October 3, 2017

SOAP-ing on the Hill

By Jacob Froehlich, PhD

Every veterinary student knows the acronym “SOAP.” Subjective. Objective. Assessment. Plan. You don’t receive a DVM without writing at least 500 SOAPS (and that number is probably generously low).

Soap1 soap2During one of my meetings with the three veterinarians in Congress – Rep Kurt Schrader, DVM (D-OR-5), Rep Ted Yoho, DVM (R-FL-3), and Rep Ralph Abraham. DVM. MD (R-LA-5) – the Congressman remarked that the SOAP can be applied to Congress and the legislative process. First, when confronting any patient or problem, one needs to first subjectively characterize that patient or problem. Is the patient a three year old castrated male Doberman Pinscher? Is he bright, alert, and responsive? Is the problem that the United States must currently shares its food-and-mouth disease (FMD) vaccine bank with Mexico and Canada? As you continue reading, note that I will be using FMD and the need for a vaccine bank to illustrate the SOAP process of thinking here.

Subjective: Shared foot-and-mouth disease vaccine bank appears inadequate to quickly respond to any future FMD outbreak.

The objective portion of the SOAP is next. Here, the facts are stated. What is the patient’s heart rate? What is the patient’s temperature?  How many vaccines are available? What is the response time for FMD vaccine deployment in the event of an outbreak in the United States?

O1. FMD vaccines available: 14 strains, with a few million doses each.
O2. Location: Plum Island, NY.
O3. Vaccine manufacturing finished overseas. 
O4. Deployment time: approximately 4 days

Now, with any patient or problem, one must make assessments in order to formulate a plan.

A1. FMD not reported in USA since 1929. 
A2. FMD vaccine bank shared between USA, Mexico, and Canada.
A3. Inadequate number of doses, strains available: rule out (r/o) international North American sharing v. poor federal funding v. no apparent need 
A4. Poor response, vaccine deployment time: r/o overseas manufacturing v. international North American sharing v. antiquated disease 

Based on one’s assessment, the patient’s problem list (or, in this case, the issue’s problem list) is then used to formulate a plan. In my example of foot-and-mouth disease prevention and outbreak response, there are currently 60 strains of FMD and 24 known vaccines to provide immunological coverage for those strains. While FMD has not been identified in the United States since 1929, it’s impact on animal health, welfare, and production would be catastrophic, should it reappear after finding its way back into the country. Hundreds of thousands of animals would be slaughtered and burned, and US exports of animal products would slam closed overnight, wreaking financial havoc on ranchers’ bottom lines and our economy as a whole.

Lastly, as foreshadowed above, a plan is made to address the various assessments and rule-outs associated with those assessments in order to make a positive impact on the patient’s health or the issue at hand.

P1. Request that Congress create a foreign animal disease (including FMD) vaccine bank for exclusive United States use.
P2. Request that Congress direct the vaccine bank to expand the vaccine strains on hand and the numbers of those vaccines available for use. 
P3. Request that Congress fund this vaccine bank adequately in the next Farm Bill.

As you can see from this very simple (but important) example, subjectively and objectively characterizing a problem, assessing that problem, and generating a plan for that problem is not too far removed the process veterinarians use every single day to treat animal patients. As I am sure the Congressmen which whom I met would agree, perhaps Congress would function more efficiently and in a more bipartisan manner if they – the 435 Representatives, 6 Delegates and Resident Commissioner, and 100 Senators – were required to write SOAPs for every problem they faced, just like every veterinary student and veterinarian does for every one of their patients.

Thank you, Congressmen Schrader and Yoho, for taking time out of your very busy days to meet with Derecka and me!