I am working on a teaching case for medical students and I have a genuine question: why do we present “mystery cases” in the order of the H&P even though this is almost never the order that information is given/collected in the real world? #MedEd

When I take an admission, I do a quick chart triage before even calling for signout. I do it in this order:
1.Vitals
2.Quick review of labs/imaging
3.Medications
4.Most recent clinic note
5.ED documentation
http://6.Call  ED for verbal signout

I do this so that I can make sure the patient is appropriately triaged for admission. It also allows me to ask more useful questions to the ED provider when they sign the patient out and guides my physical exam when I see the patient (e.g. good volume status exam if hyponatremic)

ED docs and PCPs are probably the closest to gathering info in an H&P order, but even then there will usually be vitals and triage labs before they see the patient. So this brings me back to my question: why practice something that is essentially never done in the real world?

I am leaning towards preparing my case in the order information would actually be presented in the real world (including giving that troponin that was ordered for God knows what reason and happened to be significantly elevated).

Does anyone have an opinion on why we do this the way that we do? My primary concerns with my approach is that it may lead to anchoring/confirmation bias and it is not as “patient-centric” because it is driven (at least initially) more by the objective than the subjective.

Here is an interesting article asking a similar question about why do we document the H&P in notes/presentations differently than we actually assess the patient in real life? https://pubmed.ncbi.nlm.nih.gov/28096709/