Frustrating Quackery, OR: Why chiropractors, physical therapist and massage therapists get a bad rap.

My Rant on Retarded Massage, Chiropractic and PT Practioners

by Elisheva Offenbacher on Sunday, November 25, 2007 at 4:00pm

K, I just need to rant for a minute.

Background is this: I summarise medical records for an insurance attorney. It's not always interesting, but that's beside the point. The standard chart note template is called a "SOAP Note" and generally formatted like this: S(ubjective): O(bjective): A(ssessment) and P(lan):

We can establish, I'm fairly certain, that *SUBjective* complaints are those symptoms felt by the patient, experienced by the patient and unconfirmable/irrefutable by medical personal, right?

Ok, so then *OBjective* issues are the signs that can be observed by the unbiased practitioner, right? Good. Glad we're clear.

Assessment seems obvious, it's the conclusion the practioner makes reconciling the patients reported symptoms, to the signs they are able to observe and then combine to come up with a reasonable conclusion.

And, I'd think "Plan" is fairly transparent as well, being the course of action taken by both the patient and their practitioner.

So, here's my problem:

Doctors are fairly consistent. The SOAP standard is pretty much universal. Sometimes they'll use HPI (history of present illness) or CC (chief complaint,) instead of subjective patient complaints; but either way, you always know what they're talking about.

Massage, chiropractic and physical therapy practitioners: not so much. I just don't understand what is SO freaking hard to grasp about the SOAP concept. They do ok, normally, with the subjective but then they include subjective complaints of pain in their objective reports and their treatment list in assessment! PAIN is NOT objective, people! and "decrease stress" in NOT an assessment!!

I mean, do we not all speak English here? I'll gladly hand a pass to any non-native English speaking providers, but really, everyone else...how did you graduate?? Did objective and assessment suddenly change their meanings or are these people just retarded?????? Normal people don't deal with this, so I realise everyone out there may be raising an eyebrow at my frothy frustration. I wouldn't be so annoyed by this but it takes me TWICE as long to summarise the chart notes than it does for me to summarise ER and physician reports because I have to keep going back to add subjective complaints that I find in the assessment area, or vice versa.

SO aggravating! And don't even get me started on their strange acronyms that are not standard industry wide. And the conditions they make up: chostrochondramyalgitis is **NOT** a REAL medical diagnosis!

I don't think I'm asking a lot. Keep a dictionary handy if need be, but please, for crap's sake, put things in their proper categories and for the love of all thing's good and right, stop making shit up!

Thank you and goodnight.

Disclaimer: To those of you who fall into the above professions and keep proper records for your patients and clients, PLEASE, don't email me defending yourselves. If you are a GOOD provider, clearly, I am not talking about you.