Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record.

Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor of the now-ubiquitous SOAP (subjective/objective/assessment/plan) note, for developing an electronic health record system (Problem-Oriented Medical Information System, PROMIS), and for founding a company (since acquired), which developed problem-knowledge couplers. However, Dr Weed's vision for medicine goes far beyond software--over the course of his storied career, he has relentlessly sought to bring the scientific method to medical practice and, where necessary, to point out shortcomings in the system and advocate for change. In this oral history, Dr Weed describes, in his own words, the arcs of his long career and the work that remains to be done.

Diagnosing diagnostic failure.

Diagnostic failure results from misplaced dependence on the clinical judgments of expert physicians. The remedy for diagnostic failure involves defining standards of care for managing clinical information (medical knowledge and patient data), and implementing those standards with information tools designed for that purpose. These standards and tools are external to the minds of physicians, thus bypassing two inherent constraints on human cognition: limited capacities for information retrieval and processing, and innate heuristics and biases.

Shedding our illusions: a better way of medicine.

Caregivers are constantly trying to organize their collective efforts in a way that serves the needs of individual patients. And patients themselves seek active involvement and control in their own care. Disorder in medical practice frustrates achievement of all of these goals.