Problem Oriented Medical Record (POMR): A Clear Explainer

What is a problem oriented medical record?

The problem oriented medical record is a charting method in which the entire record is organized around an explicit list of the patient's problems. A "problem" can be anything that requires management or attention: a confirmed diagnosis, an abnormal finding, a symptom, or even a social or psychological issue. Instead of flipping through pages of undated narrative, a clinician can open the chart, read the numbered problem list, and immediately see what is being managed and how each item is progressing.

This contrasts with the older source-oriented record, where notes are filed by who wrote them (physician, nursing, lab) and by date, leaving the reader to reconstruct the clinical story themselves.

What are the four components of the POMR?

The POMR is traditionally built from four linked parts:

• Database — the baseline information: chief complaint, history, examination findings, and initial investigations. It is the raw material from which problems are identified.
• Problem list — a numbered, dynamic index at the front of the chart. Problems are added, refined, merged, or marked resolved as understanding improves.
• Initial plans — for each numbered problem, a plan covering further diagnostics, treatment, and patient education.
• Progress notes — ongoing entries that track each problem over time, usually written in the SOAP format and keyed back to the relevant problem number.

How does the SOAP note fit into a problem oriented medical record?

SOAP is the structure of the individual progress note within the POMR. Each note is tied to a specific problem and broken into four parts:

• S — Subjective: what the patient reports.
• O — Objective: measurable findings such as vital signs, examination, and results.
• A — Assessment: the clinician's interpretation of that problem today.
• P — Plan: the next steps for that problem.

Because each SOAP note maps to a numbered problem, the record stays legible: a reader following "Problem 2" can trace its whole course without untangling unrelated issues.

Why did Lawrence Weed create the POMR?

The POMR was developed by American physician Lawrence Weed in the 1960s. Weed argued that the conventional medical record was disorganized and made it hard to see a clinician's reasoning or to audit the quality of care. He proposed that structuring the chart around defined problems would make thinking explicit, support teaching, and let any member of the team pick up the record and understand the plan. The SOAP note and the numbered problem list both come from his framework.

What are the pros and cons of the POMR today?

Strengths that keep it in wide use:

• Makes clinical reasoning visible and easy to audit or teach.
• Improves continuity when care is shared across a team or shifts.
• Gives a fast, structured overview of a complex patient.

Common criticisms:

• Maintaining the problem list takes discipline; a stale or duplicated list misleads.
• Rigid SOAP structure can encourage repetitive copy-forward notes.
• Overlapping or interacting problems do not always slot neatly into separate numbers.

What does a POMR look like in practice?

Here is a short illustrative problem list followed by a single SOAP progress note for one problem:

PROBLEM LIST
1. Type 2 diabetes mellitus        (active)
2. Hypertension                    (active)
3. Diabetic foot ulcer, left heel  (active)
4. Appendectomy, 2009              (resolved)

PROGRESS NOTE  -  Problem 1: Type 2 diabetes mellitus
S: Reports better adherence to diet. No hypo/hyperglycaemic symptoms.
   Checking home glucose most mornings.
O: BP 132/80. Weight stable. Fasting glucose log 6-8 mmol/L.
   HbA1c result reviewed and trending down from last visit.
A: Type 2 diabetes improving on current regimen; glycaemic control
   moving toward target. No new complications today.
P: Continue metformin at current dose. Reinforce diet and activity.
   Repeat HbA1c in 3 months. Annual retinal and foot screening due.

Is the POMR the same as a SOAP note?

No. The POMR is the overall organization of the whole chart around a numbered problem list, while a SOAP note is the format of one progress entry inside it. You can think of the problem list as the table of contents and the SOAP notes as the chapters that report on each item.

Is the problem oriented medical record still used in electronic records?

Yes. Most electronic health records carry a structured problem list and offer SOAP-style note templates, both direct descendants of Weed's model. The terminology and numbering may differ between systems, but the core idea of organizing care around explicit, trackable problems remains standard practice.

Does the format change the time it takes to document?

It can. A well-kept problem list speeds future visits because context is already structured, but writing thorough SOAP notes for every problem still takes time at the point of care. This is one reason AI medical scribes exist. Doctor Notes, for example, drafts a structured SOAP-style note from a visit recording so the clinician can review and edit rather than type from scratch; the underlying organizing principles described here stay the same.