Learning how to write a ‘SOAP’ note feels different after an MS diagnosis
What it feels like going from observing patients to becoming one
Training to become a U.S. Army Special Forces medic included all the things you might expect, as well as some you might not. Although trauma was our primary focus, we also had to be well versed in routine medicine and have a working knowledge of other aspects of healthcare.
I expected this going in, but what caught me off guard was all the documentation that was required. Even at my level, everything had to be carefully and thoroughly documented because, as one instructor put it, “If you don’t write it down, it didn’t happen.”
A SOAP note — which stands for “Subjective, Objective, Assessment, and Plan” — is the standard protocol for documenting a patient encounter, so we wrote tons of practice ones for both real and imaginary patients. But I had briefly been an English major in college, which caused me to struggle a little at the beginning.
When grading my first SOAP note, the same instructor stared hard, first at the note and then at me.
“Under ‘Objective,’ you wrote, ‘Patient seems melancholy with a kind of wistful yearning for a youth long past,’” he barked.
“You said to describe the patient’s appearance,” I argued.
“You’re an idiot!” he shot back. “A very literate one, but an idiot nonetheless. I meant describe the patient medically, backed up by vital signs and physical findings. You know, objective things!”
With practice, I eventually improved and my notes no longer read like Victorian novels.
The tables are turned
Today, after multiple sclerosis (MS) forced me to retire long ago, I don’t write any more SOAP notes. Instead, I read what other healthcare providers write about me.
And the experience I have with the medical note-taking process is both a blessing and a curse. For example, when writing a SOAP note, the subjective part is what the patient tells you. One dictionary definition of “subjective” states that it’s “influenced by or based on personal beliefs or feelings, rather than based on facts.”
That hurts a little. I was diagnosed with MS a decade ago and started having symptoms almost a decade before that. At this point, how is anything I say subjective?
Well, it’s subjective because it’s based on my experiences, which, as I’m fond of saying, aren’t like anyone else’s. My daily life with MS varies widely, and my definition of “fine” has become very flexible. This is why a solid patient-provider relationship is so important. I’ve been seeing the same neurologists since the beginning of my MS journey, and even though my words are still subjective, I feel confident that they carry more weight than that. I try to never withhold information.
Yet with a new provider I’m seeing for the first time, I still have a tendency to downplay my medical information so that it seems more believable.
I also sometimes want my subjective comments to be identical to my doctor’s objective observations, but if that were the case, then it wouldn’t be objective anymore. Even if we switched bodies for a day, my neurologist’s experience with my symptoms would still be unique. Instead of seamlessly blending the subjective and objective observations, we’d just end up with two individual subjective experiences.
I still occasionally wish a provider could feel what I’m feeling so that I wouldn’t have to struggle with defining or quantifying it. In reality, though, I need that separation that objectivity provides. I’m glad the person most involved with my assessment and treatment plan doesn’t have MS, too. The detachment between my subjective experiences and their objective observations is what makes the “A” and “P” parts of SOAP uniquely mine.
I feel seen and believed by my doctor, and I’m aware of how fortunate I am because of it.
I have stated before that I feel “melancholic with a kind of wistful yearning for a youth long past,” but that never shows up in the notes. Nobody’s perfect, I guess.
Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to multiple sclerosis.
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Comments
David Claytor
Shouldn’t it be “a life long passed”?
Benjamin Hofmeister
Hi David!
I pondered that myself and had to look it up before I wrote it. I'm quoting from:
https://www.masterclass.com/articles/passed-vs-past
The words “past” and “passed” are homophones, which means they sound alike; however, they are different words that have different uses in the English language.
Past: The word “past” is primarily used as a noun that means "an earlier time." It can also be used as an adjective, adverb, or preposition—all of which are related to an earlier time.
Passed: The word “passed” is the past tense of the verb “pass.” When combined with the words "has" or "have," “passed” can also serve as the future participle or past participle of the verb “pass.”
Ah English! It doesn't borrow from other languages. It drags them into dark alleys, beats them unconscious and goes through their pockets for loose verbs.
Marti
Totally agree with you. Moments you wish your physician could experience your condition long enough to understand what is happening in your body and how to treat such symptoms, yet not wishing it upon another soul for fear of their ultimate reaction to such pain’s, or symptoms.
Thank you for you service. May your years with family and friends be blessed
Marti
Benjamin Hofmeister
Thank you Marti! If I could project any part of my MS on anyone, it would be fatigue. That one is impossible to explain.
Linda Safran
Beautifully written. I'm going to start being more poetic in my response to, "How do you feel?" At the least, it will get my health care providers' attention.
Benjamin Hofmeister
Let me know how it goes for you Linda. I usually just get narrowed eyes and a head shake.
Susan Payrovi
As a professional SOAP note writer, I loved this article. I’d never heard a patient’s perspective of this, so this was super enlightening! Due to recent rules now patients have access to their medical charts, which is definitely changed how I now write SOAP notes. actually intend for patients to read my notes as a way to better understand and follow their care plan. It’s a fun balancing act between informing patients, but also communicating technical medical information to other medical providers, who read SOAP notes to understand what other doctors are recommending. In fact, I know among us patients there’s a lot of dissatisfaction because we think our doctors don’t talk to each other. But a lot of that” talking” actually happens through SOAP notes. So next time you want your doctors to get on the same page, rather than saying, can you get on a call with my Dr. So-and-so (logistically very hard),just say would you mind reading Dr. So-and-so’s latest SOAP note? Thank you Ben for another wonderful article.
Benjamin Hofmeister
Wow thank you so much Dr. Payrovi! I realize that I'm in the very unique place of having both written SOAP notes and having access to ones written about me. More than once I've had to explain to someone who asked to see their notes and then had to ask for an explanation, that I didn't write the note for them, but for another provider. Hence all the abbreviations etc. It's a part of a medical record and of course you should have access to it, just understand that it's not an authorized biography.
I try not to and encourage others not to read a note about themselves as anything more than that.
Glenda Hendry
Wow! I have not thought about SOAP notes in decades! In nursing school in the 1980’s I used the SOAP format. No institution that employed me after graduation used that format. I think I blocked SOAP notes completely from my memory. I love, love, love your objective example. If I had been your instructor, I’d have given you an “A” just for literary flourish!
Benjamin Hofmeister
Thanks Glenda! I'm afraid my instructor just wasn't as understanding as you lol!
Heather Buckridge
Great article! I am a former RN now. I remember when I left bedside to outpatient care that you were told to never look up your own medical records. So of course a coworker and I looked up our records lol. We were both offended and outraged at how what we said was not always what was written. Now I notice that some of what I am advised to do doesn’t always end up in the notes. Since I have some cognitive impairment it’s crucial that I have those things in the notes so that I can look it up later. This happens even after I tell them that I need it written down or I will forget it. However, I do recognize that I nobody is perfect, and that I have the responsibility to do my share. So as soon as I get in my car or get home I check the notes, and if it’s not there I write it down and verbally tell my family. Thank you for writing about this subject, and infusing it with wit and humor.
Benjamin Hofmeister
Thanks for reading and commenting Heather!
I've always looked at any records available to me and have even more than once felt sorry for the poor guy I was reading about before remembering that it was me. I'm fortunate now that my wife goes with me to appointments and is my second set of eyes on everything.