A discussion about SOAP notes and presentations - a very common format for conveying information between healthcare professionals in the hospital setting.
As a Euro this is pretty interesting to see how this works in the US. There are a lot of steps here that we just don't do in my country and some of our notes can be quite short for uncomplicated patients. Usually the problem list is kept very up-to-date and it is seen as a given for the problem list to be known to understand the progress note. Even the "A" is often omitted unless something changes. So for example the entire progress note for a stable patient with pneumonia + decompensated heart failure might look something like this. S: - Pt feels better, Dyspnea improving, cough improving O: - Vitals okay, weight -1.0kg - Edema 2+ improving P: - CoAmoxi planned till 17.06.2024 - Torasemid reduced to 10mg 2-1-0-0 - Discharge planned early next week
Dr. Strong: could you do a video about being a hospitalist? You are probably in the best position for such a video, and I’m sure it’ll benefit to many. 😊
Dr. Strong: thank you so much! My son is in class 2025 and intends to be a hospitalist, and I’ll pass your video to him. He passed STEP1 and got good STEP2 CK score. He’s looking into doing an away rotation at Stanford IM.
A couple of thoughts. 1. Regarding the events of hospitalization model, certain services that I have been on utilize a separate hospital course section in the EMR for this, which can allow for the progress note to be shorter and only include true "overnight" events. 2. I still subscribe to the model of only documenting what you are billing for, which includes relevant labs. Having all labs that were ordered in the last 24 hours documented in the note and not interpreted to me seems medicolegally risky. Also, very interested in the EAP model of progress notes, which is something that I have not heard of either. Looking forward to that video when it comes out!
Thanks for the comment! >Regarding the events of hospitalization model, certain services that I have been on utilize a separate hospital course section in the EMR for this, which can allow for the progress note to be shorter and only include true "overnight" events. This is a great idea! And thus, of course our EMR does not have something like this. Or if it does, it's so buried in submenus that no one knows about it. >Having all labs that were ordered in the last 24 hours documented in the note and not interpreted to me seems medicolegally risky. IANAL, but I don't think you are protected by having an abnormal lab result normally requiring intervention to be excluded from your documentation, with the exception that it may be more difficult for a third party to realize what happened in the event of a medical error. Regardless, the EAP note avoids this issue by usually not having any labs autopopulated into the note at all (at least for now, until AI figures out how to do this accurately).
@@StrongMed I guess what I meant with regards to the labs was that the expectation is that any abnormal lab should be commented on in the note and the comment should also include what actions are being taken to correct abnormalities associated with that lab. My contention was with, as you mentioned, whole reams of auto populated labs where an abnormality can easily be missed, particularly in a BMP that is mindlessly carried over daily, or a lab that is not auto populated that has to be kept updated.
Very interesting subject. Important information can be surprisingly hard to find. Sometimes because it isn't documented, but surprisingly often because the important information drowns in a sea of irrelevant things. This leads to a lot of unnecessary work and effort at best, and in the worst cases to patient harm. On another topic: I've been watching the series on mechanical ventilation. As always, great lectures! Though I couldn't find the twelfth lecture, which is supposed to cover troubleshooting vents, and how to approach the ventilated patient in acute respiratory distress. Is this lecture missing?
Thanks for the comment! Regarding the mechanical ventilation series, I worked on those videos over such a prolonged period that the management of vents moved out of the scope of my clinical practice, and I could no longer guarantee that what I was posting was based on the best available evidence and standard of care. So unfortunately, the last few videos never got made.
@@StrongMed Very understandable. Do you still frequently use CPAP/NIV in your practice, and would be willing to do a lecture on how to troubleshoot, titrate, and help patients tolerate these treatment modalities?
This man is a national treasure to all doctors and we don't deserve him.
As a Euro this is pretty interesting to see how this works in the US. There are a lot of steps here that we just don't do in my country and some of our notes can be quite short for uncomplicated patients. Usually the problem list is kept very up-to-date and it is seen as a given for the problem list to be known to understand the progress note. Even the "A" is often omitted unless something changes. So for example the entire progress note for a stable patient with pneumonia + decompensated heart failure might look something like this.
