Psychiatric Annals

THE PROBLEM-ORIENTED SYSTEM IN THE PSYCHIATRIC HOSPITAL

Robert S McKnight, MD

Abstract

W. P. Mazur THE PROBLEM-ORIENTED SYSTEM IN THE PSYCHIATRIC HOSPITAL Garden Grove, Calif.: Trainex Press, 1974. 94 pp., $10.95.

Brasing his methods on the Weed system of problemoriented medical record keeping, Dr. Mazur, former clinical director at the Osawatomie (Kansas) State Hospital, presents in this manual his Three-Problem List System for the psychiatric hospital with explanations for its use by mental health professionals. His expressed contention is that the Single-Problem List System is inadequate in the psychiatric hospital in conveying the relationships of the various problems to each other. He believes that recording "minor observations" and new occurrences, which may be of considerable importance, in the progress notes by the physician may not be done or may be insufficiently visible. Accordingly, the three lists are designed for use at different phases of hospitalization and for different purposes. In addition, Dr. Mazur has included a list of assets.

List I is the Problem Intake and Intervention Record (Initial Problem List), begun at admission with entries by all staff members and used until the time of staffing, when Problem List II (Main Problem List) is developed by the process of pìanned reorganization and condensation of the Initial Problem List by the entire therapeutic team. This is accomplished by a somewhat elaborate "problem-sorting worksheet" and a sequence-ofevents diagram utilizing a cross-referencing system.

List III is the Temporary Problem List, which is utilized during the remainder of the hospitalization and is equated to the flow sheet in the Single List System. The Main Problem List is updated by selection of problems from this list. To illustrate the method, a sample case is documented first by the Single-Problem List and then by the Three-Problem List.

This illustration clearly reveals the time-consuming complexities of this system, with its use of hand-written notes, charts, and diagrams. It is obvious that legibility of the record is crucial to its usefulness. Another crucial factor in the input of data and in the formulation of the diagnosis and treatment plan is the amount of time required on the part of the team members; if applied equally to a properly kept source-oriented record, such time would allow the job to be done equally well.

It is important that the increasing role of automation in psychiatric record keeping not be overlooked as an expethent method of obtaining, recording, and retrieving data to facilitate comprehensive diagnoses and treatment. Whether this system in its present form is adaptable to automation is open to serious question, but it should be thoroughly considered in choosing a different recordkeeping system. The author makes no reference to this important tool.

While it is generally agreed that the traditional psychiatric records must be improved, problems more clearly defined, and treatment plans more logically determined, the reader must determine for himself whether this particular system is suitable for his needs. He may gain additional information on the subject of the problem-oriented medical record by pursuing the extensive bibliography in the manual.…

W. P. Mazur THE PROBLEM-ORIENTED SYSTEM IN THE PSYCHIATRIC HOSPITAL Garden Grove, Calif.: Trainex Press, 1974. 94 pp., $10.95.

Brasing his methods on the Weed system of problemoriented medical record keeping, Dr. Mazur, former clinical director at the Osawatomie (Kansas) State Hospital, presents in this manual his Three-Problem List System for the psychiatric hospital with explanations for its use by mental health professionals. His expressed contention is that the Single-Problem List System is inadequate in the psychiatric hospital in conveying the relationships of the various problems to each other. He believes that recording "minor observations" and new occurrences, which may be of considerable importance, in the progress notes by the physician may not be done or may be insufficiently visible. Accordingly, the three lists are designed for use at different phases of hospitalization and for different purposes. In addition, Dr. Mazur has included a list of assets.

List I is the Problem Intake and Intervention Record (Initial Problem List), begun at admission with entries by all staff members and used until the time of staffing, when Problem List II (Main Problem List) is developed by the process of pìanned reorganization and condensation of the Initial Problem List by the entire therapeutic team. This is accomplished by a somewhat elaborate "problem-sorting worksheet" and a sequence-ofevents diagram utilizing a cross-referencing system.

List III is the Temporary Problem List, which is utilized during the remainder of the hospitalization and is equated to the flow sheet in the Single List System. The Main Problem List is updated by selection of problems from this list. To illustrate the method, a sample case is documented first by the Single-Problem List and then by the Three-Problem List.

This illustration clearly reveals the time-consuming complexities of this system, with its use of hand-written notes, charts, and diagrams. It is obvious that legibility of the record is crucial to its usefulness. Another crucial factor in the input of data and in the formulation of the diagnosis and treatment plan is the amount of time required on the part of the team members; if applied equally to a properly kept source-oriented record, such time would allow the job to be done equally well.

It is important that the increasing role of automation in psychiatric record keeping not be overlooked as an expethent method of obtaining, recording, and retrieving data to facilitate comprehensive diagnoses and treatment. Whether this system in its present form is adaptable to automation is open to serious question, but it should be thoroughly considered in choosing a different recordkeeping system. The author makes no reference to this important tool.

While it is generally agreed that the traditional psychiatric records must be improved, problems more clearly defined, and treatment plans more logically determined, the reader must determine for himself whether this particular system is suitable for his needs. He may gain additional information on the subject of the problem-oriented medical record by pursuing the extensive bibliography in the manual.

10.3928/0048-5713-19770201-14

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