Learning how to write a ‘SOAP’ note feels different after an MS diagnosis

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.

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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.