SignatureMD Minutes: Soap Opera

William Osler M.D., the father of modern medicine, said “Soap, water and common sense are the best disinfectants.” I wonder what Dr. Osler would say about a health care system that is in drastic need of disinfection? What would he think of a health care system that has abandoned common sense in favor of the special interests of third parties who have disrupted, distorted, and unbalanced the patient doctor relationship by eliminating time spent with patients in favor of running the numbers to make ends meet. Patient care, despite all the advances in computerized record keeping and medical technology, still depends on the relationship between two people.

Primary care, as administered by family physicians and internists, has been the bedrock of our nation’s comprehensive ongoing medical care with an emphasis on thoroughness and continuity -the result of which is quality medical care with its roots in prevention and wellness. Since the inception of the problem-oriented medical record and with it, the simple and yet elegant SOAP note in the late 60’s and early 70s, patients have looked to their physicians as diagnosticians, councilors, and problem solvers, depending on them to treat and prevent disease and to solve their medical problems. The concierge model allows the physician the time to return to the foundations of the SOAP note: Subjective, Objective, Assessment and Plan – and restore balance in medicine.

Dr. Osler also said: “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. The best preparation for tomorrow is to do today’s work superbly well.” and “The future is today.” I believe that before his death in 1919 William Osler gave us the first description of the concierge model.