For 30 years I have always conducted “table rounds” prior to seeing the patients. Many colleagues champion bedside rounds solely. While we each must find our most comfortable rounding style, I hope to convince other attendings of the value so that they might consider this style.
What are table rounds? We start rounds by quickly having students or residents give a brief report on each known patient. They need not provide every detail, but rather report on test results, consultant recommendations and any major clinical change. We look at pertinent images.
During this time we have several goals. First, the entire team gets an update on the patients. This allows the interns to know each other's patients. Second, we can have a discussion of further testing plans, consultations, or discharge planning. We also can have discussions of test results, or revisit our diagnosis. Third, we can teach and make certain that everyone has an opportunity to participate and hear. Finally, we never embarrass a student or intern in the presence of the patient.
Next we present the new patients. Usually, this time allows for the most teaching. We discuss the approach to the differential diagnosis. We discuss treatment strategies. We point out information that we need at the bedside.
After table rounds (usually 45-60 minutes) we visit each patient. Sometimes we repeat the history; sometimes we demonstrate a physical exam finding; sometimes we just spend time making certain that the patient understands their diagnosis, treatment, and further testing plans. We deliver good news and bad news. We discuss bedside manner at the nurse station after our encounters. When we obtain new information, we change our plan appropriately.
Many learners have told me that they find this style more educational and comfortable. I suspect that some will agree with this style, and some will disagree. What do you think?
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.