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Ideas and Opinions |

The Problems of the "Problem-Oriented Medical Record"

ALVAN R. FEINSTEIN, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Alvan R. Feinstein, M.D., Department of Internal Medicine, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510.


New Haven and West Haven, Connecticut


Ann Intern Med. 1973;78(5):751-762. doi:10.7326/0003-4819-78-5-751
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The greatest virtues of the new "problem-oriented medical record" are a flexible nomenclature for describing problems, specified details of "patient profile" and "patient education," and an easily applied method for arranging complex medical data. Many other apparent advantages arise not from the problem-structured format but from the associated enthusiasm and supervision with which the new system is applied. In particular, certain apparent contributions to the delivery, coordination, or evaluation of patient care seem attributable more to supervisory attention than to the structure used in the record. The new procedure is not concerned with outstanding scientific problems in patient care and has some major disadvantages, including a reduced emphasis on basic skills in diagnostic judgment. The many desirable features of the problem-structured record may ultimately be more valuable for augmenting and revising the standard record than for radical replacement.

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