“I want to see this whole goddamned city, this city that you purchased with our misery, burned. I want to see you hanged on the very gallows that you use to hang men for crimes far slighter than this. I want to see that noose around your neck and I want to pull that fucking lever with my own two hands!”
The demon takes Adam’s body until Persephone reminds him that he never told the demon that it could. Adam’s so smart, such a problem solver, it’s odd that he didn’t figure this one out himself. Except. Adam’s body has never been his own. Adam’s grown up with his body being a thing for other people to use for their own purposes. Adam has spent his life dissociating from his body because he never knows when it’s going to betray him by becoming a target for another man’s rage. Adam has blacked out and seen his body taken over by that same rage before. He thinks, deep down, he is infected with it. It’s a disease he carries in his DNA, so of course the day would come when something evil unlocks that sickness and brings it to full effect. Of course the monster would use his body, him.
It takes a gentle reminder from a woman who saw inside him like no one else ever could, that you are not the demon. You can take control of your actions. You get to choose what you become, this is not your destiny.
The heartbreaking thing is how Adam was so quick to accept this was his destiny, without his usual problem solving analysis, without dissecting the causes and potential outcomes and other angles, without ever separating himself from the problem at hand and thinking, I can resolve this. He just assumes this is a thing he can’t control. But as soon as Persephone says it, as soon as he does choose control, realises that being a monster does not have to be inevitable, the demon loses its grip on him. And what a revelatory moment that must have been for Adam Parrish. To understand that even with his darkness, his infected, ugly genes, he has the power to choose to be something else.
And then he goes, fearless in this power, to see his parents and tell them he is no longer theirs. He can ask for some kind of association with them because he no longer is them. He can look his father in the eye and tell him he’s wrong because he’s no longer afraid he’ll see himself looking back.
God that whole arc is so powerful that when I think about it sometimes I stop breathing. The power in Adam Parrish is awesome - the dictionary definition kind of awesome: inspiring an overwhelming feeling of reverential respect, mixed with wonder or fear.
First off, we know that Seungbae was getting frustrated. He realized pretty quick that Sangwoo was able to tell Bum what he wanted without anyone knowing.
This gave Seungbae a problem. He knew that as long as Bum and Sangwoo were together, there was no way of ever knowing what was really going on. So Seungbae decided to trick them, he even said so himself.
The trick they are implementing is an old and popular police trick. You can often see it on TV, and movies. The idea behind it is first you need to separate the suspects. The problem with what Seungbae had, was that they could not keep them for the charge Seungbae originally accused Sangwoo of, so they could not keep them. However, assaulting an officer was something they could contain Sangwoo for, and the charge did not involve Bum, so he was able to go free. This was the separation. This was the only way they could legally separate Bum and Sangwoo with what they had.
After the separation of the suspects, Usually after a long time has passed, The officers will tell one, or sometimes both, of the suspects involved, that the other has confessed to the crime.
This gives the suspect feeling either betrayed, or a false sense of
security. This way, the suspect can feel as though “well, since
everything is already known, I can just spill the beans.” Unknowingly
to the suspect, they are the ones who are actually confessing to
Whether or not Bum will fall for this trick or not is yet to be seen.
I decided that for my own sanity this is what I’m gonna hold into for the next four months. Despite everything they want us to believe and despite what they want us to forget I believe in what I see and THIS look screams LOVE, this is a look of pure adoration, and he only has looked at ONE person this way aka the LOVE of his life.
The “Betta Basics” -2.5+ gallon tank -heater (76-82F) -thermometer -low-flow filter -1+ hide -decor -silk/live plants -quality food
A More Comprehensive Guide
The absolute minimum, I do not recommend keeping a betta in anything less than
this because even in a cycled 2.5, keeping a *stable* cycle is very difficult,
and requires more frequent water changes. In a tank this small, you’ll most
likely need to buy an adjustable heater as well, since the smallest (trustworthy)
heaters on the market are 7-7.5 watts, and depending on where you live or how
hot/cold you keep your house/room, the heat will fluctuate too often, or be too
hot or too cold since the volume of water is quite small. A 2.5 gallon betta
tank is doable.
