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These principles can help keep your patients' problem lists well-curated and useful.

Fam Pract Manag. 2023;30(3):5-9

This content conforms to AAFP criteria for CME.

Author disclosures: no relevant financial relationships.

pruning problems

If you have an electronic health record (EHR), you are familiar with the problem list — the list of conditions that have been associated with each patient at some point in time. At its best, the problem list gives a quick and easy-to-understand summary of the patient. If it's not up to date, however, the problem list can become so unwieldy it's not useful or, worse, it's deceptive.

Keeping problem lists orderly is more complicated if you work for a large organization with multiple specialties that share the lists. It requires the entire team; but as primary care physicians (PCPs) and “captains of the ship,” we often have ultimate control over — and therefore responsibility for — the list.

There is no single way to organize a problem list, and no national consensus about it in the U.S., although there is in some other countries.1 Therefore, in many organizations, the problem list is a catch-all for capturing visit problems, symptoms, past medical history, family history, allergies, etc. In this article, we focus on using the problem list for only chronic conditions and recurrent acute problems considered important for patient care, and we present some principles to help you organize your lists.


  • The problem list can provide a useful snapshot of a patient's current health needs, but only if it's up-to-date and complete.

  • Problems that are no longer active but still affect treatment can be given a “History of” designation and stay on the list. Problems that no longer affect treatment should be removed.

  • Because family physicians are responsible for the ongoing care of the patient, curating the problem list often falls to us, but it should be a team effort.

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