The History of the Present Illness (HPI) is one of the first things we learn in medical school. It is the story of your symptoms. It is the way that we are taught to process information. When we are presenting hospitalized patients to the rest of the medical team on rounds, this is the format that we use. I have been surprised during my career that all physicians follow this same template, yet our patients have never heard of it. Wouldn’t it be beneficial for Wise Patients to understand how we look at your problems?  

The HPI starts with the chief complaint. It is the one liner that you use to tell us what is wrong. “My knee hurts”, “I get dizzy when I stand up “, “My legs are swollen.” With this one liner, I have already started creating a differential diagnosis in my mind. The rest of the HPI helps me to sort through the differential.

Usually, after I hear the chief complaint, I will say: “Tell me more.” I ask an open ended question so you can elaborate on your symptoms, but what I am looking for is this:

–When did it start?

–What were you doing when it started?

–Have you ever had this before?

–How many times has this happened since the first incident?

–How have your symptoms changed over time?

These first set of questions help me to establish a timeline. The next set of questions help me to understand the quality of your symptoms:

–Is it constant, or do your symptoms come and go?

-What makes it worse?

-What makes it better?

-If the symptom is pain, then I want to know if it is sharp, dull, burning, pressure etc

-How severe are your symptoms?

-When multiple symptoms are being discussed I want to know: Which symptom is the worst?

-Do your symptoms radiate anywhere?

The next set of questioning helps me to establish causation:

-Do you remember doing anything differently the day/week before or the day this started?

-Do you notice any other symptoms associated with this?

-Have you been around anyone that has been sick?

-Does anyone in your family have this as well?

And then I want to know about different things you have tried:

-Has anything worked well to treat this so far?

-Were there any treatments that you were interested in discussing with me today?

This is the template that a doctor’s brain is using as you are talking to him/her. When you follow the template, it gives us clarity, it keeps us from becoming distracted, and ultimately it helps us both to get to the right diagnosis.

Sometimes I will recommend my patients keep a journal of their symptoms so that when they come in to the office, it is easier for us to find this information. Office visits can be stressful and its very common for patients to forget the details about their symptoms. With all of our medical science and technology, perhaps hearing your story might not seem like a big deal. But it is. In fact, the way you tell me about your symptoms is the most important factor that I consider when deciding what tests to order and what diagnosis to give.

If you would like to read more about the history of the present illness, please explore the link below. This will take you to a page at the UCSD School of Medicine. The page is a guide for medical students learning how to interview patients.

https://meded.ucsd.edu/clinicalmed/history.htm

Getting ready for your doctor’s visit? Take a look at my other articles dedicated to visit preparation here.