Personal call diary: good idea or not?

[Seaglass]

I work a few EMS jobs on an irregular schedule, and keep running into difficulties getting constructive feedback on my performance. It's becoming apparent that I'm not going to get it, so I'm considering starting a call diary to evaluate my own performance.

I definitely wouldn't include any identifying information about patients, and probably wouldn't include any about other crew members unless it was particularly relevant, even though I'm not planning on sharing it with anyone. Just the nature of the call, whether I did well or screwed up, and what might be a good idea to do differently in the future. To be honest, I think it would only wind up including calls where I performed poorly. Most calls really aren't notable, and I expect myself to do my job well.

Anyone else done this? Did it help? Any insight on whether it could become a legal liability?

 

[Lifeguards For Life]

I have a really bad tendency to over analyze calls in my head. over and over again. the diary seems like a good idea though, especially if you are a visual learner.

 

[wyoskibum]

I would say not a good idea. Anything like this is discoverable by plaintiffs if you were to get sued for any reason. It could be used as amno against you. Just my opinion.

 

[spisco85]

I think if you do it correctly it would be ok. Take run forms that you have written and delete all the patient personal info such as location of call, name, address, phone number, insurance information and delete the tag number.

I do agree though if a patient decides to sue you and you have all this written down with your notes on what you could do better than that can come back and bite you in the ***.

 

[EMSLaw]

Why are you keeping the diary? If it's just to keep track of the number of calls you've been on, that'd probably be fine. Anything with details would worry me.

Since our volunteer company keeps track of calls, for example, I keep my own 'diary' - but it's more like:

10/6/09

18:04 - Medical (Transported to Hospital)
20:15 - Trauma/MVA (RMA)

And soforth, just so I have my own count of calls I've been on.

 

[trevor1189]

I can just log onto EMStat 5 and go into WebCUR and view all my calls year to date and view a full chart. You might want to see if your charting program allows you to do the same.

 

[Dominion]

Depends on how you keep it. Keeping it on your computer or written down somewhere in your home is probably going to be fine. Unless you screwed up enough to get a search warrant of your home (in which case you're probably screwed WITHOUT written proof) then a potential lawsuit will never see those entries. I can see it as a good thing as people tend to be most honest with themselves and keeping atrack record of what you fudged up on and what you can do to make it better probably would help.

 

[medicdan]

I will neither confirm or deny having a call diary for one of the services I work for... But even if one were to be sued, the prosecution can ask you, either in court or in a deposition whether you have any other written record of the call (other then the PCR), and you are compelled to answer truthfully. They dont need a search warrant for your house... they can make you give it to them.

 

[EMSLaw]

Depends on how you keep it. Keeping it on your computer or written down somewhere in your home is probably going to be fine. Unless you screwed up enough to get a search warrant of your home (in which case you're probably screwed WITHOUT written proof) then a potential lawsuit will never see those entries. I can see it as a good thing as people tend to be most honest with themselves and keeping atrack record of what you fudged up on and what you can do to make it better probably would help.

Ummm... there's something called discovery, and if you're a defendant, they're going to demand any records you have, and you'll be obligated to turn them over. If you don't, or if you destroy them, there's something called spoiliation of evidence - which means that the jury will be told that you didn't retain the records, and they can infer that you didn't retain the records because there was information in them that was damaging to your case. It's called an adverse inference, and it's a very bad thing.

Of course, there are other reasons why your personal notes may or may not be admissable in court. That doesn't mean you won't have to turn them over, though. The discovery process is permitted to cast a wide net, and then you argue later over what gets in front of a jury.

 

[Seaglass]

Why are you keeping the diary? If it's just to keep track of the number of calls you've been on, that'd probably be fine. Anything with details would worry me.

Since our volunteer company keeps track of calls, for example, I keep my own 'diary' - but it's more like:

10/6/09

18:04 - Medical (Transported to Hospital)
20:15 - Trauma/MVA (RMA)

And soforth, just so I have my own count of calls I've been on.

I'm not all that interested in counting calls. When I need to, it's done for me.
I'm more interested in seeing whether I'm repeatedly making the same mistakes, or if factors like age of patient or time of day are impacting me more than I think. Hence my worry--anything that makes it in would seem to qualify as an explicit admission of error.

