SOAP: Apply, Rinse, and Repeat

05 May SOAP: Apply, Rinse, and Repeat

1. A cleansing agent, manufactured in bars, granules, flakes, or liquid form, made from a mixture of the sodium salts of various fatty acids of natural oils and fats.
2. A process of medical evaluation and management which involves subjective, objective, assessment, and plan components.
3. Slang. Money, especially that which is used for bribery.

I have my 10 year Medical School reunion this year. It is hard to imaging that 10 years have flown by since those halcyon days at the University of Utah. Ahhh, the memories: the incredible pervasiveness of the anatomy lab smell, the 12 hour study sessions in the library, the all night test preparation, the 12 hour study sessions, the incredible pathetic instruction (I eventually completely bailed on going to class), getting introduced to the pharmaceutical pimps, the 12 hour study sessions, passing boards, starting on the wards, proud of my white coat, completely embarrassed that I was but a shell of limited knowledge within the white coat, completely arrogant attendings, even more arrogant residents, cool patients, amazing medical science, powerless medical science, trying to figure out what specialty to go into (what respectable student would “settle” for primary care), spending 5 weeks in Palau, passing Step II, match day, and ultimately graduation day. Whew – memory lane.

In reminiscing, many of the most memorable experiences were the many bizarre and absurd situations you find yourself in. One of those, involved SOAP and learning how to do the physical exam from a legendary figure named Bruce (the latter half of the story can only be shared in person).

For the medically inclined, SOAP stands for a simple paradigm of the medical thought process encapsulated in the daily note you make on patients when you “round” in the hospital. SOAP stands for Subjective, Objective, Assessment, and Plan. It is used daily, by millions of providers, as a simple way to think about the care process. First, you take a Subjective history; typically writing down the exact words that the patient uses to describe their “Chief Complaint”. It is subjective because it is what the patient perceives, experiences, or the manner in which they relate or describe their situation. Next, you perform an Objective physical exam. This is the concrete stuff that you can personally observe, elicit, palpate, or document in some hard, reproducible way. Based on the above, you develop an Assessment of the situation. The Assessment is where the diagnosticians can pontificate and conjecture on the theory behind the illness (and where the surgeons write, “Doing well” regardless of the clinical situation). Based on this, a clinical care Plan is created for the patient from which the team continues to manage patient’s care (and the surgeons write “DC with +BS” [discharge with bowel sounds]). SOAP – short, simple, and systemic way providers think about the daily management of their patients.

Turns out that SOAP has broader implications. As you consider many of the new services being promoted or benefit designs being developed, SOAP provides an excellent framework and sturdy foundation from which to create a health, wellness, or prevention plan. In fact, if you review the materials being created by groups like US Preventive Medicine, they are following the SOAP format to a T as part of their “Prevention Plan“.

USPM is helping people to complete a Subjective evaluation in the form of a Health Risk Assessment. Patients fill out a comprehensive evaluation of their health status, including socio-economic, behavioral, and family/social histories. This is patient generated content and therefore it has an appropriate, but not preeminent place in the medical context. Next, they complete a battery of health and wellness laboratory tests (Assessment) to establish a health status baseline. These tests, and the testing process, form a critical part of the overall evaluation. The patients then undergo a full physical exam to obtain the Objective data that USPM providers will need to create a personalized Prevention Plan.

By using the SOAP approach – USPM is creating a simple and systematic way to engage their patients in a iterative process of evaluation / re-evaluation that fits well into a managed prevention plan – a great concept that I have noted before. By having a solid prevention Plan in place, and adjusting as new SOA information becomes avaiable, an individual can modify their behaviors to ensure a “clean” bill of health.