S:
- Pt feels better, Dyspnea improving, cough improving
O:
- Vitals okay, weight -1.0kg
- Edema 2+ improving
P:
- CoAmoxi planned till 17.06.2024
- Torasemid reduced to 10mg 2-1-0-0
- Discharge planned early next week
Looking forward for more content like this! Thanks Dr Strong
Woohoooo new video ✨✨✨
Thanks! ❤❤ end all poverty and disease!
عيد مبااارك
عل الاقل حاجة نعقب بها عشوة العيد الثقيلة ❤
Dr. Strong: could you do a video about being a hospitalist? You are probably in the best position for such a video, and I’m sure it’ll benefit to many. 😊
You're in luck! I have one already: czcams.com/video/4ZGDP_E6oqs/video.html
Dr. Strong: thank you so much! My son is in class 2025 and intends to be a hospitalist, and I’ll pass your video to him. He passed STEP1 and got good STEP2 CK score. He’s looking into doing an away rotation at Stanford IM.
A couple of thoughts. 1. Regarding the events of hospitalization model, certain services that I have been on utilize a separate hospital course section in the EMR for this, which can allow for the progress note to be shorter and only include true "overnight" events. 2. I still subscribe to the model of only documenting what you are billing for, which includes relevant labs. Having all labs that were ordered in the last 24 hours documented in the note and not interpreted to me seems medicolegally risky.
Also, very interested in the EAP model of progress notes, which is something that I have not heard of either. Looking forward to that video when it comes out!
Thanks for the comment!
>Regarding the events of hospitalization model, certain services that I have been on utilize a separate hospital course section in the EMR for this, which can allow for the progress note to be shorter and only include true "overnight" events.
This is a great idea! And thus, of course our EMR does not have something like this. Or if it does, it's so buried in submenus that no one knows about it.
>Having all labs that were ordered in the last 24 hours documented in the note and not interpreted to me seems medicolegally risky.
IANAL, but I don't think you are protected by having an abnormal lab result normally requiring intervention to be excluded from your documentation, with the exception that it may be more difficult for a third party to realize what happened in the event of a medical error. Regardless, the EAP note avoids this issue by usually not having any labs autopopulated into the note at all (at least for now, until AI figures out how to do this accurately).
@@StrongMed I guess what I meant with regards to the labs was that the expectation is that any abnormal lab should be commented on in the note and the comment should also include what actions are being taken to correct abnormalities associated with that lab. My contention was with, as you mentioned, whole reams of auto populated labs where an abnormality can easily be missed, particularly in a BMP that is mindlessly carried over daily, or a lab that is not auto populated that has to be kept updated.
damn, i wish i found your channel earlier😢 my medical clerkship would be wonderful
Wake up babe new Dr. Strong Venn diagrams
Thanks 🙏 ❤
Thanks
Very interesting subject. Important information can be surprisingly hard to find. Sometimes because it isn't documented, but surprisingly often because the important information drowns in a sea of irrelevant things. This leads to a lot of unnecessary work and effort at best, and in the worst cases to patient harm.
On another topic: I've been watching the series on mechanical ventilation. As always, great lectures! Though I couldn't find the twelfth lecture, which is supposed to cover troubleshooting vents, and how to approach the ventilated patient in acute respiratory distress. Is this lecture missing?
Thanks for the comment! Regarding the mechanical ventilation series, I worked on those videos over such a prolonged period that the management of vents moved out of the scope of my clinical practice, and I could no longer guarantee that what I was posting was based on the best available evidence and standard of care. So unfortunately, the last few videos never got made.
@@StrongMed Very understandable. Do you still frequently use CPAP/NIV in your practice, and would be willing to do a lecture on how to troubleshoot, titrate, and help patients tolerate these treatment modalities?
Is there any PDF or written document for this class ? This was a master class. Thanks Dr for your help
I'm sorry, there's not.