Going back years ago before Meaningless Use and MIPS, etc. they were mostly dictation. Even then, some would do the Assessment/Plan first, then the Subjective/Objective. But, in a way, that made sense, because as the referring doc, you already knew or know the S/O. So, you only need the assessment and plan.
But, with the ED you have no idea why they went. So, I tend to want to know why first so I can follow along with their thinking and what I would do. I don't think I will ever get used to A/P first, plus calling it MDMs. They do give their reasoning, which is a very good idea, but in doing so, the HPI tends to be included. Of course, many of these are like this because of large hospitals or offices having the same EMR which forces you to do it that way. I.E. you can't even get to the HPI section without doing the beginning. They were having to write down what they considered as the differential. So, someone with headache and fever, they would say they considered: sinusitis, ear infection, Influenza A, strep throat, meningitis, etc. I always thought it will almost a liability to write that you considered meningitis, yet nowhere in the note is there anything to show what you did to rule it out.
Attorney: you said you considered my had meningitis
Doctor: I didn't think so. It was unlikely
Attorney: Did you write this? Considered meningitis?
Doctor: Ummm, yeah, but...
Etc.
Attorney: Did you consider my client could have been exposed to Old Yeller? Did you consider Rabies?
