Family and Community Medicine: Texas Tech MedCast

SOAP Note 1: Overview of the Medical Note

Posted: 10/31/2006
Length: 11:30

This episode includes an overview of the medical note.
Learning Objectives: the first-year medical student audience should be able to:

• List 4 purposes of a medical note
• List 4 important qualities of an effective note
• Identify 4 ways to organize a note
• Use the acronym SOAP to identify the 4 main components of a patient note

Tommie Farrell, MDFamily Medicine Lubbock

SOAP Note 2: Subjective: Chief Complaint & History of Present Illness

Posted: 11/07/2006
Length: 15:19

This episode describes begins a discussion of the Subjective component of the patient note, specifically the Chief Complaint & History of Present Illness.
Learning Objectives: the first-year medical student audience should be able to:

• Describe the purpose of the Chief Complaint section of the SOAP note
• List 7 attributes of the History of Present Illness
• Accurately document a patient's chief complaint & history of present illness in a patient note
• Use the acronym OPQRST to include all components of a history of present illness

Tommie Farrell, MD

Lia Bruner, MD
Family Medicine Lubbock

SOAP Note 3: Subjective- Documenting Chronic Illness

Posted: 11/17/2006
Length: 13:42

This episode continues the discussion of the Subjective component of the SOAP Note, specifically issues related to patients with chronic illnesses such as diabetes.
Learning Objectives: the first-year medical student audience should be able to:

• List the key parts of a history of a chronic illness, including disease history, current control & compliance, current symptoms & complications, end-organ effects, and health maintenance
• Document the History of Present Illness for a patient with chronic disease

Tommie Farrell, MD
Family Medicine Lubbock

With a special appearance by "Mr. Phillips"

SOAP Note 4: Subjective- Summary

Posted: 11/28/2006
Length: 16:24

This episode concludes and summarizes the discussion of the Subjective component of the SOAP Note, specifically the connection between what the patient says and what information goes into the chart.
Learning Objectives: the first-year medical student audience should be able to:

• Define sections of the Subjective portion of SOAP note, including 6 parts of the past medical history, the family history, the personal/social history, the review of systems, and health maintenance
• Document the Subject portion in the patient's chart

Tommie Farrell, MD
Family Medicine Lubbock

With a special appearance by "Jenni"

SOAP Note 5: Objective

Posted: 12/06/2006
Length: 15:39

This episode includes a discussion of the Objective component of the SOAP Note, specifically what the physician can observe or measure.
Learning Objectives: the first-year medical student audience should be able to:

• Contrast the Subjective component with the Objective component of a patient note
• List the Vital Signs
• Describe aspects of the patient's General Description
• List the aspects of a HEENT exam that are documented in the Objective section
• Document the Objective portion in the patient's chart

Tommie Farrell, MD
Family Medicine Lubbock

& Betsy Jones, EdD
Family Medicine, Lubbock

SOAP Note 6: Assessment & Plan

Posted: 12/12/2006
Length: 19:06

This episode includes a review of the Subjective and Objective components and a discussion of the Assessment & Plan components of the SOAP Note, including what should be documented from a patient visit.
Learning Objectives: the first-year medical student audience should be able to:

• Contrast the Assessment and Plan components with the Subjective and Objective components of a patient note
• Explain the link between billing and effective documentation
• Choose an effective organization for the Assessment and Plan
• Prepare for the Step 2CS exam patient note
• Document the Assessment and Plan portion in the patient's chart
• Practice documentation and note writing

Tommie Farrell, MD
Family Medicine Lubbock

With a special appearance by "Jessica"