A great median for those who want to give their bettas a wonderful environment,
but may be cramped on space, move around often, or whose living arrangements
have aquarium-related restrictions. A cycled 5 gallon tank with a betta
generally requires a water change 1x a week. A 5 gallon is also easier to heat
and keep a stable cycle with a 5 gallon than a 2.5 gallon. I still recommend an
adjustable heater (I’ll always recommend an adjustable heater), though, as I’ve
found that even with an appropriately-sized preset heater/non-adjustable
heater, the temperature fluctuates too often and by too much. A 5 gallon is a
perfectly good choice!
A palace! Your new betta would love to have a 10+ gallon tank! They’ll swim
over every inch of it, I promise its not too big. A fantastic choice for those
that have the space and can afford to set up a 10 gallon or larger with all the
bells and whistles (décor, filter, heater, etc.).
note: If you feel you can’t give your betta a 10+ gallon tank, and you can only
afford a 2.5 or 5 gallon setup (or something in between), that DOES NOT mean I
(or anyone else) think you’re a bad fish parent ❤ as long as
you can provide the basic necessities your fish requires and keep on top of
water quality, then do what you can when you can! Maybe it’ll be a few months
before you can buy your fish that new hide or a few extra plants, or maybe
you’ll have to wait ‘til xmas or your bday to be able to afford a larger tank
if that’s what you want, and that’s okay. As long as you do the best within
your means (provided your animal’s basic needs are met), that’s all your fish
would ask of you ❤
Bettas are tropical fish! That means they require temperatures of 76-82F.
Why do they need this temperature range, though? Well, fish are ectothermic
(“cold-blooded”) meaning that they depend on their surrounding environment (the
water) to regulate their body temperatures! Your human body also requires a
certain body temperature to optimize all those bodily functions it performs. Think about
frostbite (affects circulation) or hypothermia (affects body temperature and
bodily function). Your fish can suffer similar effects when its water is kept
too cold. A cold betta will be more prone to fin rot/melt (the tips of the fins
become necrotic) because their circulation is affected. A colder fish will also
have a slower digestive process and slower metabolism, meaning that it will
become lethargic because it’s organs can’t work fast enough to produce energy
it needs to be healthy and active. You wanna see a bright colorful active
betta? Give them a heated tank! 😃
Even if you have an adjustable heater, you should invest in a thermometer
(1.50$, glass, Walmart)! I personally use an adjustable thermometer, which has
an internal thermostat which tells it when to shut off/on, but when I set the
heater to 79, my tanks stay around 82F, but I wouldn’t know that unless I had a
thermometer to let me know what the actual tank temperature is! I definitely
recommend spending the extra buck for one :)
Also, those sticker ones that go on the outside of the tank are not reliable,
seeing as they go on the outside of the tank, and show a range of temperatures
more or less. They cost about the same as a glass one (which is much more
accurate), so I recommend either glass or digital, but not the stickers.
Bettas aren’t fond of tons of flow, which can present some challenges to
your friendly neighborhood aquarist. Luckily, there are plenty of options when it comes to betta-safe
Hang-On-Back style filters. Some have an intake pipe, which should be covered
with a sponge to keep your bettas fins (or the betta itself) from being sucked
up and shredded/injured. You can search for “pre-filter sponge” or “intake
filter sponge” on amazon, google, or find a fluval prefilter sponge at your
local petsmart/Petco. You can also DIY one out of cut-to-size filter
foam/sponge. HOB filters can also have a strong out-flow. Some have spray bars,
some have spickets, and some just have a wide-mouth waterfall-style opening. If
you find that the flow is pushing your betta around, or your betta is
struggling to swim against the current, you can baffle it! Some common
techniques for baffling filters are the “water-bottle baffle”, using a shower
loofa/pouf, covering the out-flow opening with filter sponge/floss, or an
intake sponge. I have the fluval spec v and I use an intake sponge on the
out-spout since it’s a short spigot.
