History of Present Illness (HPI)

The HPI provides information about the patient’s chief complaint (CC). A thorough HPI includes:

1. Statement of general health before illness: "How had you been feeling before this problem started?"
2. Date of onset: "When did this start?"
3. Characteristics at onset: "What was it like when this started?"
4. Severity of symptoms: "How would you rate the pain on a scale of 1 to 10, with 10 being the worst?"
5. Course since onset: "How often does the attack or pain occur?" (Once only, daily, intermittently, continuously) and "Have the symptoms changed since the first attack?"
6. Associated signs and symptoms: "Have you noticed any other changes in your health or the way you feel?"
7. Aggravating or relieving factors: "Is there anything that seems to make you feel better or worse? Do you feel better or worse at certain times of the day?"
8. Effect on activities: "Has this stopped you from going to work or kept you awake?"
9. Treatments tried and results: "Have you taken any medications or tried any treatments?" If so, "What happened when you took the medication or after the treatment?"

In addition, it is helpful to ask:

• "What do you think caused this problem?" The patient may actually know the cause but hesitate to reveal it for numerous reasons; for example, he or she may have feelings of guilt regarding the cause of illness.
• "Is anyone else in the household sick?" The answer to this question may give clues to infectious illnesses or reveal information related to stressors that may have contributed to the patient’s condition.

If the patient is a child, it is especially important to ask about the following, all of which are usually negatively affected by illness:

1. Play
2. Sleep
3. Food and fluid intake