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March 1992

Why SOAP Is Bad for the Medical Record

Author Affiliations

Medical Service Department of Veterans Affairs Edward Hines, Jr, Hospital Hines, IL 60141 and Department of Medicine Loyola University of Chicago Stritch School of Medicine Maywood, Ill; Department of Medicine University of Illinois at Chicago 840 S Wood St Chicago, Ill

Arch Intern Med. 1992;152(3):481-484. doi:10.1001/archinte.1992.00400150015004

Twenty-some years ago, Weed,1,2 Bjorn and Cross,3 and Hurst and Walker4 sought to revolutionize patient care, medical education, and clinical investigation with a new system of medical record keeping, the problem-oriented medical record (POMR). The revolution was more successful than most. Some of Weed's major reforms, those concerned with "problems" and "problem lists," endure throughout the United States. Unfortunately, the POMR also brought us SOAP.

SOAP, of course, is the acronym derived from the POMR's recipe for an initial note or a progress note about a problem: (1) subjective, (2) objective, (3) assessment, and (4) plans. Embedded in SOAP, therefore, is the important idea that clinical "data" (to use POMR lingo) are either subjective or objective.

THE CATEGORIES SUBJECTIVE AND OBJECTIVE  Weed said that he introduced the categories subjective and objective in order to distinguish one important source of clinical information (the patient) from other sources (the