Welcome back to the third year of medical school lecture series.
Now today we're gonna discuss how to effectively and strategically present a patient.
We'll discuss what's known as the SOAP format.
Subjective, objective, assessment, and plan.
If you learned this SOAP format properly,
you'll always be able to successfully present.
Now, what is presenting a patient?
In medicine, patients are presented.
It's an international and organized way
in which we present complicated problems to each other regarding patients.
Presentations are quite formal and they always follow the same format.
This is known as the SOAP format.
Not the kind of soap you wash yourself with
but it's just SOAP stands for subjective, objective, assessment, and plan.
There is really quite a skill that you need to master for the SOAP format
because strategically presenting is kind of what you need to do.
You don't present every patient the same way.
You need to present strategically based on your audience
and this is a skill that you will master over time
and the sooner you'll learn how to play with your SOAP presentation based on your audience,
you're gonna look as like a rock star as a third year medical student.
Also, following SOAP format always gives you a great foundation
for developing and growing your presentation skills.
So let's talk about the SOAP presentation format.
Now the S in SOAP stands for subjective.
What does that mean?
The subjective is where the complaints of the patients go in in their own words.
You have to write down or type, nowadays,
what the patient is complaining about or concerned about in their own words.
This is why it's called a subjective as its subjective information given to you by the patient.
Here's a quick example.
The chief complaint falls under subjective, right?
And you should not write UTI under the chief complaint
but you should write is whatever the patient said.
When you say, what brought you in today?
And they say, it burns when I pee.
You should write burning with urination or if your attending prefers it burns when I pee.
Whatever the patient said, that's your subjective. It's your chief complaint.
Now, when you're presenting a new patient in the SOAP format,
the subjective is going to include the following:
It's going to include the chief complaint.
That's where the patient complained about.
It's gonna include the HPI or the history of present illness.
This is when you ask all the questions regarding the chief complaint.
It's gonna include a past medical history,
a past surgical history, their medications,
their allergies, their family history, their social history,
and also their review of symptoms.
Now, for the history of present illness,
ensure that you include the following characteristics for the patient's chief complaint.
Whatever their problem is, for the most part,
you should be including these variables:
The onset of whatever their problem is,
the location on the body where it is,
if whatever's bothering them radiates,
the duration of how long have they had it.
Has it been an acute thing for a short period of time?
Is it sub-acute? Is it sub-acute or chronic? Whatever it is.
The character, how would they describe it to you?
The quality, the severity of what they're complaining about.
Does anything make their problem better or worse?
Have they ever had previous episodes?
Are there any associative symptoms and why they came in to the hospital or clinic today?
And that's a key point.
The why they came in can be a confusing thing for new students
and they may have a tough time trying to answer, ask that question,
or know what information they're trying to pull.
The key is problems will sometimes be super acute and it make sense why they came in.
The pain started 4 hours ago, it was too much to handle, I came in today.
Okay, that's why you came in.
But sometimes problems can be longer duration and something may have tipped the patient off
to come in today as opposed to say a week ago.
That's what you're trying to figure out.
If a problem is older, why did they come in today?
What made them say, you know, what today is the day I'm gonna get help from a doctor.
So that's what that one question means why they came in.
So that follows the subjective. All the information you're gonna gather from the patient.
The next section in the SOAP format is known as objective.
This is where you have the presentation of numbers and objective data.
This is, you know, this will include but is not limited to the vitals,
the laboratory values, the imaging results, any procedures or things done,
this is an objective thing. The sodium is 138. Their potassium is 3.6.
The imaging chest x-ray showed this consolidation or whatever.
It's just objective facts that you can see, so that falls under objective.
The next in our SOAP format is the A or assessment
and assessment is where you give a one liner for what you think is going on with the patient.
And assessment really is what do you think is going on.
Here's an example of an assessment.
This is a 45-year-old female patient who present with 3 days of burning urination
with a history of multiple UTI's and pyelonephritis who presents today with another episode of a UTI.
Period. That's an assessment. Who's the patient? What's relevant background info?
Why did they come in and what do you think's going on?
The assessment could be the patient has any problem.
We just need to know in your assessment what do you think is going on with your patient.
And if you actually think about the organization of the SOAP format up until assessment,
the organization actually makes a lot of sense.
Subjective starts first.
What is the patient complaining about?
Objective, what lab or numbers do you have to correlate with that
and with those pieces of information what is your assessment?
What do you think is going on and that's a pretty logical way to go.
And the last part is the plan.
Now that you have an idea of well, this is what I think is going on,
what do you wanna do about it? And that's what the plan is.
It's where you then present all the problems the patient has in a system
or problem based format and your plan for each one.
So in that example we gave, a patient having a UTI,
the first problem would be urinary tract infection
and you need to write what do you wanna do about it?
Give fluids? Give antibiotics? What?s your plan? Admit them to a hospital?
So really, the SOAP format is very logical.
So, you know, information above your assessment and then what do you wanna do about it?
Now, the SOAP format then is really quite easy to understand
and the purpose of us mapping it out as we did was we can create a mental pathway in our head.
Whenever you're presenting, always tell yourself that if you start with the subjective,
you then need information to go on to the objective.
You need numbers and then once you have the personal complaints or the subjective,
you got the data from the numbers in the objective,
then you need to give me a one line assessment of what you think is going on
and then what do you wanna do about it?
And this is very logical. We always gather information,
come to some conclusion, and then have a plan.
That's all the SOAP format is. But with this simple framework in your mind,
whenever you're presenting and someone interrupts you,
and I guarantee you people will be interrupting you as you present,
other people will have questions.
They'd be like hey, that didn't make sense or what do you think about that?
Then, what you can deal with the question and you can always go back to where you were in your mind.
Oh, it's in the middle of the objective. Here's where I was.
So if you know the SOAP format in your mind, you'll never lose your spot in the presentation.
Also, when you're presenting complicated patients that have multiple things going on you can always ask yourself,
okay, this patient's got a lot going on. I'm kinda overwhelmed, hold on a second.
I can always think about the SOAP format. There are problems, their complaints are here.
Organize it in your mind. The most complicated patient should always be able to be presented
efficiently and quickly using the SOAP format.
So always follow that mental model in your head
and really sticking to this format will make your presentations appear much more focused and organized.
The worst thing that happens during rounds is to listen to a disorganized presentation.
That is essentially nails on the chalkboard to us.
Even if what you're saying is accurate, if it lacks the organization of the SOAP format
it will disturb the listeners and then your presentation's going to be seen really as bad or even horrible.
And that follows like on a concept of emotional intelligence.
If you know that the SOAP format is how everyone presents patients in the world,
you better follow the SOAP format 'cause if you don't you're gonna make people feel uncomfortable
or something new is gonna be presented to them that they won't like.
So follow the SOAP format and you'll always sound much better and your presentation will be stronger.
Now, the strategy behind utilizing the SOAP format is really based on your audience.
You should always think who am I presenting it to
and how can I tweak my presentation to accommodate them?
We're always going to use the SOAP format but sometimes we do need to make some tweaks.
So, sometimes you'll be presenting to an attending.
This usually who you will be presenting to and this is usually your audience and it can be sitting down,
it can be relaxed, and you can give your entire presentation to the attending.
Most academic attending allow this. It's sit down, it's calm.
You present the entire thing and they may or may not interrupt you
but there will be other times that you'll notice the attending is in a rush
and they just wanna hear the highlights.
Now, this is a challenge for most third year medical students.
Most third year medical students that I have seen are pretty good at giving a lengthy,
exhaustive, SOAP format presentation.
They'll talk for over an hour if I let them by the patient but that's not too hard to do.
It's easy to map out the SOAP format and just put everything in there.
But if I'm in a rush or if the attending says, you know what, let's go a little bit quicker on this one.
That's when most third year medical students start to panic.
They're like whoa, whoa, how do I shrink all these down?
Well, if you stick to the SOAP format you can actually do this.
So the secret to being able to accommodate any of the requests
is to always think about the SOAP format in your mind.
If you have to give them bridge or a shortened presentation,
you can just go through each section of the SOAP format,
the subjective, the objective, the assessment, the plan
and think, okay, what is in the subjective?
What are the highlights or the pertinent positive for each section?
You can say okay, here's the really important stuff for subjective,
that's what I'm gonna tell them.
Here's the really important lab values under objective,
here's what I'm gonna tell them. Here's my assessment that he cares about
and here's the parts of the plan that he's gonna care about that I'm gonna give.
So in that way, you can still use the SOAP format,
but say okay, where are the pieces of gold that I need to take out
that are the highlights to give a short presentation?
And that works really well because you're still always saying to yourself
stick to that mental framework of the SOAP format and I'll do great.
Sometimes, I've seen third year medical students when we say,
you know what give us a quick presentation on this guy.
We don't have an hour to sit down.
And students just start to rumble and mumble and they don't even know what they're saying.
But if they were to slow down and say, you know what, let me stick to my SOAP format,
let me just pull out the highlights for each one, they'll do great.
So make sure to stick to that mental framework.
What you also need to make sure is that you thoroughly prepared for your presentations.
Presentations really are the method by which you're evaluated
and also graded by both attendings and residents.
If you present confidently in an organized manner, calm, and things are put together,
you will look even smarter even if you don't know all the details.
But if you took time to, you know, read and organize your SOAP format
and you present confidently, you're gonna look like a star.
And that's what you want to do as a third year medical student.
You want to give the appearance that you're doing well.
And of course, if we see that you're doing well, you're doing a great job.
You may feel like well, I'm trying to look good but if you're looking good I guarantee you,
you're doing great on the inside as well.
Now let's review what we've talked about. When you're presenting a patient,
always plan out the presentation in your note and in your mind following the SOAP format.
Think about your audience when you're presenting and plan accordingly.
Use emotional intelligence to tell you how much detail to cover in the presentation.
Is there lot of time or do you need to prepare or present more quickly?
Prepare for your presentations and take them very seriously.
They are the method by which you're graded and evaluated as a third year medical student.