The History of Present Illness (HPI) is the fundamental narrative a medical professional gathers from a patient regarding their current health complaint. It is a detailed, chronological description of the specific issue that prompted the medical visit, beginning from the first sign or symptom up to the present encounter. This process is the initial and most personal part of any clinical evaluation, translating a patient’s vague concern into a structured, medically useful report. The HPI is the story of the patient’s illness as told by them, which then forms the basis for all subsequent diagnostic and therapeutic decisions. It is the starting point from which the healthcare team begins to understand the context and evolution of the patient’s problem.
Purpose and Scope of the HPI
The primary goal of compiling the History of Present Illness is to transform a general reason for a visit, known as the chief complaint, into a precise clinical picture. For instance, the complaint “I have a stomach ache” is too broad for diagnosis; the HPI refines this into a specific set of details about the symptom’s characteristics and progression. This narrative structure establishes the boundaries and context of the current problem. By organizing the symptoms chronologically, the HPI allows clinicians to track the development of the illness and identify potential triggers or patterns. This detailed recounting helps focus the physical examination and guides the initial formulation of diagnostic possibilities.
The Standardized Elements of the HPI
To ensure all pertinent information is captured, medical professionals rely on a set of standardized elements, often remembered through mnemonics like OLDCARTS. These elements structure the patient interview to systematically characterize the complaint. A brief HPI consists of documenting one to three of these elements, while an extended HPI requires at least four elements to be fully detailed.
Key Elements of the HPI
- Onset: Determines precisely when the symptoms began and what the patient was doing at that time, establishing a timeline for the illness.
- Location: Refers to the exact place on the body where the symptom is felt, and for pain, this may also include whether it radiates to other areas.
- Quality: Describes the subjective nature of the symptom, such as whether pain is sharp, dull, burning, or throbbing.
- Severity: Quantifies the symptom’s intensity, commonly using a 1-10 scale for pain, or classifying it as mild, moderate, or severe.
- Duration: Notes how long each individual episode of the symptom lasts.
- Timing: Describes the frequency and pattern of the occurrence, such as constant, intermittent, or worse at a specific time of day.
- Modifying Factors: Identified by asking what makes the symptom better (alleviating) or worse (aggravating), which often provides clues about the nature of the condition.
- Associated Signs and Symptoms: Documents any other related complaints that occur with the primary problem, such as fever accompanying a cough.
This structured approach ensures a comprehensive collection of subjective data, which is the foundation for clinical reasoning.
HPI’s Role in Diagnosis and Treatment Planning
The comprehensive HPI serves as the intellectual map for the clinician, allowing for the construction of a differential diagnosis, which is a list of potential conditions that could explain the patient’s symptoms. By analyzing the patterns and details provided in the HPI, the clinician can rapidly narrow down the possibilities from a vast array of medical conditions. A thorough history, of which the HPI is the core, can lead to the correct diagnosis in a significant percentage of cases.
The information gathered directly informs the subsequent steps in the patient’s care, including the targeted physical examination and the selection of diagnostic tests. For example, a description of chest pain that worsens with deep breathing guides the physician to focus the exam on the lungs and chest wall, potentially leading to specific X-rays or lab work. The HPI also dictates the urgency and type of initial treatment, as the severity and timing elements help determine whether the condition requires immediate intervention.
HPI Versus Other Types of Patient History
The History of Present Illness is only one component of a complete patient history, and its distinction lies in its focused scope on the current, acute problem. It is strictly concerned with the development and characteristics of the chief complaint.
This differs significantly from the Past Medical History (PMH), which is a broad record of the patient’s health before the current illness began, including chronic conditions, prior surgeries, medications, and allergies.
The HPI must also be separated from the Review of Systems (ROS), even though both collect information about symptoms. While the HPI is a deep exploration of the few symptoms related to the primary problem, the ROS is a systematic, head-to-toe inventory of symptoms across all major organ systems. The ROS often uncovers symptoms unrelated to the chief complaint, such as a patient presenting with a sprained ankle being asked about their cardiovascular or gastrointestinal health. The HPI provides the focused narrative, while the PMH and ROS provide the necessary background and context of the patient’s overall health status.