Wiki HPI Bullets Question

[MJ4ever]

Need clarification of bullets for the HPI please.

If a patient comes in for knee pain, how many bullets do you count for this??

Would you consider pain under associating sign and symptom?

I was under the impression that associated signs and symptoms would be anything in addition to the current problem, for example, if the patient had swelling or fever in addition to the knee pain.

I feel it should be only one bullet for the location.

Thanks so much,

Barb

 

[btadlock1]

Need clarification of bullets for the HPI please.

If a patient comes in for knee pain, how many bullets do you count for this??

Would you consider pain under associating sign and symptom?

I was under the impression that associated signs and symptoms would be anything in addition to the current problem, for example, if the patient had swelling or fever in addition to the knee pain.

I feel it should be only one bullet for the location.

Thanks so much,

Barb

I believe that you are correct. That would only be location. Associated signs/symptoms are problems that help to identify the underlying condition responsible for the Chief Complaint, such as fever, swelling, etc.

 

[MJ4ever]

Thanks Brandi.

I've read the 1997 guidelines but it doesn't specifically give me an answer to not use pain as an associated sign or symptom if it is the chief complaint.

Do you happen to know where I can find the official guideline for this?

Thanks,

Barbara

 

[btadlock1]

Thanks Brandi.

I've read the 1997 guidelines but it doesn't specifically give me an answer to not use pain as an associated sign or symptom if it is the chief complaint.

Do you happen to know where I can find the official guideline for this?

Thanks,

Barbara

I don't know of one, but that doesn't mean there's not one. I view each of the HPI elements as trying to fulfill a specific purpose, in relation to the chief complaint (it helps them make more sense to me). The goal of the HPI elements is to paint a picture of the nature and severity of the patient's presenting problem, to give the doctor a theory about the patient's diagnosis, which he can test through his exam and using diagnostic tests, if needed. Assoc. Signs/symptoms role in all of this, is to provide other symptoms that are usually associated with the presenting problem, to narrow down the number of conditions that typically present with the same symptoms. They're not stand-alone chief complaints; just tag-along issues. Pain could be the chief complaint or an associated sign/symptom, depending on the context of the note. The example you had shows pain as a chief complaint, and knee as the location. But if the note said:

Chief complaint: Broken Arm
Patient presents with broken left arm. Fell off bicycle this afternoon. Patient experiencing pain, swelling, and bruising at break site.

Pain, swelling, and bruising are associated signs/symptoms. Since you know that the underlying problem is the cause of the signs/symptoms, and they're not indicators of a second, unrelated problem, they are associated symptoms, and not additional chief complaint(s).

Just an example of how it can go either way...I think you've got a pretty good grasp on the issue, though. Stay confident!

 

[MJ4ever]

Thanks Brandi