The phenomenon of the flipped patient

In a recent article posted in JAMA, authors presented a viewpoint about the phenomenon of the flipped patient when describing the increasing reliance that millennial trainees place on getting to know the electronic health record (EHR) of patients rather than the patients themselves. As I read through the text, I found myself agreeing with the points made by the contributing writers that EHRs are increasingly used as the first line of contact with a patient and afford practitioners the opportunity to get a bird’s eye view of a patient’s history before approaching them in their room.  And while I agree that there’s no substitute for face-to-face interactions with patients, the fact is that admitting teams are often tasked with the responsibility of gathering all relevant histories and exam findings with unrealistic time constraints.

But such time constraints are not isolated to a hospital emergency room. In fact, with the increase in patients with access to health care, more and more primary care physicians are finding that the only way to accommodate the enlarged pool of patients is to decrease the amount of time spent with each one. To some degree, this trade-off requires that physicians embrace new methods of getting to know their patients without having to physically sit down with them to review their histories. In these situations, the EHR is a tremendous resource when used appropriately.

In reference to training for students to prepare them for practice, as a student myself, one of my standardized clinical skills exams required me to perform a complete history and head-to-toe physical on a patient within fifteen minutes with a subsequent fifteen-minute time limit for the formulation of an assessment and plan via the computer. At the time, I found this task daunting, but now I see my fellow colleagues who see patients in the clinic scheduled to arrive every 15 minutes. In cases such as this, physicians have no choice but to rely on relevant histories in the form of an electronic record so they can focus on actually seeing and evaluating the patient’s current condition.

As it was mentioned in the article, most clinical problems can be diagnosed from a patient’s history. It is our duty as medical professionals to verify that the history from which we are forming our differential is correct, which inherently implies that the doctor must talk to the patient and clarify inconsistencies. As more technologically savvy physicians enter the medical field, perhaps our focus should not be on how we can use the EHR to fit into the traditional model of care but rather how we as physicians can transform our clinical practices to maximize the potential of information we can gain from embracing EHRs as a part of a patient’s presentation.

Kerri Vincenti is an internal medicine resident. This article originally appeared in The American Resident Project.

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