LOS ANGELES, CA – Cliff Kershaw of UCLA Medical Center etched his way into the record books early this morning as he wrote the fiscal year’s first perfect note. The southpaw orthopedic surgeon not only defeated his patient’s left femoral neck fracture with a successful operation free of complications, but also completed his medical progress note without the use of words, including the total omission of nouns and verbs.
“It’s truly surreal,” Kershaw shouted, celebrating with his teammates. “I just wanted to write a quick note, move on with my workday. To go out there, in front of all my fans, and write a note like that, it’s a dream come true.”
Several other surgeons in medical history have written no-worders, but Kershaw’s perfect SOAP note is the first one this year. It is also Kershaw’s first career perfect note. He has consistently displayed the potential for writing a wordless note, in fact completing three short one-worders earlier this year: “Stable” in May, “OK” in June, and “Worse” in July.
The last perfect no-word note was written by Jacob Zimmermann at Georgetown’s University Hospital last season, when he simply wrote “D/C” on a patient’s chart. Zimmermann’s masterpiece remains the most concise and efficient note in medical and surgical documentation history, totaling two letters, a slash, and zero words.
Zimmermann scrubbed out of the OR to call Kershaw and congratulate him on the feat.
“It’s an exclusive club you’re in,” Zimmermann told Kershaw. “Congratulations and definitely enjoy it while you can!”
Kershaw simply dominated the progress note from the get-go despite suboptimal conditions of poor lighting and a splotchy pen. He left pronouns, nouns, verbs, and prepositions in the dust, and displayed his complete mastery of abbreviations, acronyms, the no symbol (Ø), shorthand, commas, slashes, and numbers, all the while walking the fine line between legibility and illegibility. It was a true masterpiece and one that can be appreciated whether or not you’re a fan of Kershaw.
“When I retire, I’ll look back, reread my note, and relive this day,” Kershaw commented, signing autographs, white coats, and babies. “It’s pretty unbelievable.”
“Wow, I’m amazed and really jealous,” said Tom Lincecum with infectious diseases at UCLA Medical Center. “My average ID progress note contains 5,620 words. Sometimes I have to divide my note into chapters.”
Kershaw’s flawless note reads as follows:
AF/VSS
AAOX3, NAD
RRR, CTAB, NWOB
S/NT/ND/NABS
LLE dsg C/D/I, DP 2+
34 yo M s/p L THA POD1
WBAT LLE
DVT ppx
PT/OT
D/W HMS
D/C SAR vs. HHPT
“The crazy part is that I think I can do better, way better,” joked Kershaw, soaked in champagne. “I can probably shave the note by another ninety percent. Gives me something to shoot for going forward, you know?”
The wordless SOAP note has been retrieved for safekeeping and will likely be enshrined in the Surgery Hall of Fame (SHOF).
Best note I ever wrote: As above, see below.
He still had a scribe write it for him
“: Ortho Writes Perfect SOAP Note, First … – http://t.co/bC6rgx1nfR #StriveForGreatness
David Potter sorry had to make you read this as well
impressive for sure but, any surg. resident at 4am does better on the average day
Haha Lauren Kiscaden
Drew Ratner :)
I am worried about medical doctors because this “wordless note” sounds like gibberish to me.
This makes me happy on so many levels!
Haha.
Melissa Busovsky-Mcneal check this out. For a good laugh :)
Brilliant. Love it
Kimberly C Larson Kimberley Marin Mark Arrant
There are two words in your note…
ISQ
NAD. – Not ActuallyDone
Yeah right, ok, but WHAT does the X-RAY Look like?
Michael Flamoe!
Best note I ever saw:
S: better
O: better
A: better
P: continue
Doesn’t even come close to some of the masterpieces I’ve seen from my N/S colleagues.
TLDR
I have always dreamed of doing this. A note entirely consisting of abbreviations and acronyms. Numbers would be ok also.
This note is too detailed to be written by an orthopod.
The note should be
Nad/vss
S/p rt fem orif day 2 c/d/i
Wbat rtle
Ok to d/c w/ HHS
Stopped reading halfway through. Too long.
Something to shoot for Jeff Lutton!
Best daily note is just “Hebrews 13:8”. h/t Dr. George Aronoff
My favorite surgery progress note:
The sad thing is that I could read it, and every flippin’ year I tell the new residents NOT to document like this….worst abreviation I ever had to deal with: whaoml
WNL = We Never Looked
When I was in nursing school we used to practice writing no-word chart notes. Now, twenty years later we are on computer templates and no one bothers to read our ER notes… Sigh…
I’m with Audrey! This was clearly written by an ortho resident! It was written clearly enough to be translated to print for the article. That alone gives it away. How am I to believe it was an attending writing legibly?
:) ❤️
Probably my fav
TL;DR
He could be an ER doc!
I saw one in med school from pediatric Ortho that said “patient breathing”
Lolol
My notes rarely can be divided into chapters. Just my consults. For the record. :))
Btw, as bad as I am with acronyms, I could read that note. That in itself is a little disturbing.
Obvi not ortho Postop note. The only thing needed AVSS, SILT DP/SP/T/S/S, +EHL FHL TA GSC PRL
Ana María Concepción Castro read the whole thing.
Brilliant!
A close second is LGFD (Looks good from door) or CWF (can wiggle fingers)
The hospitalist version: http://thehappyhospitalist.blogspot.com/2014/04/Hospitalist-H-and-P-Abbreviated-Template-Humor.html
stable adv: CT (continue treatment) :P
Wow, they’ve come a long way from, “it broken, me fix”…
Adam Silbiger
It’s clear he didn’t write it! What ortho ever includes heart, lung, abdomen exam???
Lmao!!!!
Bahahahhahahahahahahahahahahahahahah!
a picture of a foot, indicating our footprints or “we were here”
When I was an Ortho resident rounding on Trauma patients in which we were doing nothing except waiting, we would leave a drawing of a foot, signifying our “foot prints”. We were there and acknowledging that all was copasthetic.