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Other Drug Use: Any drug use, past or present, should be noted. Get in the habit of asking all your patients these questions as it can be surprisingly difficult to accurately determine who is at risk strictly on the basis of appearance. Remind them that these questions are not meant to judge but rather to assist you in identifying risk factors for particular illnesses (e.g. HIV, hepatitis). In some cases, however, a patient will clearly indicate that they do not wish to discuss these issues. Respect their right to privacy and move on. Perhaps they will be more forthcoming at a later date.
Obstetric (where appropriate): Have they ever been pregnant? If so, how many times? What was the outcome of each pregnancy (e.g. full term delivery; spontaneous abortion; therapeutic abortion).
Sexual Activity: This is an uncomfortable line of questioning for many practitioners. However, it can provide important information and should be pursued. As with questions about substance abuse, your ability to determine on sight who is sexually active (and in what type of activity) is rather limited. By asking all of your patients these questions, the process will become less awkward. Do they participate in intercourse? With persons of the same or opposite sex? Are they involved in a stable relationship? Do they use condoms or other means of birth control? Married? Health of spouse? Divorced? Past sexually transmitted diseases? Do they have children? If so, are they healthy? Do they live with the patient?
Family History: In particular, you are searching for heritable illnesses among first or second degree relatives. Most common, at least in America, are coronary artery disease, diabetes and certain malignancies. Patients should be as specific as possible. "Heart disease," for example, includes valvular disorders, coronary artery disease and congenital abnormalities, of which only coronary disease has genetic implications. Find out the age of onset of the illnesses, as this has prognostic importance for the patient. For example, a father who had an MI at age 70 is not a marker of genetic predisposition while one who had a similar event at age 40 certainly would be. Also ask about any unusual illnesses among relatives, perhaps revealing evidence for rare genetic conditions.
Work/Hobbies/Other: What sort of work does the patient do? Have they always done the same thing? Do they enjoy it? If retired, what do they do to stay busy? Any hobbies? Participation in sports or other physical activity? Where are they from originally? These questions do not necessarily reveal information directly related to the patient's health. However, it is nice to know something non-medical about them. This may help improve the patient-physician bond and relay the sense that you care about them as a person. It also gives you something to refer back to during later visits, letting the patient know that you paid attention and really remember them.
In recounting their history, patient's frequently drop clues that suggest issues meriting further exploration. If, for example, they are taking anti-hypertensive or anti-anginal medications yet made no mention of cardiac disease, additional history taking would be in order. Furthermore, if at any time you uncover information relevant to the chief complaint don't be afraid to revisit the HPI.
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