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Editor's Comments on 'Signing In'

 , May 13, 2016

Bryan Sisk, in his 2013 editorial1, advocates for the addition of an extra “P” – personal – to the traditional SOAP note. “Signing In” demonstrates the value of embracing that second “P.” Pritha Subramanyam introduces us to Jay, a deaf patient admitted to an inpatient psychiatry unit who has “so much to say,” but is often frustrated by a communication barrier. When confronted with challenging patients like Jay, it is easy to come up with reasons to focus solely on the medical issues at hand: limited time, lack of training/feeling out of one’s depth, and differences in language or cultural beliefs, among others. Yet as we see here, this approach sometimes can lead to limited healing at best. It is only after Subramanyam begins to explore Jay’s personal backstory – learning of the loss of his mother, the one person who had valued and supported Jay’s identity as a deaf child, at a young age, and his effective abandonment by his father following her death – that she starts to understand the depth of his isolation. This knowledge also allows her to appreciate the significance of a small gesture made by the resident on the team, when he signs “goodbye” to Jay at the end of their conversation – the first crack in the “wall” that stood between patient and provider. Subramanyam continues to chip away at that wall by beginning “a ritual…wherein” each learned the other’s language, showing that she was invested in Jay as a person, not just as a collection of symptoms. By embracing that second “P,” Subramanyam set the stage for a deeper kind of healing, grounded in human connection rather than simply the technical provision of care.
Rachel Elkin
Sisk B. SOAP2. Journal of General Internal Medicine Web Edition. Accessed at