What's your HPI style?

Discussion in 'Psychiatry' started by FlowRate, Apr 20, 2017 at 7:28 AM.

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  1. FlowRate

    FlowRate 7+ Year Member

    Oct 13, 2008
    I've noticed that a lot of people's HPI includes numerous verbatim quotes from the patient. My personal preference, however, is to generally summarize the content of the HPI, only providing quotations when they seem particularly illustrative/important. What's your style? Is there a generally accepted "best practice" here?
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  3. Shikima

    Shikima 10+ Year Member

    Oct 15, 2006
    I tend to do this too.
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  4. Blessthefall


    Sep 16, 2016
    Keep it relevant, detailed yet concise.
  5. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor 10+ Year Member

    Dec 2, 2004
    Left of Center
    Quote as much of the patient's own profanity as possible.
  6. Armadillos

    Armadillos 2+ Year Member

    Feb 5, 2013
    I'm generally much more in the summarization camp, but generally will have some short phrases quoted in there to highlight things. I hate reading huge paragraphs of direct quotes, we aren't court room stenographers, we get paid to gather then interpret information.

    Now something like the below seems like a perfectly acceptable use of quotes to drive a point home:

    Patient reports likely delusional belief that sister is stealing his money out of the bank and wants to "shoot the bitch".
  7. fpsychdoc


    Dec 18, 2015
    I like to run the HPI as descriptive and "objective" as possible, leaving my own spin on things to the MSA and the assessment; not necessarily using quotes but paraphrasing a lot and describing behavior. Of course you will have to pick and chose what you think is most relevant. It's probably not the most time efficient way but I also think it would be helpful for whoever is reading the HPI to perhaps come to their own conclusions, so I tend to leave impressions and judgements aside (for example you'd be surprised at what people like to describe as paranoid or delusional. It's not always as clear cut as we'd like to).
    sabine_psyd and MLT2MT2DO like this.
  8. Merovinge

    Merovinge 2+ Year Member

    Aug 9, 2012
    Numerous and long quotes in the HPI has a differential:
    1) Med student
    2) Over inclusive resident trying to impress people with notes
    3) Counter-transference to the patient
    4) Writer feels this case has high likelihood of going to court (not saying this helps, but an impression I get)
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  9. erg923

    erg923 Psychologist-VA 10+ Year Member

    Apr 6, 2007
    -Attempt to demonstrate suspected personality pathology?

    -Attempt to document resistance to or lack of engagement in treatment/treatment recommendations?
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  10. clausewitz2

    clausewitz2 7+ Year Member

    Oct 13, 2008
    I remember a guy who I felt could largely be summarized in two direct quotations far more powerfully and succinctly then I could ever devise.

    When asked about employment history: "Do I look like someone who has a job?"

    When asked about what he does to earn a living: "Criminal sh*t"
    Liquid8, singasongofjoy and Jules A like this.
  11. erg923

    erg923 Psychologist-VA 10+ Year Member

    Apr 6, 2007
    Boost that ****, bro!
  12. F0nzie

    F0nzie 5+ Year Member

    Aug 22, 2011
    Still following the words of my IM attending in medical school: "The HPI tells a story..."

    Sent from my iPhone using SDN mobile app
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  13. Shikima

    Shikima 10+ Year Member

    Oct 15, 2006
    I got into a fight with my mom and now I'm depressed.
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  14. thoffen

    thoffen Member 10+ Year Member

    Aug 14, 2006
    Quotes are often very illustrative of pathology that other words cannot capture. I.E. "patient states that he hears the voice of the Messiah telling him that he must 'kill all infidels'" is much more telling than "patient has hyper-religious command hallucinations to kill others".

    That said, people put way too much in the HPI and in particular the subjective portions of progress notes. Develop a really good one-liner (pertinent background and presenting complaint) and tell a brief story. Listing symptoms to me says very little.
  15. Shikima

    Shikima 10+ Year Member

    Oct 15, 2006
    I'm curious to what the S or HPI portion needs to contain for billing either a 90204/5 or 99213/4/5.

    Rest of the note appears to be comprehensive enough with modern EMRs, so I don't think this is an issue.
  16. smalltownpsych

    smalltownpsych 2+ Year Member

    With the ubiquitous sharing of medical records, I am getting more and more concise and vague in my intakes (that's what psychologists usually call them). Pt. reported that father sexually abused her from age 8 to 14 has become pt. reported childhood abuse. I am beginning to move toward only providing biographical information and the minimum of information to justify billing. Our patients' personal story is theirs to tell and it provides very little use to other caregivers. We might want to justify the communication of hx of substance abuse and especially abuse of prescription medications, but I could argue that it is not our role to police that either.
    Criticalfreeze, FlowRate and splik like this.

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