These are block sponges which usually sit on the bottom of the aquarium and are
hooked up to an airline tube and air pump. They push air through the sponge,
creating a vacuum and pulling water through. The air bubbles that come out
of the top of the sponge don’t create much horizontal flow that pushes bettas
around, but instead the water flow is directed upwards. The bubbles provide oxygenation and surface
agitation as well.
Bettas like to feel safe (as do all fish and other pets) and giving them at
least one cave to retreat to will give your fish that sense of security. You
can buy something from the fish store, a local pet store, or a pet chain store.
Besides the pre-made ones (logs, rock caves, skulls, etc.), you can buy terra
cotta pots for around a 1$ or so. Just make sure that the pots aren’t just
painted brown, but that they’re a terra cotta material all the way through.
Fish have also gotten stuck in the small drainage holes at the bottom of these
pots, so be sure to plug it up with some aquarium-safe silicone or something.
Also, be sure to make sure that your hides don’t have sharp edges your betta
could tear his/her fins on, and that the hide doesn’t have holes that your
betta may get stuck in. Usually you can sand down rough edges though :)
Plastic plants are generally a no-no, as they can tear your bettas fins.
Usually, if they pass the “panty-hose” test they are deemed “betta-safe” but it’s
still better not to chance it when there are plenty of gorgeous silk plants out
there! “silk” plants are made from material (not necessarily silk) instead of
plastic. Silk plants may have plastic stems, but that’s ok so long as there
aren’t any sharp seams; the silk leaves are what’s important here!
Live plants are also an option. Anubias, anacharis, java fern, moss, and banana
plants are all low-light plants which require no CO2 and no special substrate.
However, this is not a plant guide so you’ll have to research how you can plant
them or add them to your tank on your own.
There are lots of food which is marked specially for bettas, but don’t fall for
marketing gimmicks! Know what’s in your pet’s food before you buy. If the first
few ingredients are “meal”s (fish meal, wheat meal, etc.) or the first few
ingredients are plant-based, then this is not the food for your betta.
What you want to look for is whole ingredients, or specifically-named ingredients
(whole fish, halibut, salmon, krill, etc.). New Life Spectrum and Omega One are
good brands to check out. Hikari is ok, but their ingredients are not as
quality as they used to be, and if you read the ingredients on their current
“Betta Bio-Gold” you’ll see what I mean. Foods with fillers/freeze-dried foods
don’t have a lot of nutritional value, and while a freeze-dried food may make a
tasty treat, it shouldn’t be your fish’s staple diet. You can also feed
frozen/live blood worms, mysis shrimp, etc. Bettas are insectivores, and cannot
digest plant matter, so they should not be given any type of algae wafer or
vegetables (this includes peas; an alternative to feeding peas for bloat is to
I’ll preface this section by stating that bettas don’t need tankmates! :) Tankmates
are more for you than for your fish, and should be chosen carefully.
Tankmates in General:
-please remember to make sure that your tank is suitable for the tank mates you
wish to house; you wouldn’t keep your betta in
a 1 gallon unfiltered/unheated tank, so don’t do the equivalent to your betta’s
tankmates your fish are all equal, so
please, please, please make sure that you put in the same amount of research
and care for the tankmates that you do for your betta! make sure your tank
mates have the same requirements are your betta, and their temperament won’t
put your betta at risk.
-ALWAYS DO RESEARCH ON THE SPECIES YOURE
CONSIDERING BEFORE PURCHASING!! :)
-always have a backup plan in case your tankmates don’t get along with
your betta, or your betta doesn’t get along with his tankmates
-a 20 gallon is the best minimum
choice for a community-style betta tank, as it opens up more options and gives
your betta and his/her tankmates plenty of space! -be
prepared to separate/rehome/etc. “problem fish” or a “problem
betta”. if your betta isn’t really the community type, don’t try to force
him/her to be; it won’t work out well for anyone. Get that betta an individual
setup as soon as possible, or if your tank is large enough, divide it so that
your betta has his/her own space.
