Charting

If I were to develop medical charts, I would have a separate section for family history, social history, and immunizations and health care maintenance. Data can be filed neatly in that designated area rather than under a section in the full history and physical exam. Family and social history change very little and do not need constant updating. But from time to time, they become fundamentally important, and you never seem to be able to find the information when you need it.

For example, take a frequent flier to the emergency department who has chartomegaly. Every time he's admitted, the team does a cursory family history and writes something useless on the note. After all, no one takes a good family history anymore; only medical students and geneticists have time to sit down and draw trees and ask how old each family member was with each diagnosis. So people just end up re-doing and re-documenting bad work.

Instead, start a family history section in the chart. After each visit, you can add new information, if any, to that section. You would not have to feel obligated to take and do a bad FHx; if you don't think it's relevant to the visit, you can be confident it would be similar to the one already documented. Once in a while, someone may take a thorough family history and it'll be easy to find. No more flipping through charts looking for that "one note that was so good."

Charts already attempt to do this with allergies, medications, and problem lists. Those fail terribly, but the reason is simple. Allergies are so important that everyone has to ask each visit; no one would just rely on a chart allergy (though having it documented may prompt a provider to ask specifically). Medications and problem lists change too much; no one has the time to update the list diligently and as a result, no one trusts that such lists are updated. But I think that family history, social history, and health care maintenance can benefit greatly from being documented in a separate section in the chart.