Can you diagnose in the field?

[Just Plain Ruff]

I know the legal answer to the question in the topic is NO we cannot but I'd like to hear honest responses to the question.

Can we as medics or EMT's diagnose in the field and if your answer is yes please explain.

I guess what I'm asking was prompted by a previous post about coercing a refusal.

I know that I've in the past told a patient it was probably a vagal reaction or a simple laceration that could wait to be transported to the ER in a private vehicle but............ can we ethically promote a diagnosis in the field? I know we've all done it but I'm just curious if anyone here will admit to being able to diagnose in the field and what the rationale is behind that thought process?

[medic-26]

Well, here is my opinion for what it is worth. I feel that we have to be able to provided some sort of field diagnosis before we can treat the presenting complaint. True diagnosis, no. I would say it is more of a differential diagnosis. Come up with a list of possible causes for the presenting complaint and attempt to narrow it down from there. But that is my opinion only...

[paramedicmike]

Absolutely! We diagnose in the field all the time! Now, the question should be "are we correct in our diagnosis and if we're not then why?".

When we formulate a list of differentials, we're looking at all the diagnostic possibilities. The more information we get from our detailed assessments the more we're able to limit our differentials. The more we limit those differentials, the closer we get to a diagnosis.

When we call the hospital and tell them "This patient is having a stroke", we diagnosing based on the assessment in the field.

Sometimes it's easy to do. Take for example two patient's I had yesterday. One had fallen and her arm had a rather nice deformity. It's a pretty easy diagnosis to say, "Ma'am, I hope you don't have to cook Thanksgiving dinner because you're arm is, in fact, broken." Or the other lady who had sudden onset left sided weakness, slurred speech and a pounding headache. She was having a stroke. That's what I called it and the ER doc confirmed it.

However, it's not always so easy for us given our limited education and training (yet again, another topic).

Legal standing aside, we make diagnoses every time we look at a patient. It's our determination, based on our assessment, of what is wrong with the patient. In order to prescribe drugs (yes, we do that, too, in a fashion), we have to have a diagnosis.

-be safe.

[Ridryder 911]

Yes, we diagnose. Period. You assess the patient, determine no pulse, start CPR (tx.) then what else would you call it ? Maybe field clinical impressions?..

Whenever, and if ever EMS matures and becomes educated, then & only then we can legitimately start discussing our own field diagnose categories and classifications. They will have to be different name as medical diagnoses, (since we cannot legally use those) but could be similar to the NANDA Dx. such as impaired oxygenation etc... the same thing, except semantics for legal purposes.

Hopefully, EMS will mature in educational and professional standards to gain this. Reimbursement rates will be better collected, and the professional will have its' own standards to follow.

R/r 911

[CCMHmedic]

Our Medical Director encourages a thorough field diagnosis. When we encode to the receiving facility, they, in part, depend on that diagnosis to better prepare for that patient's arrival. Once we arrive, he will almost always take the time to get with us and explain whether we were correct or not, what we might have missed, anything else we could have done, etc....I like that our Director encourages his medics to think for themselves. He has a lot of confidence in the information we provide, and respects our level of training and experience. It helps that he is also a paramedic. (grin)

[Doczilla]

Yes, and in fact, it is required. You have to at least some idea of the patient's problem in order to apply appropriate treatment, as Medic26 alluded to. There are some who advocate the sole use of chief complaint or physical signs as diagnosis in the field, but "shortness of breath" just doesn't cut it if you are going to do anything to treat it. Presumed CHF? Bronchospasm? Myocardial ischemia? Pneumonia? All of these have vastly different treatments. You have to have not only a differential, but a leading suspect. Things aren't always that clear, so you have to put down a complaint in the dx box sometimes (abdominal pain of uncertain etiology, dyspnea NOS, altered mental status). But overall, you've got to have an idea of what you're treating. Otherwise, you're just throwing treatment at someone and hoping something works, and that's no way to practice.

'zilla

[Dustdevil]

All day. Everyday. If all I could do was take people to the hospital and tell the doctor, "His tummy hurts," I would rather work at McDonalds.

I prescribe too.

One without the other is kind of pointless.

Am I comfortable with other medics doing so? Damn few of them! In general, no. But, as Rid said, the profession certainly has the potential to progress towards that ideal if they ever get the firemonkeys out and up the educational standards to professional levels.

[lee357]

I RECENTLY FINISHED THE INTERMEDIATE PROGRAM IN OREGON UNDER THE NEW STATE SCOPE OF PRACTICE YOU ARE TO DIAGNOSE AND TREAT ACCORDINGLY. THIS TRAINING WAS BACKED UP BY A VISIT TO THE CLASS BY THE STATE OFFICIAL IN CHARGE OF THE EMS SCOPE AND I QUOTE " SHOULD YOU BE GIVING DIAGNOSES TO YOUR PT. YOU HAD BETTER BECAUSE YOU NEED TO CHOSE A TREATMENT PLAN AND EXPLAIN IT TO THE PT." NOW TO QUANTIFY THIS POSITION: THIS SCOPE OF PRACTICE IS BRAND NEW AND THE LOCAL PROTOCOLS HAVEN'T EVEN BEEN WRITTEN YET. I WAS IN THE PILOT CLASS AND I THINK THE STATE DIDN'T EVEN KNOW JUST HOW IT WOULD END UP. THAT WAS ALMOST SIX MONTHS AGO AND THE ER DOCS ARE STILL ASKING FOR OUR DIAGNOSIS. MAKE OF IT WHAT YOU WILL. AND THE LOCAL PROTOCOLS ARE STILL NOT DONE JUST YET. EMS YA GOTTA LOVE IT ;-)

[JPINFV]

1. There is no reason to yell. Use some ATP and hit the caps lock button.

2. protocols!=differential diagnosis?

[Asysin2leads]

I say yes, with a qualifier. My usual explaination to patients as to "why they need to go to the hospital" is that the hospital can provide definitive tests and diagnosis, while we can only do so much with the equipment in the field. Maybe someday I'll get to test for troponins, but until that day comes, I can only look at an EKG and make certain assumptions and form an educated opinion. This is why I make a "presumptive diagnosis" in the field, while the guy with the MD after his name and a nice bright ER with nurses helping him out and a laboratory at his disposal makes a definitive diagnosis. In other words, yes, I do make a diagnosis, but its not the same as a physician's diagnosis. That being said, the only reason you should be treating a patient is because you formed a diagnosis.

BTW the word 'diagnosis' comes from the Greek 'dia-', across, and 'gnosis', or knowledge. A diagnosis is something you make from across different tests and knowledges. Just droppin' some knowledge.