Tuesday, April 12, 2011

SOAP notables

This is a new segment I'm starting called The POETRY of SOAP notes*.  Like all of my new segments, this will be the first and likely the last of its kind.

There was an old woman who lived in a shoe. She had so many children, she didn't know what to do. Old woman doing well, going home. 
Signed: Ob/Gyn

Roses are red, violets are blue, but up to 20% can appear inhomogeneously blue-black.  Cannot exclude mets.
Signed: Radiology

There once was a man from Nantucket, which is a major breeding ground for the Ixodes tick species that carries Lyme disease.  Consider starting Doxycycline after ID approval. Consider running serology for Nantucket Nectar intoxication after ID approval.  Consider starting ID approval after ID approval.
Signed:  ID

Humpty Dumpty 36, male, s/p great fall.  Assessment and Plan: External fixation. Going to OR now. Get platelets high before OR.
Signed: Orthoepoediaec surgery

Ring around the rosie, pocket full of posey, ashes, ashes, then see how they all fall down?  That's pathognomonic for cancer. It's the pseudo-rosette, signet ring, atypia sign.  As you can see, this is a perfect case of cancer.  We recommend starting a drug that treats cancer.  Also, from a humanistic perspective, we recommend informing the patient it has the cancer.
Signed: Pathology

I know an old woman who swallowed a fly, why oh why did she swallow a fly?
Assessment:  Hypothyroidism vs. Hyperthyroidism.
Problem list: 1) Discharge: patient ready for discharge.  Social work consulted.
2) Patient swallowed fly: Follow up on TSH.  GI consulted. Psych consulted.  Social work consulted.
3) Discharge: Nursing facility placement pending.  Patient ready to leave when social work issue resolved.
4) Hypotension: Fly anaphylaxis vs. sepsis.  Pressors started.  Patient intubated. Anesthesia consulted.  Social work consulted.
5) Discharge:  Patient refusing to leave or follow commands.  Social work consulted.  ER blamed.
Signed: Internal medicine

*Note: These are very esoteric and I apologize.  I hate both making esoteric medicine references and making fun of specialties.  This is both together.  Let's just bury this one and pretend I didn't do it.  SOAP notes are what every specialty in the hospital writes so that other doctors can see how shitty their notes are.  Mets are metastatic cancer (i.e. traveling, bad cancer) , they can never be excluded.  S/p means "status post", which is a fancy, confusing way of saying "here after". Pathognomonic means "synonymous".  Psuedo-rosettes, signet rings, and atypia are things that are specific to certain types of cancer in the same way that shirts are specific to certain types of people.  A TSH is a thyroid test and can be blamed for just about anything.  So it is.  Hypotension, pressors, and intubation are bad; very busy scene with dramatic music on Grey's Anatomy kind of bad.

1 comment:

Anonymous said...

While I was laughing at this, it occurred to me that I had, pretty much, no idea what I was laughing at...your note cleared that up. Thanks for that.

In other news, it also occurred to me that in the note to attempt to get tickets, it might have appeared (to those less philosophically inclined) that I lied. I was saved by when 'tomorrow' comes. The answer is, never...as in, "I happen to be going to NY never," as in, "I will never happen to be going to NY, there will always be a reason."

Great post.