This is a well-organized full elaboration (analysis) of the major symptoms from the start of disease (onset) until the time of presentation to doctor

  • Site
  • Onset ---- duration
  • Course
  • Character/ Quality
  • Region/Radiation
  • Provocative & palliative factors
  • Time
  • Severity
  • Associated symptoms
  • Review of concern system

Each symptom should be analysed (in a separate paragraph) according to the following characteristics:

  • Identifying the major body system(s) involved: ask about and analyze its (their) main symptoms that are not mentioned by the patient.

  • This is different from ‘Review of System’ which includes systems not involved in the current illness.

An example to illustrate a proper HPI: myocardial infarction

Mr X complain of chest pain (symptom), mainly in the retrosternal area (site), felt also in the arm and chin (referral), of 40 minutes (duration), was severe 9/10 (severity), brought out by exertion and relieved by sublingual tablets (aggravating and relieving factors), the patient  also complained of sweating and SOB (relevant symptoms).

Guidelines for a proper HPI

  • Initially, let the patient talk freely about his problems by asking him an open question to describe his problem since the start.

  • Then, open and specific questions can be asked to have more details about important and relevant aspects of the patient’s problem, e.g. what colour of vomitus?, what degree of effort causes SOB?

  • Avoid leading questions that suggest the answer (e.g. Tell me about your sleep instead of do sleep well)

  • Focus on the main problem, without wasting time on unhelpful and irrelevant details.

  • Make sure you understand what the patient is describing, especially in regard to controversial symptoms such as syncope, dizziness…etc

  • Negative answers may sometimes be very important; e.g. absence of fever in a patent with swollen leg may exclude cellulitis. So it is important to ask about and record relevant symptoms

  • In a lengthy HPI, summarise the essential points from time to time, so as not to forget any point, and to ensure understanding of the patient’s story.