Frank M. Painter

SOAP Notes: A Chiropractic Perspective

The Chiro.Org Blog

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.

There are more articles like this @:

The new SOAP Notes Page and our

Documentation Section

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SOAP Notes: Is It Time for a Cleaning?

The Chiro.Org Blog

SOURCE:   Dynamic Chiropractic – May 15, 2013

By James Edwards, DC

I have been planning for some time to write an article about how traditional SOAP notes do not fit chiropractic practice, and the unfairness of holding DCs to a model clearly created for and primarily applicable to medical physicians.

But Dr. Ronald Short beat me to the punch with his outstanding article:
“SOAP: A Chiropractic Perspective” [March 1, 2013 issue], in which he masterfully illustrated the problem. Hopefully, claim reviewers and documentation gurus will finally realize the difference between a chiropractic “assessment” visit and a chiropractic “treatment” visit.

As Dr. Short so ably pointed out, to require orthopedic and neurological testing on each chiropractic visit is the equivalent of requiring a medical doctor to perform blood tests after each antibiotic pill. I could not have said it better myself.

It is important to remember that doctors of chiropractic are unique because we wear two very different hats. First, we are physicians who examine and diagnose (assessment) the patient. Then, after doing so, we carry out our treatment plan by providing care (treatment) to the patient. Failing to realize the distinct difference between a chiropractic “assessment” visit and a chiropractic “treatment” visit places undue, unfair and unnecessary examination and documentation requirements on doctors of chiropractic, and it is time for it to stop.

This problem has been known for years, yet no one has been successful in sensitizing the chiropractic “powers that be” about this unfairness. The American Chiropractic Association’s Clinical Documentation Committee, during the process of authoring the third edition of the ACA Clinical Documentation Manual, attempted to directly address the issue by approving and submitting the following provision:

There are more articles like this @:

The new SOAP Notes Page and our

Documentation Section

It is important to understand that the chiropractic physician has two responsibilities to their patients.

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