Tips for IM Attendings – Chapter 15 – Teaching the HPI

Students (and interns and residents) provide important insights into their skills and understanding with their oral presentation of the history of present illness (HPI).  The history of present illness provides the key to diagnosis in a great majority of patients.  A recitation of the history of present illness shows us how the learner has thought through the patient’s problem and their skill at asking the best followup questions. Several years ago I heard this great description of the process of reporting the HPI.  The first paragraph recounts the patient’s story in depth.  This includes the patient’s chief complaint as well as the answers to questions that the interviewer has asked.  The first paragraph often contains relevant past medical history and medications. The second paragraph includes the answers to questions that flesh out the differential diagnosis.  The second paragraph anticipates the questions that the listener might ask. That framework starts our conversation.  As attending physicians we can use the HPI presentation to teach history taking, differential diagnosis, and the cognitive process. A common trope in medical education suggests that we should not interrupt the presenter.  Here I will agree and disagree.  At the end of the HPI we should stop the presentation and teach.  We have the opportunity to provide feedback and show provide that feedback immediately.  Delayed feedback does not work as well.  We should provide positive as well as ...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs