Arjun Khadilkar: 6 components that may be helpful for writing a good progress note

Arjun Khadilkar, Cardiology Fellow at Indiana University Health, shared a post on X:

“One of the most important (and common) things to do in residency is to write a good progress note.

Here are 6 components that may be helpful for you!

1). Subjective:

• This is pretty straight forward and it is what the patient is telling you (No objective data)!
• Make sure you focus on their relevant clinical presentation and ask specific, focused questions.
• Usually, can be pretty brief, maybe 3-4 sentences.

i.e. ‘Patient did well overnight without any acute issues. He says that he slept well overnight. This morning, he denies chest pain, shortness of breath, nausea, vomiting, or abdominal pain. He was looking forward to eating breakfast.’

2) Physical Exam:

• Usually, your note should have a template that is built in with the EMR.
• In general, the physical exam should not change significantly from day-to-day.
• However, there are certain instances, where you should document changes ( such as: diuresis with HF, improvement with COPD exacerbation, post-surgical changes).

3) Vitals/Labs:

• Should usually be auto-populated
• Make sure you ‘refresh’ the note before signing it to have the most updated objective data possible (sometimes it can be slightly outdated if you open the note earlier)

4) Relevant Imaging Findings:

• Again, this should be auto-populated
• In some EMR (i.e. CPRS, you may have to copy paste from previous notes).
• You don’t need to include every single imaging study, but would focus on the relevant or abnormal ones.

5) Assessment

• This is the most important part of the note (and where everyone else that reads your note will focus on).
• You have to see what style works for you and adopt it (problem-based versus paragraph)
• The stronger assessments you have, the more you will shine clinically and earn the respect of your attendings and colleagues.
• Some effective notes have a short paragraph followed by problems.

I.e. ‘Mr. Smith is a 78-year old male with comorbid history significant for insulin-dependent diabetes (A1c: 7.2% in 2/2024), hypertension, hyperlipidemia, COPD (on 2L baseline O2), and heart failure with reduced ejection fraction (EF of 34% on 3/1/25) who presented with decompensated heart failure in the setting of medication non-compliance on 3/1/25.

6) Plan

• Another super important portion of the note
• Personally, I like to have a small paragraph (see above) that highlights the major clinical course (or a brief hospital course) that others can quickly review to understand the clinical context. Then, I usually go into a problem-focused approach.

I follow a simple approach

1. Problem
2. Supporting Data
3. Plan to address to address the problem

Heart Failure with Reduced Ejection Fraction, Non-ischemic cardiomyopathy

• Presented on 3/1/25 with decompensated HF, volume overload, and BNP: 1000 (baseline ~300 in 2/2025)
• Weight on admission 320 pounds (b/l: 300 pounds)
• Endorsed non-adherence with medications
• Had a LHC recently completed in 2/2025 with non-obstructive coronary artery disease
• Home regimen includes: Spironolactone 25, Empagliflozin: 10, Entresto 24/26, Metoprolol Succinate 25

Plan:

• Continue to monitor on telemetry during inpatient stay
• Maintain Mg > 2 and K > 4
• Maintain BP < 130/80
• Continue diuresis with IV Lasix 80 mg BID and strict I/O
• Resumed home oral GDMT
• Will need outpatient follow-up with Cardiology after discharge.

With this method, you can focus on adjusting the plan portion on a day-to-day basis (the supporting data should be pretty consistent)

Let me know what you think! The key is to develop your system and continue to repeat (and refine it) until it become second-nature.”