Good Tank Mates:
shoaling, 6+ to a group - keeping them in
groups smaller than this will stress them to death…literally sometimes
10+ gallons (dwarf/pygmy), 20+ gallons (regular)
tropical, lots of species to choose from
sand/barebottom is a MUST - p they have soft bellies and sensitive barbels, and
gravel can scratch up their bellies (which leads to stress or infection) or
damage their barbels o.o also, they sift through sand to find little bits of
food naturally, so sand lets them display this natural behavior and you get to
see it too!
schooling, 6+ to a school – keeping them in schools smaller than this will
stress out the fish
10-15+ gallons – depending on the species
tropical, lots of species to choose from
note: “galaxy rasboras” are NOT rasboras (rasboras belong to the boraras
genus). Galaxy rasboras are actually a species of danio (other common name:
celestial pearl danio) and are not tropical.
under 10 gallons: nerites, ramshorns, horned nerites, and other small snails
10+ gallons: mystery snails & other snails listed above – mystery snails
get quite large and have a bioload as large, if not larger, than your betta’s, so
a mystery snail is more suited to living in a 10 gallon tank than in something
not all bettas are “shrimp-safe”, meaning that if you want to try shrimp, you
should be prepared for the worst case scenario: your betta eats them! if youre okay with the possibility that you may lose some shrimp, then i suggest starting out with a few shrimp.
Amano shrimp are larger, great for algae, should be kept in groups of at least 3-5
cherry shrimp (and other neocardinia sp.) are hardy, but small (most likely to be a
tasty snack), colorful/many variations to choose from!
ghost shrimp can actually be nippy, so I’d recommend against them, even though they’re
pretty cheap~ putting shrimp in a 2.5 gallon tank is doable, but a 5 gallon tank would be much better
do best in groups,
3+ - they’re not traditional shoaling or schooling fish, but are still social 20+ gallons - otos are sensitive to water quality
if your tank doesn’t have a ton of algae
for them to eat, then I suggest supplementing their diet with
tank size depends completely on the species your considering, there are a ton!!
supplementing their diet with cucumbers/zucchini/algae wafers/etc.
schooling, 6+ to a school – keeping the in schools smaller than this will
stress out the fish
10+ gallons – they do ok in a 10, but would prefer a 15 (long) or a 20 gallon! 😊
Bad Tank Mates:
NOT tropical (max temp is like 74F), they’re
schooling (6+ fish in a group), and are insanely active! this means they need at
least a 20 gallon, and need to be with other cooler/temperate water fish like
other danios and minnows :) Also, even if
they could do ok in a heated 10 gallon, their active nature tends to stress
bettas out :/
White Cloud Mountain Minnows (or any other minnows):
NOT tropical (max temp is around 74F), they’re
schooling (6+ fish in a group), and are insanely active! They’re smaller,
around 1”, but they need at least a 10 gallon, and should only be housed with
other cooler/temperate water fish such as other danios and minnows :) Also, even if
they could do ok in a heated 10 gallon, their active nature tends to stress
bettas out :/
they’re tropical, could do ok in a 10 (but
would do better in a 20). Enough people have had fin-nipping/aggression issues
that they’ve made this list. Not everyone who houses bettas with neon tetras
will have these issues, but if there’s a possibility of putting your fish’s
health and wellbeing at risk, why take the risk? There are plenty of other
safer, more suitable tank mates out there 😊
all other tetras not mentioned:
tetras tend to be nippy in general (black skirt tetras, for example) and there
are safer options out there; dont risk it! <3
get too large to be housed safely with
can be aggressive/attack/bully your betta
some peoples bettas seem to do ok, some do not, as they can be nippy or aggressive
towards your betta
their flowing tails and bright colors also tend to bring out aggression, and
since they have such pretty tails, they may be nipped at by your betta, or vice
/*Thanks for giving that book a read! If you feel as though I’ve provided inaccurate information, could make an improement, or have an addition to suggest, feel free to let me know! :3*/
Dress the candles to send negativity away from you, then light them.
