DECEMBER 6, 2007

My car has a bad belt at the moment.

Which means it makes this awesome squeaking sound when the engine idles at a stop light.
(Which gets me plenty of looks from the ladies when driving downtown - 'Yeah baby, wassup? I'm ass-load in debt and my car is broken. But I'm gonna be a doctor! Wanna hop in?')

Since my life as a med student is a combination of incredible busy-ness and incredible laziness (for example, today I went to four straight hours of lecture, a presentation from a cardiothoracic surgeon, came home, passed out face down in my bed with my clothes and coat still on cause I felt like it, drooled on my pillow, woke up 20 minutes later in said drool, went to the gym, studied for four hours, and am now home effectively wasting my evening), I haven't been able to get my car in to get the sound checked out. But while idling at an unusually long stop light today and listening to the musical tones coming from under my car's hood, I had an incredible flash of insight.

Mechanics = Doctors. Or Doctors = Mechanics. Whatever.

The key is that there is an eerie amount of similarity between how a mechanic tackles a problem with a car and a doctor tackles a problem with you. Being the massive nerd that I am (contrary to my reputation), I just had to take the analogy further. So without further ado, here's the SOAP note for my car.

For those of you not in the know, a SOAP note stands for subjective, objective, assessment, plan - it's a specific method of writing notes in a patient chart used in health care to track patient history, progress, and future planning. There are specific sections to be covered in a specific order with a specific type of language - its one of those "medicine things" you never knew about until you get on the wards and realize you don't know jack. I'll break this one down for y'all.

|| SUBJECTIVE ||
ID/CC (Identifying Information/Chief Complaint): Patient is a black '00 Nissan Sentra XE Sedan who presents with an irregular squeaking sound deep to the hood which began unexpectedly three weeks ago. Patient reports squeaking as high pitched and inconsistent and occurs when engine is idle but ceases when engages in acceleration. Patient has not noted any worsening of squeaking since it began. Patient is concerned and annoyed by squeaking but has reported no other more significant symptoms.

PMH (Past Medical History): Patient reports no serious mechanical work done prior to the initiation of squeaking. Patient has no history of serious accidents. Patient has had routine maintenance performed at appropriate times throughout lifetime.

FamHx (Family History): '00 Nissan Sentra Sedans have a history of surge and hesitation, engine clatter, and transmission failure. Patient believes both parents exhibited symptoms of engine starter squeal and 5th gear popout.

SocHx (Social History): Patient reports aggressive but not reckless driving style. Frequently takes corners at above average speed. Does not drive while intoxicated. Undergoes frequent oil changes.

ROS (Review of Systems): No reported decrease in power of acceleration or performance in day to day driving.

Meds (Medications): Patient reports usage of regular unleaded gasoline.

|| OBJECTIVE ||
Vitals: Engine idles @ 750rpm. Gas mileage 24mpg. Radiator temp 170 deg. F

Physical Exam: Car appears clean and functioning well. Mild stratching and denting of fender observed. No abnormal smell noted from engine. Consistent shrill squeak emanating from drive belt. Sound ceases upon depression of accelerator.

Labs: Couldn't think of a good analogy for a blood panel or CT scan. So sue me, its almost christmas break.

|| ASSESSMENT/PLAN ||
Patient is a black '00 Nissan Sentra XE Sedan who presents with an irregular squeaking sound deep to the hood.

For the problem of the engine-focused shrill sound, the likely cause is misalignment of the drive belt. The following are recommended:
-Further tests performed on engine performance to rule out deeper issues.
-Replacement of drive belt.
-Further followup for reckless driving habits.

So there you have it, a SOAP note. These things are the bane of the medical students existence, making for long tedious hours of paperwork as we learn how to effectively write one, but to tie my analogy full circle, I'm sure mechanics would go through the exact same sequence when a car is brought in for service. They ask the customer what the problem with the car seems to be (chief complaint), whether the car has had any serious problems before (past medical history). They begin service with an idea of common problems for that make and model of car (past family history). They ask the customer a few specific questions about the nature of the problem (review of systems). They examine the car and run appropriate tests to find the problem (physical exam and labs). They then draw up what the problem is and what they need to do to fix it (assessment and plan).

So there ya go. Your doctor tackles your abdominal pain the same way your mechanic tackles your RAV4's windshield wiper problem.