Blog | Friday, July 28, 2017

Obtaining the HPI, a #meded opportunity

Recently our team was on call, and we had two early admissions. Fortunately for the team, we had a small census going into call and our patients were relatively stable. So instead for spending extra time rounding and teaching, we decided to see the two new patients as a group. We had each intern take the HPI and as they finished I supplemented their questions. Afterwards I gave them some tips on how to get a better history—immediate feedback.

Then after lunch we had one more admission. A student presented the story, and then I took the intern and two students to see the patient. This time I took the HPI as if I did not know the story.

Talking with the learners afterwards they all thought that both exercises were extremely valuable.

Obtaining the HPI is an important skill that too often I (and many other clinicians) take for granted. We need to witness our learners taking a history and then give them very specific critiques. But we also should role model excellent technique ourselves. One student said that seeing me take the history was very helpful, because he had never seen someone with my experience sit down and carefully take the history.

We should not assume that all learners understand how to get their best history. Since the HPI is so important, we need to help our learners present succinct complete histories. But we also should teach them how to take the history. This includes body language, reading the patient, and stressing details. We should understand that patients sometimes have different understanding of the words they use than what we hear.

I should do this more often.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.