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Time to scrub SOAP notes

Posted by Dr. Suzanne Koven  October 10, 2012 09:53 AM

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soap.jpgMedicine, like law, the military, and many other professions, has its own language--a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.

Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients' understanding of their medical care. This article discusses the extent to which clinicians overestimate patients' "health literacy"--with potentially dangerous results.

But sometimes, medical lingo has a more subtle negative effect: it reinforces our false sense of being less human, less fallible than our patients.

Certain words and phrases, used commonly in the hospital and clinic, have always set my teeth on edge. One is using "male" and "female" to describe people, as if they were specimens rather than men and women. Another thing that gets on my nerves is referring to the patient unable to describe his symptoms clearly as "a poor historian." The "historian," as an old professor of mine used to point out, is the person who writes down what happened and interprets it: i.e. the doctor, not the patient.

But the convention I really hate is the SOAP note. "SOAP" stands for Subjective, Objective, Assessment, and Plan. It's the format often used for daily progress notes in a patient's hospital chart, taught to every medical and nursing student.

I'm okay with the "assessment" and "plan." It's the "subjective" and the "objective" I have trouble with. You see, the patient's experience ("I feel better" "I feel lousy" "I have chest pain") is assigned the "subjective" role, while the clinician's view is considered "objective."Are these designations fair? Are they accurate?

Take a patient I saw recently. She had a rubbery, marble-sized lump on one side of her neck. I knew, with certainty, that this lump was a benign lymph node, likely inflamed because of a minor skin or throat infection. She knew, with equal--perhaps even more--certainty, that the thing had popped up out of nowhere, that it hurt, and that her sister's cancer had started in exactly the same way.

My certainty was based in my knowledge of anatomy and physiology and my clinical experience. Her certainty was based on the sensations of her own body and on her life experience. Was either free of objectivity, or subjectivity?

Good medicine always involves a collaboration between the clinician's and patient's perspectives. But, as yet, there's no nifty acronym for that.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

Suzanne Koven, M.D. practices internal medicine at Massachusetts General Hospital in Boston. She writes a monthly column for the Globe's G Health section and her essays have appeared in the More »

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