A problem-orientated outpatient record.

A problem-orientated record for use in outpatient clinics has been in operation over a period of 2 1/2 years. Its special features include: (i) preprinted stationery bound in appropriate sequence in the conventional hospital record; (ii) clear presentation of an up-to-date list of each patient's past and present diagnoses; (iii) problem-orientated progress notes. This study considers the definition of an illness problem, recording of progress information, adjustments to a problem list in the outpatient setting and recording of minor "noise" problems. Experience with the system consisted of 5,000 patient attendances. A sampling of these indicated that there were 3-1 +/- SD 1-5 concurrently treated problems per patient, and there were 9-3 +/- SD 6-6 clinic visits per patient. The system was subjectively assessed by 18 doctors, using a semantic differential technique, with a high frequency of "yes" responses to "saves time", "benefits the patient" and "benefits the doctor". This and similar systems may help to resolve the present paradox of the clinical chart becoming decreasingly useful with increasing complexity of illness.