Objective

The ‘O’ in SOAP stands for objective.  Traditionally this is used to document the physical examination which is appropriate for a particular complaint.  For example, if the patient is complaining of abdominal pain, the examination should include the abdomen and possibly the chest and pelvis, depending on the exact nature of the pain and the associated features.  If the complaint is emotional, there is a mental status exam which can comment on how that patient engages with the visit, whether they appear to be in a psychotic or manic state, whether their insight and judgement are intact.

In the example of the bored child, this might include observing such cues as whether they appear tired, restless, angry, sad or other factors which may contribute to the chief complaint.  One could take note of what the child says and does during the conversation.  The objective portion of evaluating a problem includes facts which are verifiable or which could be observed by someone else.  As much as possible, they should be devoid of opinion.  When evaluating someone’s mental status, there will likely always be some interaction with the observer.

If one is providing technical support, the complaint might be that the printer doesn’t work and the objective fact might be that the printer is unplugged, or that the network is slow, or that the printer is not set up correctly, or that the printer is out of ink or paper.

So for a given subjective complaint, we can find out a lot about what is likely causing it by our objective assessment.  And of course, this is an iterative process.  What we observe during the objective phase may prompt us to ask more questions to further develop our understanding of the patient’s problem.

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