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ggparker14

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Can I please get other opinions on number of elements in this HPI?

Patient presents with psychiatric evaluation. Presents c/o hearing voices and wanting to hurt himself. No homicidal ideation. Also reports dry cough, rhinorrhea and wheezing. No chest Pain. No abdominal pain, back pain, leg pain, arm or leg weakness, edem. No dyspnea on exertion.

Thanks for any help.
 
I agree with Hearing Voices as - Psych or Ear - Location and Chief Complaint and then wanting to hurt self as either severity/context, what about homicidal ideation as severity/associated signs-symptoms. Also dry cough - quality. Rhinorrea and wheezing could also be associated signs or symptoms also.

We might be able to stretch to four. I would educate the provider that a patient isn't probably going to say "I have homicidal ideation" but rather "I feel like killing someone" would be the best way to record the information.
 
Stretch to 4

This is one of those cases where counting HPI elements is almost funny. Does a person really hear delusional voices in their ear? Pretty sure any shrink would tell you the ear has nothing to do with it, but I guess "in their head" is almost the same thing. In terms of feedback to the doc I'd suggest they ask are the voices angry, when do you hear them...often Schizophrenics or other delusion patients hear voices when stressed; what relives it, listening to music or whatever. I think an ED doc can get to 4 HPI elements with a psych patient but has to get a bit more specific/creative.

As to the dry cough etc. Are they really associated with the PP? I'll use anything I can get, but I'm not sure if they would hold up.

Jim
 
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