Jennifer Middleton, MD

Should the SOAP note be changed?

January 22, 2018Jan 22, 20186

Our hospital system's IT department has recently encouraged us all to change our default encounter note template from the traditional "SOAP" format to the "APSO" format. For those not familiar with those acronyms: S: subjective -- the patient's story O:…

Our hospital system’s IT department has recently encouraged us all to change our default encounter note template from the traditional “SOAP” format to the “APSO” format.

For those not familiar with those acronyms:

S: subjective — the patient’s story
O: objective — physical exam, labs, other data
A: assessment — the identified issues/diagnoses
P: plan — details of how to address issues/diagnoses in the assessment

The argument in favor of APSO, putting the assessment and plan …

Should the SOAP note be changed?

Medical Jeopardy is a terrible way to learn. Here’s why.

September 28, 2015Sep 28, 20155

Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation. Not that I don't think games can have an important…

Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation.

Not that I don’t think games can have an important role in education — far from it. Heck, I once worked on a presentation that turned our residency conference room into a giant Game of Life board with …

3 questions to ask prospective family medicine residencies

July 30, 2014Jul 30, 201411

This time of year I get a lot of questions from fourth-year medical students about applying to residency. So, here's my answer to the question, "What should I look for in a good family medicine (FM) residency program?" It's FM,…

This time of year I get a lot of questions from fourth-year medical students about applying to residency. So, here’s my answer to the question, “What should I look for in a good family medicine (FM) residency program?”

It’s FM, so everyone (for the most part) is going to be nice, friendly, and welcoming when you go to visit. They will show you a curriculum that’s in line with the Accreditation …

Family medicine is the solution to American health care

March 27, 2014Mar 27, 20146

I believe that family medicine is the solution to American health care. I believe that family doctors give high quality, cost efficient care. Counties with the right proportion of primary care to specialty care have populations who live longer and…

I believe that family medicine is the solution to American health care.

I believe that family doctors give high quality, cost efficient care. Counties with the right proportion of primary care to specialty care have populations who live longer and health care that costs less. Too many specialists and not enough family physicians leads to unnecessarily expensive care and shorter life expectancy.

I believe that family doctors provide something intangible to our …

A thank you makes a family doctor’s day

February 25, 2014Feb 25, 20144

I had a pretty grueling office session yesterday -- one of those days where you're sending someone to the hospital and calling another consultant on the phone and bouncing among three rooms at once. A typical family medicine day. I…

I had a pretty grueling office session yesterday — one of those days where you’re sending someone to the hospital and calling another consultant on the phone and bouncing among three rooms at once. A typical family medicine day.

I was 45 minutes late seeing my last patient. I was a little surprised that she was still on the schedule — we had actually resolved her issue over the phone the …

A thank you makes a family doctor’s day

Limiting resident work hours: Patients remain our utmost priority

May 26, 2013May 26, 20133

When I was a fourth-year medical student in 2002, I signed up for an intense sub-internship rotation in family medicine. My goals for this rotation were two-fold: first, I wanted to make sure that I was ready for intern year and, second, I needed a good letter of recommendation to match into a good family medicine residency program.

On this rotation, I was essentially treated like the other interns. I had …

How I weather the yearly residency cycle

May 5, 2013May 5, 20132

I've been a family medicine residency faculty member for nearly 5 years, and I've come to observe the yearly cycle of a residency over that time. Reminding myself of that cycle helps me weather and celebrate the peculiarities of each…

I’ve been a family medicine residency faculty member for nearly 5 years, and I’ve come to observe the yearly cycle of a residency over that time. Reminding myself of that cycle helps me weather and celebrate the peculiarities of each time of year.

July-September: Adjustment

Every resident’s role changes on July 1. For the first-years, it’s their first day of being called “doctor.” Second- and third-year …

Why don’t our patients do what we tell them?

April 29, 2013Apr 29, 201318

This question was what drove me to graduate school for an MPH degree a few years ago. I was finishing up my family medicine residency at, arguably, one of the top residency programs in the nation. I had been well trained in both medical science and doctor-patient relationship skills. Yet my patients still consistently did not adhere to my advice.

I was not disappointed in my MPH studies. It turns out …

Because I said so: Why that doesn’t work with patients

April 17, 2013Apr 17, 20133

Let's explore one of the most well-studied health behavior theories - the health belief model (HBM). The HBM states that our health choices are a direct consequence of our perceived susceptibility to a disease, our perceived severity of a disease,…

Let’s explore one of the most well-studied health behavior theories – the health belief model (HBM).

The HBM states that our health choices are a direct consequence of our perceived susceptibility to a disease, our perceived severity of a disease, and the perceived barriers that keep us from adopting better habits.

