SOAP Notes: A Chiropractic Perspective
SOURCE: Dynamic Chiropractic ~ March 1, 2013,
By Ronald Short, DC, MCS-P
S.O.A.P: We all learned it in school and we all do our best to follow it in our daily charting of patient encounters. My good friend Dr. Mario Fucinari expresses it as a formula:
S+O=A yields P.
Your subjective findings plus your objective observations equal your assessment, which leads to your plan. Simple. Easy to understand.
The important thing to remember regarding the SOAP is that it was designed for the practice style of a medical doctor. To illustrate this, let’s assume a scenario. You are working in your garden, clearing under a rose bush, when you are startled by a small snake. You reflexively jerk your arm back and cut your forearm on one of those monstrous thorns that reside at the base of the rose bush. You now are the proud owner of a 4-inch gash on your forearm. You know you should go inside, and clean and bandage it, but you are nearly done and it is getting dark, so you blot it with a towel (that isn’t too dirty) and keep working.
Two days later, your forearm is swollen, red, painful, and hot to the touch. You go to your MD and tell them of your gardening misadventure. This is the subjective portion of the encounter. The doctor then examines your arm, noting the redness and swelling, and how you flinch when they instinctively touch the sorest point on your arm. They order a CBC and note an elevated white count. This is the objective portion of the encounter.
The doctor determines that you have an infection. This is their assessment. They write you a prescription for a course of amoxicillin and tell you to take four pills each day for the next 10 days, and to come back if the arm gets worse or if the pain, swelling, and redness are not gone by the time the pills are gone. This is their plan.
You take the prescription to your pharmacy and purchase 40 units of therapy, which you take home and self-administer. By the time the pills are gone the pain and swelling are nothing more than a bad memory. You are done and the whole episode lasted less than two weeks. This is how a medical doctor practices.
Chiropractors practice similarly, but with a few significant differences. When you jerked away from the snake, you felt a “pop” in your low back and the pain has been getting progressively worse and has started to radiate down your right leg. You go to your chiropractor and tell them of your gardening misadventure, and that the pain is getting worse and radiating down your right leg. This is the subjective portion of the encounter and is essentially the same as it was with the medical doctor.
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Next, your chiropractor has you complete an outcome assessment questionnaire and conducts some orthopedic and neurological examinations. They suspect an underlying problem and order low back X-rays. This is the objective portion of the encounter. Your chiropractor reviews the findings and determines that you have lumbosacral sprain-strain with sciatica, complicated by degenerative disc disease of L3, L4 and L5. This is the assessment portion of the encounter. The chiropractor prescribes an adjustment and electro-stim therapy three times per week for four weeks.
Here is the point where we deviate from the medical doctor. We cannot write a prescription for the adjustments, have you pick them up at the pharmacy and take them home to self-administer. You have to come back to the chiropractor for each adjustment. This means we have two distinctive types of patient encounters: the assessment visit and the treatment visit.