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Lawrence Leonard Weed
Photo courtesy of Leslie Kernisan, MD
Obituary
Lawrence Leonard Weed Inventor of the problem-oriented medical record. He was born in Troy, NY, USA, on Dec 26, 1923, and died in Underhill, VT, USA, on June 3, 2017, aged 93 years. Larry Weed was one of the great radicals of medicine—but relatively unsung, perhaps because his contribution to health care lay not in identifying a new disease or devising better treatments but in trying to change one of the more prosaic elements of good doctoring: the medical record. Prosaic or not, patient notes are self-evidently vital, and it was Weed’s contention that the art (or science, as he would no doubt have described it) of effective record keeping had been unforgivably neglected. Harold Cross, now retired and living in South Carolina, was a family practitioner in Bangor, Maine, and an early convert to Weed’s ideas, having first encountered him as a student at Yale where his mentor was then teaching. Cross points out that before the 1930s the amount that a doctor could do for most patients was limited. As that began to change, so did the quantities of information about patients that had to be recorded. The conventional form of medical notes as a kind of narrative became ever more cumbersome. “Larry saw that there was a need to have order, so that you could follow each problem distinctly”, says Cross. “If you want to find what’s going on you have talk about the diabetes separately from the gout and separately from the depression.” Weed’s approach to good record keeping can be summarised in two familiar abbreviations: SOAP and POMR. The former, a method of 450
documentation used to create patients’ charts, stands for Subjective, Objective, Assessment, and Plan. Weed devised this as an essential ingredient of what became known as the Problem-Oriented Medical Record. It was not medicine but science that inspired Weed to concoct a more systematic approach to medical records. Following the completion of his medical degree at Columbia University in 1947, and then internships in Cleveland and New York, Weed moved away from clinical work and into basic research in biochemistry and microbial genetics at Duke University, the University of Pennsylvania, and the Walter Reed Army Medical Center in Washington. After a year of clinical work at Johns Hopkins University in Baltimore he then returned to science with an appointment at Yale School of Medicine. It was there, according to Charles Burger, recently retired from practising internal and family medicine, also in Bangor, that Weed began to formulate the ideas that were to preoccupy him for the rest of his life. “At Yale he taught pharmacology”, says Burger. “He was working in a laboratory keeping precise records. But he also had a clinical appointment, and on the wards he found a mess of records that weren’t decipherable to him. That’s when he first came up with the idea [of POMR].” Putting that idea into practice proved difficult. “He couldn’t do it in a big institution because everybody wants to maintain their own turf”, says Cross. “But he had an opportunity to go to a small hospital in Maine…where he could start maintaining records in his unique way.” It was at Eastern Maine Medical Center in Bangor that he put POMR into effect. By 1964, and now running the outpatient clinics at the then Cleveland Metropolitan General Hospital, Weed had begun working on a computerised version of POMR. 5 years later he moved to the University of Vermont College of Medicine in Burlington as Professor of Community Medicine. Despite having a laboratory devoted to his work, he felt it would be easier to promote his thinking within the context of a commercial company. His aim was to devise tools for combining patient data with medical knowledge: “problem-knowledge couplers”, as he called them. He remained with his PKC Corporation until 2006, and even then continued to preach the POMR gospel. A problemorientated approach did eventually become standard practice—but not so all the underlying and more disciplined thinking that Weed believed to be an essential ingredient of his complete medical record system. Burger describes his friend as having boundless energy and a true passion for his ideas. “He was always interested in you as an individual”, he adds, “and because of his vast learning he was a fun person to be around with”. Cross recalls Weed as gentle and perceptive. “He believed in order and truth…Everything he did was to achieve excellence.” Weed leaves a sister, Nancy, and five children.
Geoff Watts www.thelancet.com Vol 390 July 29, 2017
Obituary
Lawrence Leonard Weed Inventor of the problem-oriented medical record. He was born in Troy, NY, USA, on Dec 26, 1923, and died in Underhill, VT, USA, on June 3, 2017, aged 93 years. Larry Weed was one of the great radicals of medicine—but relatively unsung, perhaps because his contribution to health care lay not in identifying a new disease or devising better treatments but in trying to change one of the more prosaic elements of good doctoring: the medical record. Prosaic or not, patient notes are self-evidently vital, and it was Weed’s contention that the art (or science, as he would no doubt have described it) of effective record keeping had been unforgivably neglected. Harold Cross, now retired and living in South Carolina, was a family practitioner in Bangor, Maine, and an early convert to Weed’s ideas, having first encountered him as a student at Yale where his mentor was then teaching. Cross points out that before the 1930s the amount that a doctor could do for most patients was limited. As that began to change, so did the quantities of information about patients that had to be recorded. The conventional form of medical notes as a kind of narrative became ever more cumbersome. “Larry saw that there was a need to have order, so that you could follow each problem distinctly”, says Cross. “If you want to find what’s going on you have talk about the diabetes separately from the gout and separately from the depression.” Weed’s approach to good record keeping can be summarised in two familiar abbreviations: SOAP and POMR. The former, a method of 450
documentation used to create patients’ charts, stands for Subjective, Objective, Assessment, and Plan. Weed devised this as an essential ingredient of what became known as the Problem-Oriented Medical Record. It was not medicine but science that inspired Weed to concoct a more systematic approach to medical records. Following the completion of his medical degree at Columbia University in 1947, and then internships in Cleveland and New York, Weed moved away from clinical work and into basic research in biochemistry and microbial genetics at Duke University, the University of Pennsylvania, and the Walter Reed Army Medical Center in Washington. After a year of clinical work at Johns Hopkins University in Baltimore he then returned to science with an appointment at Yale School of Medicine. It was there, according to Charles Burger, recently retired from practising internal and family medicine, also in Bangor, that Weed began to formulate the ideas that were to preoccupy him for the rest of his life. “At Yale he taught pharmacology”, says Burger. “He was working in a laboratory keeping precise records. But he also had a clinical appointment, and on the wards he found a mess of records that weren’t decipherable to him. That’s when he first came up with the idea [of POMR].” Putting that idea into practice proved difficult. “He couldn’t do it in a big institution because everybody wants to maintain their own turf”, says Cross. “But he had an opportunity to go to a small hospital in Maine…where he could start maintaining records in his unique way.” It was at Eastern Maine Medical Center in Bangor that he put POMR into effect. By 1964, and now running the outpatient clinics at the then Cleveland Metropolitan General Hospital, Weed had begun working on a computerised version of POMR. 5 years later he moved to the University of Vermont College of Medicine in Burlington as Professor of Community Medicine. Despite having a laboratory devoted to his work, he felt it would be easier to promote his thinking within the context of a commercial company. His aim was to devise tools for combining patient data with medical knowledge: “problem-knowledge couplers”, as he called them. He remained with his PKC Corporation until 2006, and even then continued to preach the POMR gospel. A problemorientated approach did eventually become standard practice—but not so all the underlying and more disciplined thinking that Weed believed to be an essential ingredient of his complete medical record system. Burger describes his friend as having boundless energy and a true passion for his ideas. “He was always interested in you as an individual”, he adds, “and because of his vast learning he was a fun person to be around with”. Cross recalls Weed as gentle and perceptive. “He believed in order and truth…Everything he did was to achieve excellence.” Weed leaves a sister, Nancy, and five children.
Geoff Watts www.thelancet.com Vol 390 July 29, 2017