Perceived susceptibility, perceived severity, and perceived barriers are three of the main constructs from the HBM. The word “perceived” is very …

Blaming others for their health problems helps no one

April 5, 2013Apr 5, 20134

I inherited motion sickness from my father's side of the family. I can't sit in the back seat of a car for more than 10 minutes without becoming sick. I take meclizine before every plane flight. I inherited asthma from…

I inherited motion sickness from my father’s side of the family. I can’t sit in the back seat of a car for more than 10 minutes without becoming sick. I take meclizine before every plane flight.

I inherited asthma from my mother’s side of the family. Exposure to perfume, 90+ degree temps with 90+% humidity, or even a good laugh will all prompt me to cough.

These two maladies of mine have …

We need to change the definition of beauty

January 18, 2013Jan 18, 2013

Wrinkles are bad. So are small breasts. Also crow's feet and age spots. Jiggly arms and muffin tops. Don't forget untrimmed pubic hair. This tirade isn't limited to women. Guys, are your muscles ripped? Chest gleamingly hair-free? Male member sufficiently…

Wrinkles are bad.
So are small breasts.
Also crow’s feet and age spots.
Jiggly arms and muffin tops.
Don’t forget untrimmed pubic hair.

This tirade isn’t limited to women.
Guys, are your muscles ripped?
Chest gleamingly hair-free?
Male member sufficiently enhanced?

On a regular basis, I see 9 to 11 year-old girls who tell me that they’re cutting back on what they eat because they’re “fat.” While I’m examining them, …

Conditions and diseases

Please don’t wear perfume to the doctor’s office

December 17, 2012Dec 17, 20126

Along with about 8.4% of the US population, I have asthma. To promote good doctor-patient communication, I can't sit too far away from you. To perform a high-quality physical examination, I must enter into your personal space. Several minutes of…

Along with about 8.4% of the US population, I have asthma. To promote good doctor-patient communication, I can’t sit too far away from you. To perform a high-quality physical examination, I must enter into your personal space. Several minutes of inhaling that strong scent, however, can cause me to have trouble breathing.

I’ve never been brave enough to bring this up before, …

Drugs and prescribing

The bias behind narcotic prescribing

August 9, 2012Aug 9, 20128

Narcotic pain medication prescribing is an issue heavily laden with emotion these days. I have observed that most doctors tend to fall on one side of a spectrum bordered by these two extremes: "Undertreated pain is worse than addiction." On…

Narcotic pain medication prescribing is an issue heavily laden with emotion these days. I have observed that most doctors tend to fall on one side of a spectrum bordered by these two extremes:

“Undertreated pain is worse than addiction.”

On one end is the doctor who is deeply, morally troubled by patients in pain. This doctor is not unaware of the risk of addiction but is willing to risk being taken advantage …

The bias behind narcotic prescribing

My audacious goal for family medicine

December 21, 2011Dec 21, 20115

I have a BHAG (Big Hairy Audacious Goal). I want people to hear "family medicine" and know that it refers to a medical specialty dedicated to providing relationship-based, patient-centered health care. I want people to know that family docs take…

I have a BHAG (Big Hairy Audacious Goal).

I want people to hear “family medicine” and know that it refers to a medical specialty dedicated to providing relationship-based, patient-centered health care.

I want people to know that family docs take care of a lot of complicated, challenging diseases – and not usually in isolation. Our patients have high blood pressure, complications from type 2 diabetes, congestive heart failure, depression, chronic kidney disease, …

My audacious goal for family medicine

Why is it so difficult for doctors to stay on time?

August 16, 2011Aug 16, 20116

"I'm sorry." I said that phrase a lot last night during evening patient hours. With an overfilled schedule, I mostly said it to patients who waited twenty, thirty, even forty-five minutes for me to see them. "I'm sorry for your…

“I’m sorry.”

I said that phrase a lot last night during evening patient hours.

With an overfilled schedule, I mostly said it to patients who waited twenty, thirty, even forty-five minutes for me to see them. “I’m sorry for your wait. I appreciate your patience.” I say these sentences far more often than I should. Why is it so difficult to stay on time?

I could blame my inadequate supply of nursing staff; …

Should doctors be addressed by their first name?

May 29, 2011May 29, 2011132

I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name ... but not with "Doctor." (e.g.,…

I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.” (e.g., “Hi, this is John Smith from the Family Health Center.”)

I occasionally see the residents’ patients for urgent visits. When I ask them who their regular PCP is at the office, …

Your medical career and the waning interest in bridal and baby showers

March 16, 2011Mar 16, 201117

I think that I am missing a gene from one of my X chromosomes. I attended my sister-in-law's baby shower recently. I love my sister-in-law dearly and was happy to be there to support her. If only I could have…

I think that I am missing a gene from one of my X chromosomes.

I attended my sister-in-law’s baby shower recently. I love my sister-in-law dearly and was happy to be there to support her. If only I could have supported her in another way.

I detest showers. Once I was engaged, I stated clearly to everyone I knew that I did not, under any circumstances, want a bridal shower. Naturally, everyone …

Kind and thoughtful words from a fellow physician colleague