By Joy Daughtery Dickinson, Executive Editor


Is it ethically and clinically appropriate to label patients in the ED as frequent flyers with an airplane icon in their electronic medical record (EMR)? No, according to a viewpoint just published in The Journal of the American Medical Association. 

Every hospital leader knows that there are some patients with serious mental health conditions who come to the ED repeatedly. They also are referring to as “borderlines,” “drug seekers,” “malingerers,” or “treatment resistant,” according to the viewpoint. They have a reputation among staff of draining employees’ time, energy, and resources. In the mind of many staff members, they are a problem. One EMR system uses an airplane icon on the first page of the record to identify the patient to the staff before the patient is assessed.

Labeling a patient as a frequent flyer is inappropriate for two reasons, the author says. “First, the icon reinforces and encourages the use of disrespectful and stigmatizing terminology,” they say. “Second, the icon may frame the initial clinical interaction in a way that inhibits good diagnostic judgment, potentially placing the patient at increased risk of a poor outcome.” In fact, an issue of ED Legal Letter earlier this year discussed a fatal outcome that rose out of complacency with a frequent flyer. (See “Complacency Is Risky for Frequent ED Users with Psychiatric History.”)

Healthcare providers are guilty of stigmatizing these patients, the author says. “Given these facts, the reinforcement of any stigmatizing concept within the medical record system or health information infrastructure is ethically problematic,” they say. A patient’s medical history shouldn’t be off-limits, the authors say. However, putting an airplane icon on page 1 of the medical records discourages providers from digging deeper into the patient’s use of healthcare resources.

At a bare minimum, health IT “should do no harm,” the author says. Icons that stigmatize should be unacceptable, they say. (To keep up with news on ethical healthcare issues, read Medical Ethics Advisor. To stay updated on more ED news, read ED Management.)