A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication

We evaluated the impact of using a structured, timeline-based format, the Chronology of Present Illness, to guide the initial patient interaction

Laura M. Mazer; Tina Storage; Sylvia Bereknyei; Jeffrey Chi; Kelley Skeff

2016

Scholarcy highlights

  • One of the first clinical skills taught in medical school is patient history-taking, a skill that directly impacts diagnosis, treatment, patient satisfaction, adherence, and overall health outcomes
  • A complete patient history can lead to a correct diagnosis in up to 75–80 % of patients, emphasizing the need to identify tools that can improve our practice of this key clinical skill
  • Residents reported increased patient satisfaction, describing in their comments that patients felt that a Chronology of Present Illness-oriented interview made it easier for them to tell their story, highlighting the potential to improve patient–physician communication
  • The open-ended comments in this study demonstrate that residents found the CPI to be a useful framework for each stage of the process, indicating that this structure can facilitate patient care through the entire patient interaction with the healthcare system
  • Future studies should investigate the direct impact of the CPI on patient satisfaction and diagnostic reasoning skills
  • This first study provides compelling initial evidence that the Chronology of Present Illness can improve the efficiency, clarity, and usefulness of the patient history, with potential benefits for provider communication, diagnostic reasoning, and patient satisfaction

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