What is the purpose of the SOAP format?

[fanc2234]

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It seems to me the SOAP format for notes is inefficient and redundant. Why not just have a problem-based note and presentation structured in this way:
e.g.
1. A-fib
Hx: Onset in 2003. Continues to be well controlled. Patient denies any recent palpitations. HR 65 today. CHA2DS2VASc 3 for age and HTN.
Plan: Continue warfarin and metoprolol.

...and so on for each problem.

Instead, in the SOAP format you have to first put in the HPI: ‘Afib with onset in 2003, patient denies any recent palpitations’ and so on in both your HPI as well as assessment (since that is all anyone reads). It seems redundant.


Can someone explain the reasoning behind this or am I just doing this wrong? I find I am often repeating pertinent facts in both the HPI (because the patient told it to me subjectively) and Assessment for each problem (because it's important), is this necessary?

 

[Storph]

The reason for the SOAP format is to allow other physicians to read your information in an unbiased (less biased) way. First they get all the information the patient said in the HPI, then they get all the information in the PE. This allows them to come to their own conclusions before they read your assessment, which could influence the way they see the information presented by the HPI and PE. It's basically a way to track clinical logic in a reasonable order.

 

[sliceofbread136]

We put it in the SOAP order so everyone can skip to the A/P and not read any of the other useless crap we are forced to write

 

[ACSurgeon]

Billing.

 

[Celestia]

Some programs are moving to put A/P first in documentation. I don't particularly agree with that, although I do tend to skip to the A/P of consultants' notes because I figure I can get S and O on my own.

SO before AP is also how you do things in practice, you take a history, gather objective data, then make your assessment/plan. You don't have to be overly lengthy in the A/P in my opinion- if you find there is a lot of redundancy, you might want to get some feedback on items that belong more in SO or more in A. My guess from the example you gave is that you probably have stuff that doesn't need to go into A.

Assessment for Afib could be simply: paroxysmal Afib, Chads2 score X, continue abc meds/ Anticoagulation.

Onset and presence/absence of palpitations belongs elsewhere.

Everybody has a different style for their notes- you will figure it out.

Also- for your problem based Afib A/P you don't include the physical and ECG result. Will you divvy up different parts of your physical and ECG to the different problems? You may still repeat information in a problem based format. I like to think of the SOAP as a SOP to gather the information I need for MDM. The convention makes it easier for you to do it the same way every time as well as for other clinicians to know where to find the information they are looking for.

 

[DrBowtie]

It seems to me the SOAP format for notes is inefficient and redundant. Why not just have a problem-based note and presentation structured in this way:
e.g.
1. A-fib
Hx: Onset in 2003. Continues to be well controlled. Patient denies any recent palpitations. HR 65 today. CHA2DS2VASc 3 for age and HTN.
Plan: Continue warfarin and metoprolol.

...and so on for each problem.

Instead, in the SOAP format you have to first put in the HPI: ‘Afib with onset in 2003, patient denies any recent palpitations’ and so on in both your HPI as well as assessment (since that is all anyone reads). It seems redundant.


Can someone explain the reasoning behind this or am I just doing this wrong? I find I am often repeating pertinent facts in both the HPI (because the patient told it to me subjectively) and Assessment for each problem (because it's important), is this necessary?

For a stable problem unrelated to the chief complaint, I would not put it in the HPI.

 

[evilbooyaa]

It seems to me the SOAP format for notes is inefficient and redundant. Why not just have a problem-based note and presentation structured in this way:
e.g.
1. A-fib
Hx: Onset in 2003. Continues to be well controlled. Patient denies any recent palpitations. HR 65 today. CHA2DS2VASc 3 for age and HTN.
Plan: Continue warfarin and metoprolol.

...and so on for each problem.

Instead, in the SOAP format you have to first put in the HPI: ‘Afib with onset in 2003, patient denies any recent palpitations’ and so on in both your HPI as well as assessment (since that is all anyone reads). It seems redundant.


Can someone explain the reasoning behind this or am I just doing this wrong? I find I am often repeating pertinent facts in both the HPI (because the patient told it to me subjectively) and Assessment for each problem (because it's important), is this necessary?

No. If it's a long soap note you can sometimes have a one-sentence summary, but if it's a first one, you can usually skip the assessment and just put the plan. However, if you do that, then start the note with a one-liner about the patient so that you keep track of why they're here and what conditions are improving/worsening/stable.

Also, are we talking about SOAP notes or H&Ps? SOAPs don't have HPI.

 

[Celestia]

No. If it's a long soap note you can sometimes have a one-sentence summary, but if it's a first one, you can usually skip the assessment and just put the plan. However, if you do that, then start the note with a one-liner about the patient so that you keep track of why they're here and what conditions are improving/worsening/stable.

Also, are we talking about SOAP notes or H&Ps? SOAPs don't have HPI.

I was thinking that too, but my outpatient SOAP notes have an HPI- I usually call it an interim history. Whereas in hospital it's usually a very brief and focused 24hr ROS.

 

[mvenus929]

Your assessment is not a rehashing of the patient's problem list. It is a way for you to give your opinion on the patient's status. Do you think they are ill? Are they improving or are there no major changes? Is what we've done for them in the last 24 hours (for inpatient) or at the last visit (for outpatient) helping them or not? It is a place for you to discuss the differential diagnosis and explain the reasoning for why you think they have what they have.

In theory, the SOAP note provides all the pertinent information in a short summary. In practice, there is a lot of filler that is added for billing purposes that really isn't needed.