My entries would look something like this:
May, Company W, MVA, midnight: distracted from pt assessment when partner became involved in dispute w/crew from Department Z. Pt care error.
June, Company X, ankle sprain, early afternoon: forgot to bring AED inside. Policy violation.
July, Department Y, asthma, early morning: didn't give medic towel before starting IV, resulting in pt's mother freaking out over spilled blood.
August, Agency Z, cardiac, noon: failed to ask for available relief after performing CPR beyond 2 minutes. Policy and pt care error.

(For the record, these are totally made up.)

I'd be interested in being able to sort by month, company, type of call, time of day, and type of error, in order to see what trends develop. Crew involved, and type of patient would also be nice, but those seem sticky enough for me to leave them out entirely.

At any rate, my eventual goal would be to plug all that data into SPSS three months later and see what's impacting my performance most. At that point, I'd start testing and documenting fixes.

Edit: To be honest, I haven't started yet because I know it could become evidence in court. I'm more just wondering if there's a way to keep it general enough so that a specific call couldn't be identified... or if simply having scientific evidence that I tend to do poorly on a certain type of call would be enough to get me screwed. (And I'm pretty sure my analyses would meet Daubert standards. I'm worried that would make it all the more harmful.)

 

[Mountain Res-Q]

A log for calls? NO. IN a few years it won;t matter what you have written down; all the calls will merge together and you won't remember that happened June 4, 2003 at 1657... unless you have TOO many details, and that would concern me. In fact, rather than help you, such a log could hurt you legally (or at least cause issues). I understand your desire to be evaluated objectively so as to become better, but keeping a log could present problems down the line.

A log for training? That I would recommend and exactly for defense against what others are concerned over: Lawsuits or Investigations. I advocate that every member on the SAR Team keep a personal training log; and the same could be said of Ambo an Fire. Yes, the team keeps logs of ALL the training the team does, but a personal training log allows you to review what kind of training you personally are doing and with what frequency. For us the concern is "what if OES comes at us post 'things-went-bad' and investigated the team"? I know the amount of training and educating I have done hour-by-hour since 2001 and I can reference that and point out that in the last X years I have done XXX hours of Medical training, XXX hours of Swiftwater Training, XXX hours of Ropes training, etc. and I can show exactely what that training consisted of.

 

[Hal9000]

I'll go against the grain a little and say yes. However, the log needs to be consistent, not just pick-and-choose, for calls and for it to look good in court.

Of course, some people are just paranoid. But, as long as it is professional, accurate, consistent, and private, it can only be a help. The EMS Director in one of the states I'm in keeps one...bad or good? He says good. Has he used it in court? I don't know. I know he has gone to court before.

Always keep a log of your training. My girlfriend keeps all of her training and the details, certificates, etc. on a private section of our website, as well as a hard copy. It is available to our members, but we seem to be the only ones that use it.

 

[Dominion]

You first have to admit you have the records before they can find them. I still say yes. If you fudged a call you're screwed one way or another. Don't fudge calls I guess. I have been considering doing this for myself and while not keeping an exact log but more of a 'diary' type deal to help me out personally.

What I have thought of doing is keeping it digitally on a thumbdrive, just a recap of the more interesting days, things that made me step back and think or just I felt I had thoughts that needed to be recorded. Regardless of whether or not you are taken to court and if you do or do not tell the attorneys of your logs is up to you. If you go to court and they ask and you say "No, the only records are the official run reports" unless you REALLY screwed up you're going to be fine. But that's up to you if you want to be honest and bring them up or not.

If you do it, don't be stupid. But if you screw up, it's not going to matter if you write your own records or not.

 

[ffemt8978]

You first have to admit you have the records before they can find them. I still say yes. If you fudged a call you're screwed one way or another. Don't fudge calls I guess. I have been considering doing this for myself and while not keeping an exact log but more of a 'diary' type deal to help me out personally.

What I have thought of doing is keeping it digitally on a thumbdrive, just a recap of the more interesting days, things that made me step back and think or just I felt I had thoughts that needed to be recorded. Regardless of whether or not you are taken to court and if you do or do not tell the attorneys of your logs is up to you. If you go to court and they ask and you say "No, the only records are the official run reports" unless you REALLY screwed up you're going to be fine. But that's up to you if you want to be honest and bring them up or not.

If you do it, don't be stupid. But if you screw up, it's not going to matter if you write your own records or not.

Just to be clear, you're advocating perjury, obstruction, tampering with evidence, and withholding evidence in a situation where your integrity as an EMT may be called in to question?!?

You do realize the consequences if you get caught having your own records after denying their existence in court or a deposition? And if you're willing to lie about even having the records, how can anybody be sure that you're not retaining PHI under HIPAA?

