically on the current presenting illness. 1