Lawrence “Larry” Weed (born December 1923, died June 3, 2017) was an American physician, researcher, educator, entrepreneur, and author, who is best known for creating the problem-oriented medical record as well as one of the first electronic health records. (https://en.wikipedia.org/wiki/Lawrence_Weed )
The POMR, including what evolved into the current standard for structured medical visit notes (SOAP: Subjective impressions, Objective data, Assessment of the situation, and Plan) was first introduced in 1964 as a response to the growing importance of data and evidence in medicine. The previous approach had been to organize medical information by source: x-ray reports in one section, lab reports in another, operative reports in another. By organizing the information in the medical record around problems, the POMR and SOAP note supported better data collection and retrieval, more organized clinical analysis, and better care over time.
An excellent way to understand how revolutionary his concepts were (and how good a speaker he was) is to view this video of him presenting at a 1971 grand rounds on the POMR.
Physicians who trained in the late 1960s and early 1970s will remember how transformative the POMR and associated SOAP note were, not just for the record, but for the practice of medicine.
Here are a few links to previous posts we had about Larry Weed:
Lawrence Weed, the father of the Problem Oriented Medical Record, looks ahead Nov 2011
(Video) Larry Weed, father of the Problem Oriented Medical Record – Grand Rounds, 1971 Sept 2014
JOPM: Is Larry Weed Right? – Terry Graedon – March 18, 2013
An excerpt from this last article shows that Larry Weed predicted Precision Medicine:
“In their book Medicine in Denial, Larry and Lincoln Weed argue that no single clinician has the cognitive capacity to match each patient’s presenting signs and symptoms to the correct choice out of hundreds of possible disease conditions that might correspond. According to the Weeds, misdiagnoses “are not failures of individual physicians. Rather they are failures of a non-system that imposes burdens too great for physicians to bear.”
They argue that software tools should be employed first. Software linked to the medical evidence base could present a true list of probable diagnoses for physician and patient to consider together, rather than the ad hoc list of differential diagnoses that a doctor may construct based on his or her particular interests or specialization.”
Let us know how the work and life of Larry Weed influenced your work!
Health IT journalist Neil Versel, who saw Larry speak three times, published Health informatics pioneer Larry Weed dies at 93.
I was lucky to call Larry Weed a mentor and a friend. When i first met Larry in the 80’s he was constantly advocating for the patient. His view then, and until his death was a systems view. He realized that healthcare requires a shared information platform, not independent consumer health websites and professional systems, but a single knowledge base with feedback loops for both patients, clinicians and researchers.
A film about Larry’s idea and vision is planned. Here is a recently posted tribute clip:
Medpage also covered a tribute to Larry here:
In addition to changing medicine, he was a wonderful human being.
Larry Weed was a true visionary, when it comes to healthcare. Many know of his work on POMR, but I wish more would know that involving and empowering the patient has long been an important part of his vision for healthcare.
In 1975, he wrote a book called “Your Health Care and How to Manage It.” In this book, he said:
“The patient must have a copy of his own record. He must be involved with organizing and recording the variables so that the course of his own data on disease and treatment will slowly reveal to him what the best care for him should be.”
“Our job is to give the patient the tools and responsibility to organize the knowledge and slowly learn to integrate it. This can be done with modern guidance tools.”
He is known as the father of the SOAP note, but he should also be known as one of the fathers of the epatient movement.
Wow, that’s amazing, Leslie – thank you. I have no idea how that never came to our attention! I wish I’d known that when I visited him a couple of years ago. :(
In the next few comments I’m going to paste in links to coverage of Weed’s death, which give an usually vivid portrait of the man and his personality.
First, I’ve just now had the chance to fully read Neil Versel’s in-depth post, which I linked to the the first comment. Please do read it. Items:
– Weed’s two standing ovations at the HIMSS physician symposium in 2013 (age 89);
– Enumeration of some of Weed’s books and articles, giving good insight into how differently he saw the fundamental work of medicine. Consider this, from 49 years ago(!): “Since a complete and accurate list of problems should play a central part in the understanding of and management of individual patients and groups of patients, storage of this portion of the medical record in the computer should receive high priority to give immediate access to the list of problems for care of the individual patient and for statistical study on groups of patients.” That may seem common sense today, but remember, Weed was the one who proposed the POMR, and described above. Back then it was a new idea.
– And this, which I hope you’ll remember forever:
Indeed, it could be argued that Weed was a founding father of patient empowerment. Back in 1969, Weed wrote a book called “Medical Records, Medical Education, and Patient Care.” In that, he said, “patients are the largest untapped resource in medical care today.”
Lincoln Weed said that the late Tom Ferguson, M.D., who founded the journal Patient Self-Care in 1976, “thought Dad was one of the originators” of the empowered patient movement.
Thanks, Neil. A great contribution.
John Lynn at EMR and EHR posted a brief appreciation of Neil’s post that adds the perspective of someone who’s newer to HIT journalism. He too says “Everyone should go and read Neil’s full tribute.”
The New York Times obit includes this Weed quote: “I realized then — and it was very upsetting — that they weren’t getting any of the discipline of scientific training on those wards,” Dr. Weed told The Journal of the American Medical Informatics Association in 2014. “When I pick up a chart that is a bunch of scribbles, I say: ‘That’s not art. It certainly isn’t science. Now, God knows what it is.’”
And these – important, because this is (IMO) the main reason his later thinking was rejected:
(There are lessons in this story for people who want to be agents of change.)
Finally, while the above posts are informative and valuable, nothing tells the story from an e-patient perspective nearly as well as geriatrician and SPM member Leslie Kernisan’s podcast episode:
Why Healthcare is Flawed & How to Improve It: The Work of Dr. Lawrence Weed
Please, please, if you want to understand the nature of practicing medicine and how it can be made better, spend 45 minutes listening to it.
I read his articles as a medical student and saved a copy for decades. Landmark concepts still viable today. I saw the lecture before and it is still incredibly relevant in today’s healthcare environment.