applauding doctors

Ortho Writes Perfect SOAP Note, First No-Worder This Year

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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.

applauding doctors
“An amazing feat!”

“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).

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  • Show Comments

  • Avatar
    woo131

    Best note I ever wrote: As above, see below.

  • Avatar
    Casca

    He still had a scribe write it for him

  • Avatar
    Jeff Stambough

    “: Ortho Writes Perfect SOAP Note, First … – http://t.co/bC6rgx1nfR #StriveForGreatness

  • Avatar
    Saad Mohammad

    David Potter sorry had to make you read this as well

  • Avatar
    Mark Roberts

    impressive for sure but, any surg. resident at 4am does better on the average day

  • Avatar
    Angie Montecino-Barco

    Haha Lauren Kiscaden

  • Avatar
    Kathryn Sowinski

    Drew Ratner :)

  • Avatar
    Joseph Kuhn

    I am worried about medical doctors because this “wordless note” sounds like gibberish to me.

  • Avatar
    Melissa Busovsky-Mcneal

    This makes me happy on so many levels!

  • Avatar
    Ruben Molière

    Haha.

    Melissa Busovsky-Mcneal check this out. For a good laugh :)

  • Avatar
    Victoria Beveridge

    Brilliant. Love it

  • Avatar
    Michael Flamoe

    Kimberly C Larson Kimberley Marin Mark Arrant

  • Avatar
    Donna Otwell White

    There are two words in your note…

  • Avatar
    Justin Chipman

    ISQ

  • Avatar
    Miles Callahan

    NAD. – Not ActuallyDone

  • Avatar
    Miles Callahan

    Yeah right, ok, but WHAT does the X-RAY Look like?

  • Avatar
    Maranatha Anderson

    Michael Flamoe!

  • Avatar
    Anthony Daniels

    Best note I ever saw:
    S: better
    O: better
    A: better
    P: continue

  • Avatar
    Meredith Broderick

    Doesn’t even come close to some of the masterpieces I’ve seen from my N/S colleagues.

  • Avatar
    Derek Seib

    TLDR

  • Avatar
    Andrew Tan

    I have always dreamed of doing this. A note entirely consisting of abbreviations and acronyms. Numbers would be ok also.

  • Avatar
    Onur Kutlu

    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

  • Avatar
    Patrick Murray

    Stopped reading halfway through. Too long.

  • Avatar
    Shazia Choudry

    Something to shoot for Jeff Lutton!

  • Avatar
    Andy Talbott

    Best daily note is just “Hebrews 13:8”. h/t Dr. George Aronoff

  • Avatar
    Rishi

    My favorite surgery progress note:

  • Avatar
    Becky Waynee Bratten

    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

  • Avatar
    Katrina Gabelko

    WNL = We Never Looked

  • Avatar
    Katrina Gabelko

    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…

  • Avatar
    John Kelly

    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?

  • Avatar
    Patricia Kidd

    :) ❤️

  • Avatar
    Shannon Bass

    Probably my fav

  • Avatar
    XY Zee

    TL;DR

  • Avatar
    Martha Bauder

    He could be an ER doc!

  • Avatar
    Vikash Mishra

    I saw one in med school from pediatric Ortho that said “patient breathing”

  • Avatar
    Katie Marsh

    Lolol

  • Avatar
    Ana María Concepción Castro

    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.

  • Avatar
    J. Andrew Younghein

    Obvi not ortho Postop note. The only thing needed AVSS, SILT DP/SP/T/S/S, +EHL FHL TA GSC PRL

  • Avatar
    Rebecca Sentman

    Ana María Concepción Castro read the whole thing.

  • Avatar
    Rebecca Sentman

    Brilliant!

  • Avatar
    Mersiha Hadziahmetovic

    A close second is LGFD (Looks good from door) or CWF (can wiggle fingers)

  • Avatar
    The Happy Hospitalist Blog
  • Avatar
    Sara Hughes

    stable adv: CT (continue treatment) :P

  • Avatar
    Steve Gerke

    Wow, they’ve come a long way from, “it broken, me fix”…

  • Avatar
    Ryan Caldwell

    Adam Silbiger

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    Audrey Maminta

    It’s clear he didn’t write it! What ortho ever includes heart, lung, abdomen exam???

  • Avatar
    Jessica White

    Lmao!!!!

  • Avatar
    Joanie Sapienza

    Bahahahhahahahahahahahahahahahahahah!

  • Avatar
    Stephen Rockower

    a picture of a foot, indicating our footprints or “we were here”

  • Avatar
    Stephen Rockower

    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.

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