Psych H&P Question

[gschl1234]

Hi, our attending just told us that he wants us to email him an H&P every week with a "detailed formulary". He said he doesn't care if it's not detailed in the chart but that he wants to see it in the typed-up version. Can someone define "formulary" and explain what type of info is usually in it and the purpose/philosophy of having it in the H&P (i.e. how is it different from an assessment or plan)? Thanks!

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[whopper]

The exact medical definition from an online medical dictionary

http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=formulary

I think he means he wants exact medications used, not just the type or even the name. He may want very specific & detailed information such as the name of the med, the dosage, and the dosing schedule.

I'd also figure you'd throw this in the "plan" section.

This is of course only what I think he meant from what you said. You could ask him.

 

[Doc Samson]

Hi, our attending just told us that he wants us to email him an H&P every week with a "detailed formulary". He said he doesn't care if it's not detailed in the chart but that he wants to see it in the typed-up version. Can someone define "formulary" and explain what type of info is usually in it and the purpose/philosophy of having it in the H&P (i.e. how is it different from an assessment or plan)? Thanks!

Sure he didn't ask for a formulation?

 

[gschl1234]

Sure he didn't ask for a formulation?

Maybe that was it. What's a formulation?

 

[atsai3]

Maybe that was it. What's a formulation?

A case formulation is a narrative account in wich you try to explain the patient's current problems and situation. Not a restatement of the HPI, but rather a meaningful, integrated view of the patient and the factors you regard as the dominant occasion for the presenting complaint / hospital admission. The formulation is important because you use it as a basis for selecting treatment modalities rather than simply targeting symptoms one by one. In a way, the formulation is a set of flexible clinical hypotheses that can be tested and modified in light of new data obtained through the patient encounter. Your approach to the formulation will basically depend on your attending. Some like the biopsychosocial model (see Engel GL, "The need for a new medical model: a challenge for biomedicine", Science 1977;196:129-136) whereas others like the 3 P's (see Kline & Cameron, "I: Formulation", Can Psych Assoc J 1978;23:39-42), and some integrate both approaches in a way that makes the most coherent sense.

Cheers
-AT.