Calico
Forum Probie
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My, my, my, people are testy around here this evening, aren't they? I'm just the EMT, not the whole hospital. I'm glad you guys are, though. Makes me feel safe and secure.
Race in a narrative
- Thread starter twarrick0831
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You're a student, maybe try and glean a bit of education from the postings here instead of spotting off?
A narrative is not related at all to a radio patch to a hospital, just by the way.
JPINFV
Gadfly
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1. Some of us do actually use this information in our practice.
2. The inpatient teams really do read EMS reports. Honestly... we do.
Brandon O
Puzzled by facies
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Yeah, gotta nail that eGFR before you hit Main St.
I write novellas for my narratives and even I don't really see much utility in mentioning race. Painting a picture is one thing, but there's a legitimate objection if you're only mentioning it to "add color" without medical relevance. Like telling a story that starts, "So this gay guy was being an *******... not that it matters he was gay, but, uh..."
I suppose I can think of rare cases where it might be relevant, such as a question of sickle cell. I wouldn't do it routinely, any more than I'd get into three generations of family history or a complex social history... there's a point where subtle risk factors have no bearing on emergency medicine and you don't have to dig very far to get there.
JPINFV
Gadfly
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Does it apply much or often to EMS? No.
Do I normally use it in my ID section? No.
Can I see why people do? Yes.
Is saying "it has no bearing on patient care" 100% wrong? Yes.
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I'm yet to come across an ePCR program that does not ask for race in the demographics section. In Colorado your program must meet certain data reporting requirements to allow for data exchange and mining, I imagine race is one of the criteria.
akflightmedic
Forum Deputy Chief
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Testy? Hmmm, let's see...several of us have given references to support our position from credible, reputable sources. Some have weighed in with anecdotal experience as well (me), and some of us here who used to be EMTs or Medics are now doctors and large business owners in the medical field. Yet, the only replies against it...."well, you just shouldn't", "it is racist", or a sassy attempt at an insult.
Please bring the data and counter with a legitimate point, otherwise you are simply doing a disservice to the younger folks who are asking great questions.
I cannot believe in this day and age, we still have such ignorance among so many in our ranks.
Please bring the data and counter with a legitimate point, otherwise you are simply doing a disservice to the younger folks who are asking great questions.
I cannot believe in this day and age, we still have such ignorance among so many in our ranks.
ExpatMedic0
MS, NRP
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I don't use it in my narratives nor have I ever been trained to do so. Aside from the narrative section of my PCR there have always been mandatory demographic information such as age and sex, which must be populated, race has never been one of them. I have worked for private, for-profit, non-profit, and government EMS agencies in systems using SOAP charting, paper PCR's , and ePCR point and click systems, for a decade. I've never been dinged by QI/QA or medical oversight for not mentioning it. However, in some middle eastern countries I have been mandated to document the patients nationality(not to be confused with ethnicity or race), but this is a pre populated mandatory field, the same as sex, age, ect. Just my 2 cents, not saying your wrong or right for doing it, but I see little, if any relevance for most prehospital circumstances.
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If race is in the demographics section of a PCR, then it probably is redundant to put it in the narrative as well. However, what I took from the OP's question wasn't "should I put race in both the demographics section and the narrative", but rather "should race be charted at all"?
Personally, I do not re-write anything that was already documented elsewhere, unless it is an important piece of information that is critical to the patient presentation or response to treatment that I am trying to describe in the narrative. For instance, I might put "patient found supine on ground next to car, minimally responsive" in my narrative even though I already charted "6" in the GCS box. Or I might write "BP improved after XYZ drug given", even though that drug and the VS are charted elsewhere. Race is probably not pertinent in that way, I would agree - so I would probably never document it anywhere other than the demo section.
However, the bigger picture is that in clinical medicine, race is pertinent because it can have direct clinical implications, as well as social implications that are known to affect health status. Probably not as likely to be clinically important as age or BMI or even gender, but definitely important enough to be considered. A comprehensive HPI that includes age, gender, PMHX, FMHX, CC, presenting problem, ROS, height/weight, and diagnostic data will almost always include race, because it is a part of the overall clinical picture. If nothing else, you can put it in the same class as descriptors such as "well-appearing".
Is it important for EMS to chart? Probably much less so, because by the time your written report is finished, the patient has already been seen by ED staff, so they don't need to be "informed" of race at that point. And if the inpatient staff later refers to your PCR for some reason, they will likely have already seen the patent or at least the rest of their chart, so will already be aware of things like age, gender, and race.
So you probably won't be causing your patient any harm down the road by failing to document race in your PCR, but if your goal is to communicate a comprehensive overview of your patient's health status, race is a pretty standard part of that.
Personally, I do not re-write anything that was already documented elsewhere, unless it is an important piece of information that is critical to the patient presentation or response to treatment that I am trying to describe in the narrative. For instance, I might put "patient found supine on ground next to car, minimally responsive" in my narrative even though I already charted "6" in the GCS box. Or I might write "BP improved after XYZ drug given", even though that drug and the VS are charted elsewhere. Race is probably not pertinent in that way, I would agree - so I would probably never document it anywhere other than the demo section.
However, the bigger picture is that in clinical medicine, race is pertinent because it can have direct clinical implications, as well as social implications that are known to affect health status. Probably not as likely to be clinically important as age or BMI or even gender, but definitely important enough to be considered. A comprehensive HPI that includes age, gender, PMHX, FMHX, CC, presenting problem, ROS, height/weight, and diagnostic data will almost always include race, because it is a part of the overall clinical picture. If nothing else, you can put it in the same class as descriptors such as "well-appearing".
