A wonderful senior resident helped me understand the goal of rounding. Rounds should focus primarily on understanding the key problems and the diagnostic and therapeutic approaches to those problems. She suggested that some rounds spend too much time on “minutia” that the resident could handle, and not enough on understanding the big issues. According to her, rounds work best when we spend our time addressing the problems that the patient has and increasing the learners’ understanding of those issues.
Her understanding of different rounding styles highlights a key question about rounds and graduated responsibility. Our learners want to understand the thought process involved in making big decisions. There are many details that the interns and residents can handle perfectly well without attending involvement. I rarely need to help the team make decisions about IV fluids, constipation treatment, or insomnia. If the resident wants help on those issues, I am glad to give an opinion, but that rarely happens.
Diagnostic challenges, antibiotic selection and/or stewardship, interpreting lab tests are all examples of issues that we should address. I do not need to hear the vital signs every day, unless we are following a particular sign and there is a significant change. We should focus on where the patient’s course is going, and where we are going to help the patient.
In my mind, the key to successful rounding involves prioritization. We should discuss high priority items (including understanding the basic science when that basic science informs decision making) on a daily basis. When we do, the learners tell us that they benefit.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
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