Seriously, if maintaining your own records is that important to you, then you better not lie about them in court. If you lie about one thing, it calls into question the truthfulness, accuracy, and completeness of ALL of your testimony and PCR's. And you would lose whatever benefit you think you would gain by having your own records.

 

[Seaglass]

IN a few years it won;t matter what you have written down; all the calls will merge together and you won't remember that happened June 4, 2003 at 1657... unless you have TOO many details, and that would concern me.

The calls already blend together. When someone asks me what sort of calls I had the night before, I often need to think pretty hard about it to answer. That doesn't really bother me, since my goal isn't to remember every single call. My goal is instead to evaluate my performance, and I don't need details of the date or patient to do that.

As for training, I already keep a document tracking that and my certs, and any conversations about them that I have with state or county OEMS. If I don't, maintaining everything in a few states gets a lot harder.

 

[Seaglass]

Just to be clear, you're advocating perjury, obstruction, tampering with evidence, and withholding evidence in a situation where your integrity as an EMT may be called in to question?!?

For the record, I wouldn't lie about having this log.

However, its nature might be such that it would be very hard to isolate a particular call. At the same time, though, it would sharply reveal any deficiencies I generally have as a provider. I don't think I'm repeating mistakes, but I don't have a good enough memory to know that without documentation over several months. But if I collect that data and a later analysis shows that I usually make way more mistakes on early-morning geriatric calls... and someone's suing my company about an early-morning geriatric call... it could be pretty bad. Although they may or may not be able to isolate their call in particular, the fact that I've scientifically demonstrated the pattern alone seems like it could be almost as harmful.

 

[Kookaburra]

This discussion is interesting, and it makes me wonder where blogs fall under all of this? I've come across several EMS/Fireservice blogs, and they are ridiculously specific about types of calls and in what city the call was... has anyone gotten in trouble for those?

 

[amberdt03]

I work a few EMS jobs on an irregular schedule, and keep running into difficulties getting constructive feedback on my performance. It's becoming apparent that I'm not going to get it, so I'm considering starting a call diary to evaluate my own performance.

I definitely wouldn't include any identifying information about patients, and probably wouldn't include any about other crew members unless it was particularly relevant, even though I'm not planning on sharing it with anyone. Just the nature of the call, whether I did well or screwed up, and what might be a good idea to do differently in the future. To be honest, I think it would only wind up including calls where I performed poorly. Most calls really aren't notable, and I expect myself to do my job well.

Anyone else done this? Did it help? Any insight on whether it could become a legal liability?

i know people who keep ekg strips and made a diary out of those and they write down the nature of the call.

 

[Dominion]

Just to be clear, you're advocating perjury, obstruction, tampering with evidence, and withholding evidence in a situation where your integrity as an EMT may be called in to question?!?

You do realize the consequences if you get caught having your own records after denying their existence in court or a deposition? And if you're willing to lie about even having the records, how can anybody be sure that you're not retaining PHI under HIPAA?

Seriously, if maintaining your own records is that important to you, then you better not lie about them in court. If you lie about one thing, it calls into question the truthfulness, accuracy, and completeness of ALL of your testimony and PCR's. And you would lose whatever benefit you think you would gain by having your own records.

I'm just saying that's an option. It's not my business if someone wants to take that route, I"m just bringing it up just like someone brought up the opposite of disclosing the records.

Imo this falls under the same category as very popular EMS bloggers and the books they have written (books and posts which DO include their mistakes I might add).

 

[firetender]

It's somewhat a shame/horror that so much focus must go to the legal vulnerability aspect of the job these days.

If you specifically keep an ongoing evaluation of what a crappy medic you are...your doubts, poor errors in judgment, rotten timing, remarks or whatever, you're building a case against yourself no matter what you do. You are building a record that very well could be used against you. If it's specifically for that purpose, than to deny the material to the court is illegal.

Personally, I question the utility of taking the time to list all your mistakes. I'd prefer to see your entries reflect what you're learn TO DO, not what you messed up.

That having been said, if you keep a journal that includes themes around calls, along with other notes of a more personal nature, in the unlikely possibility of your being questioned, you have some room to protect your entries.

This field is extremely rich in humanity and any of us who wish to explore it in writing (they call it "Free Speech") should not have to consider this BS. I heartily encourage any and all of you to keep journals.

Ten years from now, when I guarantee you'll still be sorting through your experiences, it can be an invaluable insight into to who you were and who you are, and also offer a unique view of your place in these times.

Who knows, you could make a movie out of it!