Hold each end of the ribbon and name the ends.
Pass the silver bell over the altar several times until you feel you are in tune with the universal energies of love and peace.
Put on the black gloves and say:
I call upon the energies of Universal balance
I call upun the ancient energies of my people
I call upon the living essence of the Morrigan
I call upon the mighty presence of Herne
Underworld and heaven
Land and sea
I waken these energies unto me.
Witness now that I renounce and sever
Break bonds and connections with ________________
By all powers that are One Power
May the great sisters of karma now weave anew
And separate me from you
As I will, so mote it be!
Cut the ribbon:
“It is so.”
Light the cauldron and burn both pieces of ribbon.
Maybe a D&D story is cheating a bit because you’re in my party, so if you would like another story, lemme know! But this one was too good to pass up.
So, early in our campaign, in the worst fucking city full of assholes, we end up talking to the one wizard in the whole damn place. He was distracted and had trouble identifying reality, and his magic was all over the place. But he’s helpful and periodically friendly and ends up coming along to help us out (for meta reasons, in part, because we were going after some cultists with a party member missing).
He was a little frustrating at times, but he also saves us from being eaten by a beholder, so.
Two of us have some temporal-dimensional travels (and set a dimension on fire, Quil) and run into much younger versions of him who ends up being 850 years old. In our time, he looks like an old man. Dude is Weird.
He tags along with us though, and at his recommendation, we end up tracking down the head of the renowned wizard’s college and master of a magical rift crystal for some information. Head Wizard tells us that our wizard, the grumpy often-incoherent curmudgeon who we are vaguely fond of, is the human embodiment of Paladine, the FUCKING GOD OF PALADINS.
(And then asks us to look after him, because they’re old friends.)
Which, haha, we FUCKED THAT UP, because eventually three of our party members waltz down a mountain of death to find our ship blown to fucking pieces and entire crew (including our wizard-avatar) missing.
We, uh. Panic. A bit.
Eventually, we find out that Lloth, an evil spider-goddess of chaos, has kidnapped our poor wizard and is torturing him. She is, in fact, keeping him on the verge of death without actually letting him die.
There was some painful description about this and we all made very distraught faces. And were feeling guilty about not having been able to protect him.
So. We decide we’re going to Save Our Wizard, come hell or high water.
It’s hinted that we’ll have to do a swap-and-replace with an enemy-who-may-have-been-deep-down-redeemable, which we find super horrifying and are like LET’S NOT SACRIFICE PEOPLE. But, uh, there’s no way we can go up against a goddess as squishy as we are, so there are several months of “Okay, we’ll do this thing, but THEN WE GET BACK TO RESCUING PALADINE AND HIS VESSEL.”
(Our DM forgot our wizard’s name, which. Rude.)
Anyway. We eventually get to the point where we think we won’t immediately die in the void at the edge of the Abyss, and even though we’re still terrified, we are doing to rescue our friend or die trying.
There are plans and careful spell preparations, and we even distribute some locks of hair around for resurrection purposes, and finally. Finally, we descend to Lloth’s domain.
She’s waiting for us, because of course she is, and all of us aaaaaaare panicking quite a bit. Because Lloth presents us with two choices: either we attempt to fight her, or we agree to transport some mystical egg to her handmaiden in exchange for our wizard. We trust the continent sized spider-lady about as far as we can throw her.
So, we’re trying to decide, and @socpuppet is missing, so we’re jaegering her cleric between us.
We’re arguing ethics and consequences, and I am desperately thinking, until I remember the cleric feature Divine Intervention. It lets you call on your god for a favor - it’s not a spell or anything, just a prayer.
Kithri, our cleric, prays to her goddess for anything, anything to help us get our wizard back safely without taking this deal.
For Divine Intervention to succeed, you have to roll below your cleric level on a 100-sided die. There’s like a 15% chance of success. This is a Hail fucking Mary. We hold our breaths.
I roll a 7.
Kithri’s goddess can move our entrapped and insensate wizard within range of a Dimension Door (short range teleportation) spell. We have one surprise round.
