Race in a narrative

twarrick0831

twarrick0831

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Question....when you do your narrative, do you include the patients race? I do, because it is an identifying factor when "painting your picture" of the scene. However, I have been told that it is racial and opens a door for litigation. What are your thoughts, concerns and/or experiences?
 
Do you ask them what race they are? No? Then how do you know if they're Hispanic, Asian, Pacific Islander, mixed? You don't know what race they are unless you ask. And it has no bearing on your assessment or treatment. So no, I don't include it, and I don't know anyone that does.
 
I include in my narrative those details that are relevant to the situation at hand. I have yet to have a patient for whom their race was relevant to their condition or its treatment.
 
Is that a serious question and reason?

It's always "the pt." You don't need to write out what race you think they are to paint a picture. Its pretty obvious who you are talking about considering you have their name, address, and social. That's all your company has to know.

Now for thinking it would help you in court to remember the call then whatever I guess do what you please and hopefully it doesn't bite you one day. You usually have a feeling if a certain call is going to be going to court. For most people just rereading the ePCR will jog their memory, but you can always write stuff down in a notebook that you wouldn't write in a PCR, if you think you had a sketchy call.
 
I absolutely would include race as it is a descriptive identifier of your patient. Yes, you do not know the breakdown as they could be a very white looking Hispanic or they could be an adopted Islander who looks nothing like the race they would normally claim. Describe it as best way you see it at that time.

Do you put their sex down? Are you sure they are a male or a female? Or a little bit of both? If you are going to say you do not know their race then I also contend you do not know their sex. You are making an educated guess based on information in front of you at that time. Instead of guessing, why don't you flat out ask them? Where is the offense? Sir or Ma'am which race do you normally identify as...you ask every other personal question, what is wrong with this one?

Can a white looking black male have sickle cell??? What if they are giving you every sign for sickle cell crisis but you do not connect the dots because you do not know the race? Sure, your treatment will be the same but wouldn't knowing this connect it faster?

Also, I have worked VERY busy systems in major tourist areas...having a race and nationality has actually helped me recall cases down the road. I have been in court a few times in my couple decades of doing this and all of them were years after the event. When you want to recall that, knowing a specific race or any other memory jogger would be very beneficial.

Knowing on 18th August I worked a MVC with 4 males at X and Y intersection is meaningless when in that very same shift I could have had same scenario but it been 4 males of different race or mixed or all kinds of combinations.

So I disagree with the above responders and think you should put down race and anything else to help you and if in doubt ask...cause there was this one time I cut off a woman's pants after a rollover MVC only to discover she was a he...race is no different.
 
Race is absolutely a pertinent detail. It has many potential clinical implications.

I've always charted it. I'd say 95% of the H&P's that I read include it.

Nationality is pertinent as well.
 
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Our PCR's have a drop-down list that allows you to select a race. There is also an option for "unknown"
 
Eh, now that I think of it, we have a drop down meno on our ePCR that asks race and we always put it in. Same thing I suppose. Just be careful how you write it yourself.
 
Exactly. There's a drop-down for race in every ePCR I've ever seen. There's no reason to include it in the narrative (which is what the OP asked about) unless it is in some way relevant to the patient's condition or the treatment administered.
 
You are operating on the assumption that everyone has an ePCR and a nifty drop down box.

Typical Narrative: Responded to Resp Distress. On scene found patient to be a 55 year old black male tripoding in obvious distress.....and so on. Easy to mention and relevant. Not racist in any way.

Edit: Every copy of my own personal medical records and records I have collected when transporting patients to move to a higher level of care have included race in the narrative.
 
What? You mean knowing the race of patients could also assist with future studies on various conditions and race? Could it also reveal some disparities in care received? Could it give indicators of which races are more susceptible to certain conditions or races within a certain area being more impacted than same races in other areas? Lot of data...useful, beneficial data can be pulled from studies. Studies are not always performed on from this point forward we will monitor X....a lot of times it is we will pull data from this past date until now or past date and then some forward data.

Really need to get off the hang up on reporting race and trying to imply it has no use (whoever may do this).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924616/
 
Why does it need to go in the narrative? There is a place to document race in another area.
 
Race goes in the demographics section of our ePCRs. I have yet to see any provider place race in the narrative.

