It has been nearly 30 years since Weed introduced the problem-oriented medical record [1]. His system revolutionized the manner in which patient care was described in the medical record. It later resulted in the development of the progress note formatted by the acronym SOAP (S = subjective, O = objective, A = assessment, and P = plan). These terms have evolved and have often led to the misunderstanding of clinical information as either subjective or objective [2]. Subjective information has come to be viewed as "existing only in the mind," whereas objective information is seen to reflect "actual existence or reality" [3]. The net effect is to minimize the patient's world while exaggerating the reality of the physician's [2]. Dr. Donnelly previously suggested that we control this issue and replace SOAP with HOAP (H = history, O = observation, A = assessment, and P = plan) [2]. His "hope" was to legitimize what the patient reported as true by replacing "subjective" with "history." Furthermore, he noted that replacing "objective" with "observation" is both more accurate and less presumptuous [2].

It was refreshing to read about this issue again in Donnelly's essay "The Language of Medical Case Histories" [4]. Certainly, a more patient-centered medical record enhances the importance of the patient's perspective to our medical record keeping. With computers and the Internet, our patients have more access to medical-information and can enrich our medical record.

I suggest we also add the final letter E, for "education," to Donnelly's acronym-HOAPE. Educating our patients shifts the emphasis from our patients' compliance to their participation in their health care. It invites our patients to take ownership of their health. It reminds the health care provider that education is an important component of the total care of the patient. Certainly, it better expresses our "hope" (and not soap) that our patients will be restored to health.