The Initial Plan

Abstract

Plans for the possible diagnosis and management of each problem, keyed by number to the problem list, should be prepared as the next logical step after the problem list has been formulated. Each problem should have its own plan, numbered correspondingly, so that an experienced observer can see at a glance whether an anemia, or a urinary tract infection, for example, has a complete and reasonable plan. Too many serious omissions occur when sleeping pills, blood urea nitrogen orders, and side rails are all mixed up in a list of 20 items, which were spun off the top of the physician’s head in a totally random fashion. As time goes on, detailed progressive plans for each problem will appear as a section of the succeeding progress notes. When a well conceived plan is written at the outset, all that is necessary for long periods in the progress notes is a record of the data as they are produced. The initial statement of plans is important because it establishes the character of the further data that are to be obtained and the treatment that is to be given.