Clinical Framework: PQRSTU
PQRSTU is a six-dimension HPI framework used as an alternative or complement to OLDCARTS. Its distinctive feature is the "U" dimension — Understanding — which captures what the patient believes is causing their symptom. Health beliefs directly affect treatment adherence, patient education planning, and therapeutic communication. PQRSTU is widely used in nursing education and is explicitly named in the WGU D443 health history content alongside OLDCARTS. Use this tool to guide and document a structured history of present illness; the generated summary can be used for documentation practice.
PQRSTU — History of Present Illness Framework
An alternative six-dimension HPI mnemonic emphasising the patient's subjective understanding of their condition. PQRSTU covers Provocation/Palliation, Quality, Region/Radiation, Severity, Timing, and Understanding. The "U" dimension — what the patient believes is causing the symptom — surfaces health beliefs that directly affect treatment adherence and education planning. Use as an alternative to OLDCARTS or to supplement it when patient understanding is clinically relevant.
PQRSTU dimensions
P
Provocation / Palliation
What makes it worse or better?
Q
Quality
What does it feel like?
R
Region / Radiation
Where is it? Does it spread?
S
Severity
How intense is it? (0–10)
T
Timing
When? How long? Constant or intermittent?
U
Understanding
What do you think is causing this?
HPI Documentation (PQRSTU format)