Although many U.S. teaching hospitals are bucking tradition by moving morning "rounds" from thebedside to the conference room, patients seem to prefer the bedside discussions by physicians andmedical students, a Johns Hopkins study suggests.
"Rather than upsetting patients, bedside rounds, if they're in understandable terms, make them feelmore comfortable and attended to," says lead author Lisa S. Lehmann, M.D., formerly a fellow inmedicine at Hopkins and currently a fellow in medical ethics at Harvard Medical School.
Results of the study are published in the April 17 issue of The New England Journal of Medicine.
Developed a century ago at Hopkins, rounds bring together young residents and medical studentswith an experienced physician to discuss diagnosis and treatment of each patient. "There should be noteaching without a patient for a text, and the best teaching is that taught by the patient himself," saidthe late William Osler, M.D., one of Hopkins medicine's founding fathers. But in recent years,concerns about patient discomfort, privacy and sensitivities have led to conference-room roundsinstead.
Researchers studied the perceptions of 182 patients during three weeks of rounds: bedsidepresentations were made with 95 patients and conference room presentations with 87 patients.
Most patients in both groups said their physicians had introduced themselves properly, explainedtests and medications adequately and treated them respectfully. More than three-quarters of patients inboth groups said rounds did not upset them. In the bedside presentation group, about 87 percent said such presentations should continue and 50 percentsaid the presentations helped them better understand their illness.
Results also show that patients in the bedside group thought their doctors spent about twice asmuch time with them during morning rounds (10.5 minutes versus 5.7 minutes) and were slightlymore likely to be satisfied with their care. "The recent trend in teaching hospitals has been to movecase presentations into the conference room for expediency, and so patients would not be confused orupset," says Lehmann. "But our results suggest that, from the patient's perspective, bedsidepresentations are at least as good and perhaps better."
More educated patients were 40 percent less likely to complain about confusing terms and six timesmore likely to say tests and medications were adequately explained than patients who had notcompleted high school, the results show.
Patient suggestions for improving bedside presentations included using fewer confusing medicalterms, allowing the patient to say more, reducing the number of physicians in the room, introducing allphysicians in the room, making physicians sit and pay better attention, and respecting patient privacymore.
"When presenting at the bedside of less educated patients, physicians should be especially careful toavoid medical jargon and to explain fully their plans for care," Lehmann says. "If interns and residentsare taught to encourage patient participation and avoid confusing terminology, both patients andphysicians in training might benefit from presentations at bedside."
Rounds were conducted by teams that each included a chief resident, two senior residents, fourinterns and three medical students. Bedside presentation continues to be the norm at Hopkins.
"Bedside presentations encourage physicians to view patients as real people rather than as abstracthosts for disease," Lehmann adds. "They also allow physicians to observe physical findings which mayinfluence their understanding of a patient's illness and provide an opportunity for students to learn theart and science of clinical medicine from more senior physicians."
Other authors were Frederick L. Brancati, M.D., Min-Chi Chen, M.S., Debra Roter, Dr.Ph., andAdrian S. Dobs, M.D.
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