Larry Weed's "Problem Oriented Medical Record" was a huge big deal at UofO Medical School in 1967/68 and for a few years afterwards. The "old" clinical staff was appalled by the new way of organizing medical thinking and charting. They got used to it after a while.

The original Weed system was pretty cumbersome and complicated for anyone with more than a few problems (like virtually everyone at the medical school chronic disease clinics) -- especially when they saw multiple students and attendings, each of whom had a different take on what the "Weed System" really was.

It sort of collapsed into the various versions of the SOAP format which actually does work pretty well for most narrative-style notes.

I don't see that anything improves by starting the note with the conclusion of "medical decision-making" (as opposed to starting with why the patient went to the doctor in the first place) , then piling on boiler-plate garbage to presumably bolster that conclusion -- it's backwards, and the only advantage is that if it is done correctly you don't have to try to read a 15 page note if you are seeing a patient in followup from an ER visit for a cold.


Tom Duncan
Family Practice
Astoria OR