The History of Present Illness (HPI) is the detailed, chronological narrative a patient provides about their main health concern. It is a structured account of the development and specifics of the current problem from the first sign to the present moment. The information gathered forms the foundation for the entire diagnostic process. By focusing the conversation on the central complaint, the HPI allows clinicians to begin generating and refining potential causes for the patient’s illness. This subjective, patient-reported history is crucial for determining the correct diagnosis.
Defining the History of Present Illness
The primary function of the HPI is to create a focused, organized context around the patient’s chief complaint. It transforms a simple statement, like “I have a headache,” into a comprehensive clinical picture that guides the subsequent examination and testing. This narrative context is derived entirely from the patient’s subjective experience, or from a caregiver if the patient cannot speak for themselves.
Healthcare professionals prioritize this detailed information because it allows them to efficiently narrow the list of possible conditions, known as the differential diagnosis. By asking specific, targeted questions, the clinician acts as a medical detective, using the patient’s answers to rule out improbable diagnoses. A precise and thorough history alone can lead to the correct diagnosis in a large percentage of cases, connecting the patient’s symptoms to a potential underlying cause.
Essential Elements of the HPI
To ensure the patient’s story is complete and clinically useful, the HPI systematically explores several distinct elements of the complaint. Gathering this information helps to create a precise profile of the illness necessary for accurate documentation and clinical decision-making.
- Onset: Establishes the specific date or time the symptom first appeared and whether its start was sudden or gradual.
- Location: Specifies the exact area of the body where the symptom is felt.
- Character: Describes the sensation itself using terms like “sharp,” “dull,” or “throbbing.” Different types of sensations often point toward different physiological causes.
- Severity: Measures the intensity of the symptom, often quantified by a pain scale (zero to ten) or by how much the problem interferes with daily activities.
- Timing: Clarifies the pattern of the symptom, determining if it is constant, intermittent, or occurs only at certain times. The pattern helps determine if the condition is stable, improving, or worsening.
- Aggravating and Alleviating Factors: Identify what makes the symptom better or worse, such as taking medication, changing position, or eating a meal.
- Associated Signs and Symptoms: Include any other related issues the patient is experiencing, like fever, nausea, or light sensitivity, which provide additional diagnostic clues.
HPI Versus the Full Medical Record
The HPI is a focused, distinct component that contributes to the broader structure of the patient’s complete medical record. It is strictly concerned with the chronological story of the patient’s current illness or injury.
This focus distinguishes it from the Review of Systems (ROS), which is a comprehensive, system-by-system inventory of symptoms across the entire body. While the HPI is a deep dive into the main complaint, the ROS is a broader screening tool that asks about symptoms in areas not directly related to the chief complaint, such as vision changes or digestive issues.
The HPI also differs significantly from the Past Medical History (PMH), which documents all of the patient’s prior health information. The PMH includes past illnesses, surgeries, allergies, current medications, and relevant family history. In contrast to the HPI’s focus on the present, the PMH provides the backdrop of chronic conditions and historical events that may influence the current diagnosis and treatment plan.