Focus on the HPI – #meded

During my 37 years of inpatient internal medicine teaching, my style has evolved.  Periodically I try something and the feedback that I receive changes my standard style in a significant way.  Students and residents stimulated my recent focus on teaching the HPI. As educators we should first understand our goals.  Obviously, patient care trumps everything, but once that is accomplished we all want to help our learners grow.  Experienced and inexperienced educators quickly notice the student or intern who delivers smooth informative presentations.  A recent JAMA viewpoint addressed this issue – The Oral Case Presentation: A Key Tool for Assessment and Teaching in Competency-Based Medical Education The noted clinician educator (and my educational mentor) Dr. Kelley Skeff recently wrote about the HPI – Reassessing the HPI: The Chronology of Present Illness (CPI) Taking these two important articles into consideration I offer my own observations.  When we think about the HPI, any seasoned clinician will tell you that the HPI helps us answer and understand the patient’s concerns.  An excellent HPI often streamlines our clinical evaluation, decreasing imaging and focusing our laboratory testing. Dr. Phillip Tumulty in his famous NEJM essay – What Is a Clinician and What Does He Do? Philip A. Tumulty, M.D. N Engl J Med 1970; 283:20-24, July 2, 1970 (note to readers, in 1970 proper grammar used masculine pronouns only). He is meticulous in accumulatin...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs