From SOAP to HOPE: Adding Healing into the Traditional Medical Encounter
It’s time we got rid of the SOAP note.
The SOAP note is the subjective-objective-assessment and plan around which every medical encounter in the country is framed. The priority is to identify the disease, measure it to confirm that it is a disease, and develop a treatment plan to try to control and eliminate it. This disease-based approach frames everything that goes on in health care.
It works well when a cause of a disease is easily identified and eliminated. However it works poorly for the factors that are now seen to impact most of health— prevention, lifestyle and holistic practices.
We now know that 80 percent of health care actually comes from outside of the clinic, and it won’t fit into that particular diagnostic plan that we create with SOAP. Patient’s goals and their decision-making are crucial for the creation of health and healing, even more so than the specific treatments of disease medical professionals sometimes provide.
Putting all encounters into a framework of subjective-objective-assessment and plan, around a specific diagnosis and verification of treatment, is no longer the model needed in the health care box.
From SOAP to HOPE
We need a new model for structuring the visits within the health care system. To achieve patient-centered care this new model must include the factors that change behavior and create health. These include social determinants of disease, holistic and integrative medicine, the importance of lifestyle, as well as the key role of purpose and meaning in the patient’s life.
In this new Healing Oriented Practices and Environments (HOPE) model, the patient and their own goals in life would be part of the diagnosis and the plan – all components that don’t currently fit into a standard SOAP note. Expectations and beliefs are a key part of healing, and so are social support and the relationships that are essential for recovery and the optimization of any kind of treatment. Thus, the social components must be part of the note.