Pay Attention to Your Format - The Writing Exercise

In the spirit of active learning, I’m posting another sample exercise. Actively implementing a concept solidifies your understanding of it better than passively reading about it.

This post will focus on how to format a chart to make it easier to read. We discussed this in an earlier post: Pay Attention to Your Format.

Like the previous post, Omit Needless Words - The Writing Exercise, this will be a good exercise to solidify a writing concept.

There are 2 basic concepts to remember with formatting your chart:

            1. separate different ideas

2. lump similar ideas together

Remember that this functionally means use paragraphs.

As in the previous exercise blog, you will:

1.       Copy and paste the HPI onto the format of your choice

2.       Make paragraphs

3.       Compare to the “answers” at the end.

As with the Omit Needless Words exercise, there may be more than one way to format the sample, fictional HPI. Remember that this is more closely related to the art of medicine than the science of medicine. As in clinical medicine, often we have more than one reasonable way to address a problem.

Please pass this on to colleagues, residents, medical students, PA students, NP students, and scribes. I think many people will find these exercises useful to sharpen the clarity of their charting.

The Sample HPI:

56 year old male with a history of gastritis, HTN, and cholecystectomy. Takes PPI daily. He comes in with 3 days of nausea, vomiting, diarrhea, and epigastric pain. No blood in his diarrhea. About 3 episodes of diarrhea daily. Small streaks of blood in his vomitus today. About 6 episodes of vomiting daily. Symptoms started after eating fried fish. Mild, transient improvement after taking his PPI. Has poor appetite, generalized weakness, dizziness on standing, and generalized body aches. No fever, runny nose, nasal congestion,  headache, dysuria, skin color changes, chest pain, cough, syncope, or episodes of confusion.

One possible answer:

56 year old male with a history of gastritis, HTN, and cholecystectomy. Takes PPI daily.

He comes in with 3 days of nausea, vomiting, diarrhea, and epigastric pain. No blood in his diarrhea. About 3 episodes of diarrhea daily. Small streaks of blood in his vomitus today. About 6 episodes of vomiting daily. Symptoms started after eating fried fish.

Mild, transient improvement after taking his PPI.

Has poor appetite, generalized weakness, dizziness on standing, and generalized body aches.

No fever, runny nose, nasal congestion,  headache, dysuria, skin color changes, chest pain, cough, syncope, or episodes of confusion.

With this answer, I’ve made different sections to this HPI separating his medical history, presenting symptoms, inciting factor, positive ROS, and negative ROS. Each section communicates separate, aspects of the history. When your readers see a different section, they know that you are going to talk about a different aspect of the case.

Another possible answer:

56 year old male with a history of gastritis, HTN, and cholecystectomy. Takes PPI daily.

He comes in with 3 days of nausea, vomiting, diarrhea, and epigastric pain.

Small streaks of blood in his vomitus today. About 6 episodes of vomiting daily. No blood in his diarrhea. About 3 episodes of diarrhea daily. Has poor appetite, generalized weakness, dizziness on standing, and generalized body aches.

Symptoms started after eating fried fish. Mild, transient improvement after taking his PPI.

No fever, runny nose, nasal congestion,  headache, dysuria, skin color changes, chest pain, cough, syncope, or episodes of confusion.

With this possible answer, I’ve re-arranged some of the sentences. I’ve grouped the further description of the GI symptoms with the positive ROS, to illustrate the severity of the symptoms. I’ve grouped inciting and improving factors into one separate section. Finally, I’ve separated the negative ROS information.

I hope you found this a useful exercise to sharpen your chart writing.

To learn more about clarity in writing your own medical charts, please check out other posts on this blog, and my book, The Handbook of Medical Charting.