History of the present illness (HPI)

The HPI includes details surrounding the chief complaint. This section is often split into two paragraphs as follows:

The first paragraph provides the immediate details surrounding the chief complaint, usually using information obtained from the patient. The first sentence often provides important demographic details about the patient and any relevant details about the past medical history, in addition to the chief complaint. For example:

"Mr. Smith is a 53-year-old Caucasian male with a history of hypertension, hyperlipidemia, diabetes, and smoking, who presents to the emergency room complaining of chest pain."

Regarding the rest of the paragraph, a first HPI paragraph usually contains the seven standard elements listed here. These seven elements tend to assume that the chief complaint is some type of pain; some chief complaints (for example, amenorrhea) require different sets of questions. The seven elements are summarized in the following table:

HPI element	Corresponding question	Example answer
Location	Where is the pain located?	The pain is left-sided and radiates to the left arm and back.
Quality	What does the pain feel like?	Patient reports a shooting, stabbing pain.
Severity	On a scale of 1-10, how bad is the pain?	Severity is 8/10.
Timing	Onset: When did the pain first start? Frequency: How often does the pain occur? Duration: How long are the pain episodes?	The current episode began half an hour ago. Episodes have occurred for a few months, following exercise, and for periods of up to 15-20 minutes.
Exacerbating Factors	What makes the pain worse?	Pain is exacerbated by exercise.
Alleviating Factors	What relieves the pain?	Pain is relieved by rest and weight loss.
Associated Symptoms	Do you notice any other symptoms when the pain is present?	Patient reports symptoms associated with dyspnea.

 

The second paragraph should contain all the previous medical care the patient has already received for their ailment. Typical questions include: Have they seen a physician already or been hospitalized previously? What labs and tests were performed? How well controlled are the patient’s medical conditions relevant to the chief complaint? Which treatments were previously tried? Is there a copy of the x-ray?