Our sorcerer jumps over, grabs our wizard, and uses a sorcerer ability that lets her cast a second spell on her turn, and casts the high-level spell that will let her shift back to our home plane. Our druid grabs the other two of us and casts the same spell.
Our cleric, who’d been a “guest” of Lloth’s previously, yells “Yondalla says fuuuuuck yooooooooou” on the way out.
Our DM teases us with the horrible possibility of being insta-killed due to an old optional rule set we weren’t told about, but then decides to just make us trek through a towel embroidery pattern of treacherous giant spiderwebs, which is an entirely different ridiculous story, but damn, that roll and whole sequence was one of the most amazing of the whole campaign.
Every once in a while, I see a complaint from somebody demonizing YOI because it doesn’t include homophobia or racism or whatever other thing, and uhm, no.
To be clear, Kubo and staff have said the YOI takes place in a homophobia-free universe. Cool, fine, good. But I see people sometimes saying the YOI isn’t proper representation and completely disregarding the series because of this. Like fine, you can have an opinion; I’m not prying your eyelids open and forcing you to watch anime, but to say that YOI isn’t “proper” representation or that it contributes nothing is completely misguided.
First of all, a show–or any piece of media, really–that has a queer couple and/or character in it doesn’t have to relegate itself to being about discrimination. Sure, it can, and it’s absolutely important that there are cultural records of the awful shit happening in the world. But our lives are more than that. We’re more than the hate directed towards us. We’re all individuals with our own problems, perspectives, preferences. Why should every story including us have to essentially be a form of torture porn?
For those who don’t know, the term ‘torture porn’ is used in cinematic circles to describe a subgenre of horror film that deliberately focuses on graphic depictions of torture, gore, violence, etc etc. That doesn’t mean any film with gore in it, it means a piece that has no real plot, emotional depth, or suspense; it’s only about suffering, plain and simple. Think of things like Bloodfeast (1963)–one of my personal fav b movies actually–the Saw series, and Hostel: Part II (2007). Films like Evil Dead 2 (1987), however, are splatstick because of the comedic tone.
I make this comparison because if every single story with queer characters and couples only focused on the suffering of these people, then it just becomes an emotional–and sometimes physical–form of what I explained above. If it has nothing going for it but that, then the story is nonexistent, plot is flat, the characters are caricatures rather than people, etc etc. Again, it’s not a bad thing to portray stories like this. But it’s important to keep in mind that we experience more than hate and romanticized depression.
Anyway, my point is is that YOI has a complex story on its own. Yuuri and Victor are people, not romanticized caricatures. They have their own problems separate from discrimination, and that’s so important in normalizing queer people and relationships. I mean, honestly, if we keep portraying queer people as “outsiders,” how are we going to get anywhere?
I was talking to my mother about this, and she made a great point: not only is the show a great step for normalizing queer relationships–especially since younger generations will be able to see it–but it’s also a wonderful blueprint of what the world could be. It’ll take time, and work, but this is a place we can get to. People can love and be themselves and hold their identities proudly instead of repressing and hiding out of fear of assault or even death.
If we don’t have a map, we’ll lose our way. YOI is a piece of the map to lead us to a better, kinder world.
This show has worth, and it means things to people, whether you think so or not. Opinions don’t change the reality.
just neurodivergent things: constantly apologizing for forgetting things; feeling vulnerable when you don’t remember something; living with the vulnerability of a shit memory bc you can be easily convinced of something that isn’t true; being unsure if you can truly trust anyone’s information about your past.
Basics for the Wards: Suggestions for improving your SOAP notes
When I was a first year we had basically no guidance on our notes, and as a result I was lazy with mine and developed bad habits. When I got to clinical rotations during third year my notes were horrible and it took a lot of feedback and effort to improve them.
In my experience helping med students improve their notes, as well as feedback on my own notes, here are some suggestions. This is mostly oriented towards an outpatient-type SOAP note, but also relevant to inpatient SOAP notes.
