MD & DO Endless, inefficient rounds: why is this a thing?

[Lynx zwo drei vier]

Between IM, IP Peds, and IP Neuro, I’ve had a handful of attendings who rounded efficiently, vs countless who didn’t.

Recent example: walk rounds without actually seeing patients. Our huge team (so many FLOCs that none of us was carrying more than 3 patients) spent 4 hours every morning walking around our Death Star-sized hospital to get to each patient’s room, we’d present outside the room … and then 90% of the time, we’d move on without even going in to see the patient.

Why do so many hospitalists think that stuff like this is good practice? From my POV, it just delays tasks and gives everyone back pain. Every time I had an attending who did table rounds and then just took us to see the sick folks, we got more done every day, and our list moved faster. If there’s any evidence that walk rounding improves patient care, I’d be interested in reading it.

I’m really, really trying to like inpatient work (since fun as I found EM, everyone says it’s a dying specialty). But doing this in residency sounds like going to the dentist’s every morning for 3 years.

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[VA Hopeful Dr]

Walking rounds without actually seeing each patient always seemed kinda pointless to me as well. Either see each patient or do table rounds.

Keep in mind, every hospital is different in how they do rounds. My residency did table rounds with seeing a few select patients, my wife's did walking but saw every patient in their room barring absence for testing.

But even if you end up somewhere like where you are now, its only for a few years. You can power through it.

 

[AlbinoHawk DO]

Gotta get your 10k steps a day and roll with your resident/med student posse so then non-teaching service is jelly

 

[Lynx zwo drei vier]

Gotta get your 10k steps a day and roll with your resident/med student posse so then non-teaching service is jelly

Too bad our COWs’ batteries can’t last as long as we do.

 

[xffan624]

Between IM, IP Peds, and IP Neuro, I’ve had a handful of attendings who rounded efficiently, vs countless who didn’t.

Recent example: walk rounds without actually seeing patients. Our huge team (so many FLOCs that none of us was carrying more than 3 patients) spent 4 hours every morning walking around our Death Star-sized hospital to get to each patient’s room, we’d present outside the room … and then 90% of the time, we’d move on without even going in to see the patient.

Why do so many hospitalists think that stuff like this is good practice? From my POV, it just delays tasks and gives everyone back pain. Every time I had an attending who did table rounds and then just took us to see the sick folks, we got more done every day, and our list moved faster. If there’s any evidence that walk rounding improves patient care, I’d be interested in reading it.

I’m really, really trying to like inpatient work (since fun as I found EM, everyone says it’s a dying specialty). But doing this in residency sounds like going to the dentist’s every morning for 3 years.

As someone with chronic knee pain this was probably the thing I hated most about medical school. I did end up in a residency that still had rounds but I would bring a roller chair on days my knee was hurting. The only reasonable argument I've heard is so nurses who can't step away from the patient rooms for long periods can listen and be involved in their patients' rounds. This was mainly in the NICU and peds floor that I saw this benefit play out.

 

[Dral]

Too bad our COWs’ batteries can’t last as long as we do.

We weren't allowed to call them that where I did intern year. I think it had something to do with that if an overweight female was in the hall or passing us (whether a visitor or patient) and someone mentioned 'cow' or 'the cow', they could overhear and take offense. I kid you not.

 

[SurfingDoctor]

Well, I sometimes am able to see the patient before rounds. This is especially true if the patient is unstable over having a bad trend because I get a better sense from the staff at the bedside what is going on, I can see the trends in real time and frankly, the residents generally don't present up to date information on those types of patients (wrong ventilator settings, wrong vasoactives, don't know what numbers are important). Granted this is ICU, so they may not have experience to know, but me pre-rounding on patients is tremendously helpful for me to enact patient care for a subset of patients.

If I can't preround, I see them when we are done rounding on that particular patient. Which is usually the least sick or the chronic patients.

The other point of bedside rounds are 1) to ensure the bedside staff are up to date on the plan and 2) at least in pediatrics, make sure the family is up to date. To the latter point though, I do know attendings who go into long diatribes on rounds or let families or consulting services run the dialogue. I don't personally allow that. If there is an urgent that needs to be addressed, sure. If not, then it can wait till after rounds are completed for more detailed discussions.

 

[patriot6]

We weren't allowed to call them that where I did intern year. I think it had something to do with that if an overweight female was in the hall or passing us (whether a visitor or patient) and someone mentioned 'cow' or 'the cow', they could overhear and take offense. I kid you not.

this is a story told at many institutions.

 

[mrbreakfast]

The goal is for med students/residents to get additional "reps" of seeing patients and to learn something with each patient, if only to practice seeing an examining patients. Medical education is training by volume. If you round but don't actually go into patient's rooms, then I guess the benefit is exercise.

I think it had something to do with that if an overweight female was in the hall or passing us (whether a visitor or patient) and someone mentioned 'cow' or 'the cow', they could overhear and take offense. I kid you not.

This is the medical equivalent of a tall tale; you'll hear this story at every medical facility with COWs.

 

[PathNeuroIMorFM]

We weren't allowed to call them that where I did intern year. I think it had something to do with that if an overweight female was in the hall or passing us (whether a visitor or patient) and someone mentioned 'cow' or 'the cow', they could overhear and take offense. I kid you not.

 

[Dral]

Sounds about right. However, I remember specifically one of my attendings on rounds one day told us not to call it a cow. Maybe it was a joke and I was too much of a rule follower intern to not get it. Anyway, sorry for off topic.

I would have loved table rounds. Where I trained on my floor months, we did walking rounds and saw every patient most days.

 

[Lynx zwo drei vier]

We weren't allowed to call them that where I did intern year. I think it had something to do with that if an overweight female was in the hall or passing us (whether a visitor or patient) and someone mentioned 'cow' or 'the cow', they could overhear and take offense. I kid you not.

Karen intensifies

 

[Lynx zwo drei vier]

How much can you realistically learn from a group physical exam? If it’s 2 people doing an exam, or a floridly obvious finding that everyone can see, I can understand that. But when 6 students and interns are crowding around a patient’s bedside, all you accomplish is bothering the patient.

 

[VA Hopeful Dr]

How much can you realistically learn from a group physical exam? If it’s 2 people doing an exam, or a floridly obvious finding that everyone can see, I can understand that. But when 6 students and interns are crowding around a patient’s bedside, all you accomplish is bothering the patient.

Lots? So what if 6,8, 15 people each look at <insert unusual finding here>? Its not like it goes away after the 5th exam.

As for bothering the patient, that's one of the prices you pay going to a teaching hospital.