Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why I hate the SOAP note

Suzanne Koven, MD
Physician
November 19, 2012
Share
Tweet
Share

Medicine, 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.

Suzanne Koven is an internal medicine physician who blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50. 

Prev

Where are the tonsils and why would we take them out?

November 19, 2012 Kevin 1
…
Next

Cancer survivors are truly remarkable people

November 19, 2012 Kevin 2
…

Tagged as: Primary Care

Post navigation

< Previous Post
Where are the tonsils and why would we take them out?
Next Post >
Cancer survivors are truly remarkable people

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Suzanne Koven, MD

  • A hospital leader speaks out against the transgender military ban

    Suzanne Koven, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Don’t hesitate to talk to your doctor about work

    Suzanne Koven, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Patients should silence their phones in the exam room

    Suzanne Koven, MD

More in Physician

  • Why wanting more from your medical career is a sign of strength

    Maureen Gibbons, MD
  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • How inspiration and family stories shape our most meaningful moments

    Arthur Lazarus, MD, MBA
  • A day in the life of a WHO public health professional in Meghalaya, India

    Dr. Poulami Mazumder
  • Why women doctors are still mistaken for nurses

    Emma Fenske, DO
  • Adriana Smith’s story: a medical tragedy under heartbeat laws

    Nicole M. King, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How Gen Z is transforming mental health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Recent Posts

    • How Gen Z is transforming mental health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nurses aren’t eating their young — we’re starving the profession

      Adam J. Wickett, BSN, RN | Conditions
    • Why wanting more from your medical career is a sign of strength

      Maureen Gibbons, MD | Physician
    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How Gen Z is transforming mental health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Recent Posts

    • How Gen Z is transforming mental health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nurses aren’t eating their young — we’re starving the profession

      Adam J. Wickett, BSN, RN | Conditions
    • Why wanting more from your medical career is a sign of strength

      Maureen Gibbons, MD | Physician
    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why I hate the SOAP note
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...