December 1992

Why SOAP Is Good for the Medical Record?: Another View-Reply

Arch Intern Med. 1992;152(12):2511. doi:10.1001/archinte.1992.00400240121029

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In Reply.—  We thank Manning, Di Poala, Payne, and Singer for their comments. Their negative reactions to our proposal1 are not surprising. The problem-oriented medical record (POMR) has become something of a sacred cow in academic medicine. Proposals for substantive changes in the POMR are thus likely to elicit strong reactions. Lawrence Weed's original proposal for reform of the medical record also encountered vociferous objections.The medical record is already changing in subtle ways that few people are objecting to or even noticing. Much of the record now functions as an annotated bill prepared for third-party payers. This can have the chilling effect of making our patients appear sicker than they are, as physicians strive to add enough pathologies (and ICD-9 codes) to justify the hospital and physician services the patient is receiving. We need to think about ways to reclaim the chart for the patient.Calling what the

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