Do you document the race of your patient ?

[flamingemt2011]

Because a thorough history is important, incidents of colitis is higher in middle European's, asians react differently with opiates, blacks have different pulmonary function, first nations have a higher incidents of reaction to first generation antibiotics ... just to mention a few issues.

Walk me through a scenario where your failure to document race in your narrative would somehow harm the patient please.

[NYCEMS9115]

Race doesn't change your treatment but outside EMS/PHC, it is important to note the race. Noting not necessarily documenting.

We as Practitioners ask and document many things that may seem inappropriate. We ask for reason of Emergency Activation. A big Why, What, When, Where, & How. Past Medical, Social, & Surgical Histories. We even include a Working, Family, & Educational History. Medications current and past with compliance habits. Last solid and fluid intake. Events leading to. Recent illness. Travel outside the Country. Names of Physicians. Last Hospitalizations and Diagnosis. Recurrence of symptoms. Over the counter remedies. Illicit drug use. Use of Erectile Dysfunction medications. Physical level of activity. Last bowel movement and how was it. Plus, anything else that may be bothersome. We ask all this to formulate a Diagnosis with the help of Physical Examination and Tests. We all do this but no one questions this method of assessment. The reason why we ask is to get a better understanding so the right health plan regiment can be introduced. Race and Ethnic Culture are part of this assessment not racism and discrimination. As some have stated it is when documenting one's race...

[tniuqs]

Walk me through a scenario where your failure to document race in your narrative would somehow harm the patient please.

I would prefer to waltz, there is no down side in a thorough reporting process for many reasons , ie statistical data gathering (ps because different ethnicity propensity for disease) where you pulled do no harm out of this question is beyond me, all good MDs will go further into a "family history" as well.

ps When one hears the sound hoof beats sure think horses, but don't rule out the family history zebras.

[Dustdevil]

I guess I describe race when relevant the same way I would describe age or sex. Not simply to fill out my forms but to add information that I felt made them different from the 'norm' where medical decisions are/were concerned.

^ This. You can argue the relevance of just about any piece of info on a PCR. But, the more thorough you are, the more respected your assessments will be. It's always amusing to hear someone argue against including items in our assessment, when so many of us are trying to encourage more thorough assessments.

I believe some are confusing race with colour. To describe someone as black or white is absurdly ambiguous. I prefer the actual racial labels, such as negro or caucasian.

[DwayneEMTP]

Ok Dwayne, not trying to put you on the spot, but to help me understand, can you give me an example of when you used race in your documentation to help explain or justify your treatment plan.

There is never any need to apologize for putting anyone here on the spot for statements that they've made, particularly me, as you'll often catch them talking out of their ass. I kind of lost track of the fact that we seemed to be investigating the 'need' to report it as opposed to it simply being 'my way.'

For instance, dispatched for 'failure to thrive, headache.' Find a 50 year old male laying in bed, tachypneic, slightly diaphoretic, history of general malaise for the last few weeks with limited compliance to eating, drinking, medications. Skin cool at extremities, joints painful with movement, urine output decreased, yadda, yadda, yadda..

Should this be a while male, I will be thinking possible dehydration, electrolyte imbalance, cardiac issues. (You'll have to help me out to follow this point as I have a full day and no time to lay out two complete case scenarios), and, say that I feel confident that the majority of his symptoms are coming from dehydration, will attack this problem with fluids.

Should this be a black male with or without a history of Sickle Cell I will treat with fluids as well as pain management, again, assuming that that is where my assessment leads me.

More than being a required part of my PCR, I consider it a part of a thorough assessment. The black male will get a lot more attention to his eyes, the exact condition of his cool extremities, a much more detailed interrogation of family history in regards to SCA, as well as a more thorough investigation regarding diabetes/hypertension/heart disease based not only current symptoms but also racial predisposition.

It's possible that if the ER Doc or Med control looks at the black mans assessment without the mentioned race that they will simply assume that I am too ignorant to do a logical, s/s driven assessment, as it will appear to be all over the place. But list the race and my logic should become much more clear. The same is true for the first, change the race of the first patient to a black man and the Docs should have serious issues as the assessment/ treatment as it was not as thorough as it should have been for a black man with those symptoms.

Yeah, this is a point I shouldn't have made on the fly as I've not taken the time to cut off the "Everyone should get a thorough assessment!' argument, or 'If that is the extent of your assessment you should go back to school!" crowd...grin. But I think that most will get my point and be able to agree or disagree with it based on the above.

I actually love doing narratives on my PCRs. I take it from the beginning of the call, walk through the symptoms, what I saw, what I chose to do based on what I saw and why I chose to do it. It's like a mini call review each time..looking for places that I intelligent decisions, others where I was a bigger idiot than usual. So I guess that that is the spirit in which I list race..who did I treat, why did I treat them that way, how did it work?

Dwayne

Edit. Started my post during the night when I got up to pee and finished this morning without revisiting the thread first so posted on top of Dust. Not my intention to be redundant.

Edited May 23, 2011 by DwayneEMTP

[Siffaliss]

I used to do it when I first started using E-PCR's when I started at my current job over 3 years ago. This was only because it was a field that was there, so I thought I should put something in. Stopped doing it a long time ago because I really don't feel it has any relevance to patient care. Race doesn't affect what I need or need not to do for any patient in particular.

[Chief1C]

I only write down vitals and enough info to get a registration "face sheet" from the hospital. I do the PCR on a computer, then fax it in to where ever we transported. The ePCR won't accept a trip sheet that doesn't have every drop box filled in. Race is one of the items, unless no patient is found. I always fill it in, our former paper trip sheets had no mention of race.

[Siffaliss]

I only write down vitals and enough info to get a registration "face sheet" from the hospital. I do the PCR on a computer, then fax it in to where ever we transported. The ePCR won't accept a trip sheet that doesn't have every drop box filled in. Race is one of the items, unless no patient is found. I always fill it in, our former paper trip sheets had no mention of race.

On our PCR's it's not a mandatory field, so if left empty it doesn't ask for a reason why at the end when we attempt to finalize. Which kinda makes me wonder why it's there in the first place ...

[Chief1C]

I have the admin password, I suppose I could go in and put "not applicable" as a selection. But, just like I've been meaning to put in the major insurance companies.. I probably won't. I'll still enter the info, and fill out a billing slip by hand.

[xselerate]

This topic seems to have been clubbed repeatedly in the head now... let's talk about something fun that we can all agree on like firefighting 101: fire bad, water good... or firefighting 201: more fire bader, more water gooder...

Lol... sorry...