Even from doing countless IFTs I have never seen the race in any other section aside from the demographics.
 
"Pt is a ## y/o AA/caucasion/whatever M/F....."

Race can have clinical implications and can be a risk factor for multiple diseases. I would argue that including it to "paint your picture of the scene" could be viewed as racist, so maybe OP should think/research more about how ethnicity and genetics can lead to epidemiologic and pathophysiologic differences.
 
akflightmedic said:
What? You mean knowing the race of patients could also assist with future studies on various conditions and race? Could it also reveal some disparities in care received? Could it give indicators of which races are more susceptible to certain conditions or races within a certain area being more impacted than same races in other areas? Lot of data...useful, beneficial data can be pulled from studies. Studies are not always performed on from this point forward we will monitor X....a lot of times it is we will pull data from this past date until now or past date and then some forward data.

Really need to get off the hang up on reporting race and trying to imply it has no use (whoever may do this).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924616/
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Not sure what "hang up on reporting race" you're referring to, since those of us who argue against including race in the narrative have noted that it is redundant to the reporting of race that occurs in the demographic section of the PCR. By the same token I don't typically include vitals in my narratives other than to note "vital signs as documented" since there's a section of the PCR dedicated to recording vital signs.

Interesting article, by the way, although I'm not convinced that it makes the case you think it does. Regardless, thanks for sharing it.
 
Angel said:
Why does it need to go in the narrative? There is a place to document race in another area.
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...because most narratives/HPI/etc starts out along the lines of ___y/o M/F presenting with a CC of ___. However, age, sex, and chief complaint are often elsewhere as well.

In regards to whether it's pertinent or not, there are conditions that exist more often in some races than others, and even some tests. The traditional calculation for glomerular filtration rate under calculates the level for people of African ancestry and has to be corrected for that.
 
I would like to point out that some of you have repeated that the race is reported in other parts of the PCR. Again, as stated earlier...you are making an assumption that other PCRs are similar to yours or everyone has ePCR with a drop down box.

Also, look up definition of narrative. It is my story of what I see and what I found. Aside from the clinical aspects and other support I have posted...it is my story of what I see at this time and place.
 
If by narrative you mean the radio in to the hospital, I don't see why it would make that much of a difference. They're going to see when the Pt gets there anyway, and like someone said, you might have someone who passes. *shrug* Anything having to do with susceptible diseases (sickle cell, HIV, cancer, etc.) will probably be documented and reviewed in hospital if it's relevant, but that would be between pt and doctor (meaning non-pertinent history; I don't care about your dad's heart attack in '97 if we're bumbling along with a broken leg). But for all the paperwork and everything, fine, let the statisticians work out their numbers.

I guess part of my point would be someone who says they have a history of heart disease and has had a heart attack in the past. Am I going to broadcast to the ED that this patient is 300# because statistically this person would be susceptible to heart disease? No. Maybe the hospital will assume; maybe they won't. Or someone has is HIV+ or full-blown AIDS. Does it matter, between that person's house (or wherever) and the ED, if this person is black, white, or purple with yellow polka dots? Are there different pills for them to take? I've never seen a case where melanin directly affected patient care.

But like I said, if the state wants it to crunch their little numbers and make pretty pie charts, whatever, let them worry about it.
 
Calico...either you did not read or you did not comprehend. Nothing to do with the "narrative" as you defined to be a hospital verbal report. We are talking about the actual written report. The rest of your wild tangent was superfluous.
 
Calico said:
I guess part of my point would be someone who says they have a history of heart disease and has had a heart attack in the past. Am I going to broadcast to the ED that this patient is 300# because statistically this person would be susceptible to heart disease?
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It might change what hospital the patient goes to if the current destination's cath lab table's weight limit is under the patient's weight.

No. Maybe the hospital will assume; maybe they won't. Or someone has is HIV+ or full-blown AIDS. Does it matter, between that person's house (or wherever) and the ED, if this person is black, white, or purple with yellow polka dots? Are there different pills for them to take? I've never seen a case where melanin directly affected patient care.
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Actually, there is different pills and medication combinations for patients depending on their ethnicity.
http://www.ncbi.nlm.nih.gov/pubmed/11558858


But like I said, if the state wants it to crunch their little numbers and make pretty pie charts, whatever, let them worry about it.
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Why do you hate evidence based medicine?
 
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