The HPI: A Timeline, Not a Time Machine

Abstract

In presenting the history of present illness (HPI), an accurate timeline is essential. Physicians from Hippocrates onward have used timelines to describe the natural history of disease. Lawrence Weed, who developed the problem-oriented medical record, championed the use of timelines and flow sheets to document clinical data and provide the best possible care. Case reports, which use timelines, graphs, and tables to reveal the interrelatedness of events, can be useful models for student case presentations. Medical students should think of the timeline as an “origin story” for the chief complaint and trace back to the true onset of the problem. This approach helps students to see the big picture and understand the context of the illness in the patient’s life. Medical students should sketch out a timeline for every patient they see, keep the oral presentation linear and focused, and use clinical flow sheets to spot important trends early and monitor the effects of treatment.