How to Not Hate Writing SOAP Notes

SOAP Notes for Massage Therapists

SOAP Format isn’t Designed for Massage Therapists

Let’s get one thing straight: SOAP notes weren’t designed for massage therapists. By and large we are treating pain, which is hard to define as anything but subjective. We’re very limited in the diagnostic tests we can run and therefor have little objective data outside of what’s passed along from other members of the healthcare team. And our assessment usually runs an hour with our hands covered in oil or lotion, which makes it hard to break and take notes along the way. Not to mention there are 600+ muscles in the body and if I do a full body massage I’m not listing out everything I worked on.

That being said, charting is still very important. When trying to make progress with a patient you will experiment with different modalities, synergistic muscles, trigger points, essential oils, and more in an attempt to find what works best for that individual. Patients will have specific needs or requests regarding heat/cold tolerance, pain threshold, or body areas worked; and when you have a busy practice it’s simply foolish to think you can juggle all this information and provide high quality care to your patients. Keeping good notes, I’ve been able to educate patients’ about their pain patterns/cycles and help them isolate what behaviors are aggravating their condition.

Assessment without Diagnosis

Most therapists don’t have training in orthopedic assessment techniques (side note, I recently bought the text book ‘Orthopedic Assessment in Massage Therapy’ by Whitney Lowe and I’m loving it). Therefor we are left with History, Observation, and Palpation to document our patient’s condition and progress. Some motivated types will include some range-of-motion references when patients specifically mention a limited movement.

I discussed interviewing skills in my post Communicating for Success and how to get the information you need about a patient’s history. Observations would include posture and movement patterns as well as any visible skin conditions or signs of inflammation. Palpation is the information therapists spend the most time on, as this is what we address in the session itself.  To understand where this information fits into the standard SOAP chart:

  • Subjective: History and First impressions
  • Objective: Observations, palpation, and results from ROM and resistive tests
  • Assessment: Impressions on the nature of the condition and tissues involved (muscle, tendon, ligament, nerve) given the results from the first two sections
  • Plan for Care: A lot of therapists write {water, stretch, get massage} in this section; but we can do so much more. Make note of instructions from other health care providers and develop actionable goals for your patients (also discussed in Communicating for Success)

 

Using Symbols in SOAP Notes

My solution came from ‘Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists’. She has a system of charting where you still have written information in paragraph form; however, most of the objective findings and assessment pre/post treatment is marked on an anatomical figure using symbols. For me, this makes the charting process muchfaster. Instead of writing

I found severe adhesions in the Left lower/middle fibers of the trapezius, rhomboid, and surpra/infraspinatus. After applying deep tissue, light cupping, and Tiger Balm adhesions diminished to light.

I can draw a few Xs over the muscles and mark beside the area with a S- ^ L+ (imagine that’s a delta symbol, which means change, in the middle). If I find inflammation I can mark the area with a starburst pattern, postural distortions can be easily marked with the shortened, lengthened, or rotated areas, and pain experienced during the work can be circled (which is a great tool for showing patient’s their progress as they tolerate more pressure and in session pain is reduced or shifted)

 

How Do I Make My Own SOAP Charts? 

At the end of the day we all provide our therapy differently. I’m combining Medical training with Essential Oils, Massage Cupping, and Thai Massage to address the fascial restrictions, deep inflammation, range of motion, and muscle spasms of my patients’ conditions. This means I’m going to need to relay different details than someone who focuses on Shiatsu, Reiki, and CranioSacral. To this end it’s best when we craft our own SOAP charts to fit the information we’re trying to share.

When designing your SOAP notes think about what you work on, what tools you use, do you work on the table/chair/mat, etc. Does it make sense to have checklists, multi-color ink, or maybe larger paragraph areas? Once you’ve reviewed what tools, techniques, etc. that you use, you can identify what components to include in your chart to streamline the process. For Example:

 

[  ] Hot Pack: ___(area used)___

[  ] Cupping: [ S ] Stationary [ M ] Massage

[  ] Neck [  ] Upper Back [  ] Lower Back [  ] Chest [  ] Abdomen

[  ] L/R Hip [  ] L/R Arm [  ] L/R Leg [  ] L/R Hand [ ] L/R Foot

[  ] Essential Oils: (type the ones you use most frequently and have a few blanks)

[  ] Lavender: ___(areas used)____

[  ] Rosemary: _____________________

[  ] Eucalyptus: ____________________

[  ] Peppermint: ___________________

[  ] Cedarwood:____________________

[  ] ______________:___________________

 

By turning regularly used tools/treatments into checklists and using symbols on an anatomical chart we can create a shorthand process to streamline charting and significantly reduce time spent doing so. And being a checklist this font can be smaller to reduce the space used per note.

 

Schedule Time for Charting

Depending on the nature of your practice charting will take more or less time. The medically/rehabilitative focused therapists will need more time to convey the details of their work. These days I work as an employee while I focus on personal projects; and with a receptionist to handle rebooking, payments, and chatty clients I still find 30 minutes to be barely sufficient for turnover between clients.

Let’s face it, most turnover periods don’t go smoothly. What started as 30 minutes gets chipped away when we run over with the first client by 5 minutes, then they take another 5 minutes to get off the table, and our next client arrives 10 minutes early. We’re left with a measly 10 minutes to cash out and consult the first client before turning the room over and writing our SOAP notes. That leaves no time for a pee break, snack, water, responding to calls/texts, etc. and so at the end of they day we feel wiped out and in no mood to get to all the secondary work of running a practice (i.e. everything that’s not doing the massages themselves).

As much as we don’t want to admit it, I would recommend scheduling 45 minutes in between clients. Making sure you have time immediately after the session to write your notes insures that it will not only happen, but that the information will be fresh and accurate. Tasks are far less daunting when we do them a bit at a time rather than all at once in a big pile.

 

And that’s the big secret:

  1. Design your own SOAP template that is relevant to the work you do
  2. Schedule time in between clients to do them as you go

By streamlining the process and planning time for it, this valuable tool can be managed and implemented in your practice.

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