Is it important for EMS to chart? Probably much less so, because by the time your written report is finished, the patient has already been seen by ED staff, so they don't need to be "informed" of race at that point. And if the inpatient staff later refers to your PCR for some reason, they will likely have already seen the patent or at least the rest of their chart, so will already be aware of things like age, gender, and race.
So you probably won't be causing your patient any harm down the road by failing to document race in your PCR, but if your goal is to communicate a comprehensive overview of your patient's health status, race is a pretty standard part of that.
Brandon O
Puzzled by facies
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Recording race as a demographic for data purposes is different from adding it to your narrative. The latter (as you say) is optional, so adding it implies that it's relevant to the clinical picture. And while I also don't think it's a big deal and this easily fits into the realm of practice variation that I couldn't care less about, if you ask me, it's usually not super relevant.
But we've probably already written far more words on this subject than it deserves.
But we've probably already written far more words on this subject than it deserves.
Shishkabob
Forum Chief
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Sure it does. There are conditions that are much more prevalent in certain races than others, and many diseases have been tied to have higher risk factors for certain races. Sickle cell, hypertension, CVA, MIs... all have been linked or are more prevalent in one or some races over others. While it's possible, the likelihood of your blonde haired, blue eyed, Norwegian tourist having joint pain has sickle cell is not that high.
Genetics aren't racist, and realizing a black or hispanic / latino person is more likely to have a certain disease doesn't make you racist, it makes you a clinician.
gotbeerz001
Forum Deputy Chief
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Agreed. I do not rewrite that I performed a 12-lead unless it makes a difference. I already wrote the details in my interventions. If it's not listed, it is presumed to be normal. Furthermore, the 12-lead is uploaded on page 5 for them to see.
I still want the MD/Nurse/PA to read my whole PCR. I can paint a good picture without allowing them to run with just the highlights.
Angel
Paramedic
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The way you guys are talking it seems like you put every detail and bit of history in your pcr. Unless it's pertinent to the call at hand (ie sob with hx of asthma and takes albuterol atrovent ect) it generally doesn't get included.
Just because their black and sickle cell mostly affects blacks has little to nothing to do with their fever and back pain today...so??? And if it did WHY does it belong in the NARRATIVE?
What do you write? "PT having all over body pain and is black so treated for sickle cell anemia."
You guys are reaching
Just because their black and sickle cell mostly affects blacks has little to nothing to do with their fever and back pain today...so??? And if it did WHY does it belong in the NARRATIVE?
What do you write? "PT having all over body pain and is black so treated for sickle cell anemia."
You guys are reaching
JPINFV
Gadfly
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Because the standard for writing a HPI involves starting with an identification sentence to introduce the reader to the situation. I don't care whether it was at a physician or an EMT, I've never seen a good narrative/HPI that doesn't start along the lines of "[Dispatched to a] 45 year old male presenting with a C/C of _____." Every single bit of that information is someplace else, but it's being tied together to start the story and give the reader a perspective.
Oh, and back pain, black and sickle cell? Salmonella osteomyelitis has a much higher incidence in patients with sickle cell.
I wonder how many people ever stopped to think how much better the world would be if all the PC BS went away...
I've got a question for everyone who says that the patients race doesn't matter and there is no reason to mention it; if it really doesn't matter, then why do you seem to care so much when it does get mentioned? If it's not important, why are you so concerned with it?
I've got a question for everyone who says that the patients race doesn't matter and there is no reason to mention it; if it really doesn't matter, then why do you seem to care so much when it does get mentioned? If it's not important, why are you so concerned with it?
Shishkabob
Forum Chief
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I make over 1200 patient contacts a year. Every detail I put in my chart, be it "Black male" or "Patient was missing pants, had purple shirt on", can help me remember things in the future, if / when I get asked about it. No, not every single detail makes it in, but seemingly needed ones do.
I may have run 10 shootings last year, only one was a white female. Does being a white female pertain strictly to the fact they were shot? Probably not. But seeing as how it was the only ''white female shooting'' I ran, it can jumpstart my mind on the call.
Angel
Paramedic
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bahaha, ok. do you also include hair color? eye color? how was their hair styled? tall? short? scars? tattoos? color of their shoes? What about the fact that is was raining?
since there is a SECTION in the beginning or TOP of the PCR that asks, pt name, GENDER, birthday and race.... I could see why you ALSO need it in your narrative...again....for the second, maybe third time in your PCR.
If you cant figure it out based on that...then by all means, write it 8 times if it helps
I guess my memory is better than I thought.
Cheers
Shishkabob
Forum Chief
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Not everyone has the same PCR software, not everyone has every option to choose in their software (heck, even paper) that others do.
JPINFV
Gadfly
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Quick question, when you write a narrative, what do you start off with when you write it? Any sort of standard phrase?
akflightmedic
Forum Deputy Chief
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I gave an example earlier and I raised the same issue about paperwork or ePCR.
The ones against this have consistently mentioned how their software has spaces for this identifier. Huge asinine assumption to make that everyone has same paperwork or same computer software.
Additionally, my narratives have always been like this....
M-1 responded for report of chest pain. Upon arrival, found patient to be 57 y/o black male sitting in chair clutching chest with obvious signs of respiratory distress. .....on and on
Mentioned his race one time and it was slipped right in there. I fail to see the issue of race reporting.
The ones against this have consistently mentioned how their software has spaces for this identifier. Huge asinine assumption to make that everyone has same paperwork or same computer software.
Additionally, my narratives have always been like this....
M-1 responded for report of chest pain. Upon arrival, found patient to be 57 y/o black male sitting in chair clutching chest with obvious signs of respiratory distress. .....on and on
Mentioned his race one time and it was slipped right in there. I fail to see the issue of race reporting.