1. Note writing is different from anything else you’ve written before. And it does not come intuitively, it is a skill that you work on. While a SOAP note or H&P may be a page or more, it is not an essay. You do not need to write “The patient says the cough causes pain in her left side,” when “Painful cough, left side” will do. You do not have to have perfect grammar and sentence structure. Why?
2. Condense condense condense. Because nobody has time to read or write a novel. Be as brief as possible while still communicating the relevant info (what is the complaint? when did it start? inciting event? exacerbating/relieving factors? if their is paint what is the quality/radiation/level on a scale of 10, etc). This may mean you scribble notes in the patient encounter and then distill them in your SOAP note.
3. Organize the complaints. Do not give me three separate sentences about the cough with an interjection in the middle that the patient stopped taking their headache medicine. Group your complaints together, with the chief complaint (AKA why they are there) at the top.
4. The subjective. ALWAYS start your subjective with “Patient Q is a xyz year old M/F who presents with blah blah blah”. EVERY. NOTE. EVERY. TIME.
The subjective is where you write what people tell you. Everything in your subjective will be coming from the patient unless otherwise specified. YOU DO NOT HAVE TO WRITE ‘PATIENT SAYS’ or ‘HE/SHE STATES’ EVERY SENTENCE. We know the patient is saying those things, putting that in there makes your subjective wordy to read and time consuming to write. Remember, sentence structure doesn’t have to be perfect.
Every subjective should have a brief review of systems of things not included in the chief complaint. It does not take very much time and ensures that you are being thorough. Ones I always hit on are: headaches, fevers, fatigue, vision changes, nasal congestion, sore throat, cough, trouble breathing, chest pain, nausea, vomiting, abdominal pain, constipation, diarrhea, trouble peeing, muscle/joint pain, rashes, swelling.
Your do not need to put past medical/surgical/family history in your SOAP note unless something has changed or it is relevant to the visit (Ex: “Bobby is a previously healthy 5 year old boy with a history of asthma who presents today complaining of wheezing and shortness of breath” OR “MaryAnn is a 77 year old lady with a past history of multiple abdominal surgeries for diverticulitis who presents with a left sided abdominal bulge”). Otherwise, that info is in the H&P that was done when the patient was first admitted to the hospital or began coming to clinic. Your SOAP note is not a history and physical.
5. Objective This is where data goes, things you see with your eyeballs or feel or hear. Most objectives are organized like this: Vitals Labs (CMP, CBC, etc) Physical exam (that you do!) Imaging (ultrasound, chest x-ray, etc)
6.Objective: Vitals If you are hand-writing your note vitals go on one line like this: BP HR T RR O2 (L/RA) Not BP HR T RR O2 (L/RA)
6. Objective: Physical exam The biggest thing I have noticed is the first years either aren’t doing a physical exam or they write ‘normal’ or ‘no significant physical exam findings’. DO NOT EVER EVER EVER EVER DO THIS. Why? Well, for starters, your normal and my normal may be two very different things. ‘Normal’ does not tell me what you looked at, what it looked like/felt like, or help me see how you used your physical exam to arrive at your diagnosis. Finally, IT IS LAZY AND ARROGANT. As students we have not had the necessary clinical experience to say what normal is.
7. Assessment OK, time to regroup. There has been a lot of information. Summarize all your findings and what you think is going on, along with a differential. Example: Patient is an ### yo M/F with a chief complaint of XYZ, relevant objective findings such as vitals, labs, physical exam, imaging. Suspect patient has blah blah blah due to evidence, but differential includes yakkety yak and whatever.
8. Plan I suggest grouping plan under each problem. So, if a patient is here with cough and sore throat but also has hypertension and needs a med refill, those would be two separate problems each with their own plan. Be sure to list dose of med and directions for taking it, as well as a return to clinic if (such as, return to clinic if no improvement in 3 weeks, consider antibiotics and imaging). This will help if someone sees the patient for followup after you. For clarity sake, I suggest formatting like this:
Problem 1 (chief complaint) - plan - plan
Problem 2 (second most important problem) - plan - plan