Encore! Another Round?

Of late, I had an interesting conversation with one of my senior colleagues in another department.

We were discussing about the number of ward rounds per day that should be fulfilled. In my department, we only had 1 official round per day. Altogether bosses, SHO's and HO's would do round together and settle clinical issues as they arise. Of course, unstable patients will be kept in mind for more reviews in the late morning or afternoon, keeping in view of passing over to the on-call team for review after office hours.

My senior colleague had proudly told me that in his department, there is no such thing as daily round. Ward rounds are carried out in a tds (3 times a day) or at least bd (2 times a day) basis, and that is compulsory!

He suggested to me that maybe my department should follow their 'noble' path as well.

;)

Ward rounds are designed to pick up clinical problems, so that appropriate clinical action can be taken. Imho, ward rounds should NOT be routine or compulsory, as there are no such thing as 'routine' clinical problems in all patients. Unstable patients should be given more attention and hence more reviews (I won't even call it a ward round!). On the other hand, doing a routine round on a stable patient would be mean a wastage of manpower and resources, which could be channeled elsewhere more needful.

I end my blog by giving you my own experience when I was a paediatric HO.

In the morning, I was following the ward round.
HO:'Day 3 of life, admitted for NNJ, now on single phototherapy...'
While examining the child, the specialist murmured:'Active, not tachypnoiec, jaundiced. CVS no murmur. Lungs clear. Per abdomen, soft non-tender, liver palpable 1cm. Moro's complete. OK, continue the single photo.'

At noon, the same baby was reviewed.
HO:'Day 3 of life, admitted for NNJ, on single phototherapy...'
The same specialist:'Active, not tachypnoiec, jaundiced. CVS no murmur. Lungs clear. Per abdomen, soft non-tender, liver palpable 2cm. OK, continue the single photo.'

Right before going home late in the evening, another round.
HO:'Day 3 of life, admitted for NNJ, on single phototherapy...'
Again, the same specialist:'Active, not tachypnoiec, jaundiced. CVS no murmur. Lungs clear. Per abdomen, soft non-tender, liver palpable 1cm.'

As you can see, the only changes were that of the liver size, which grew to 2cm and shrunk back to 1cm in the same day!

Switched Folders, I Have

Shortly following my blog on the public health equation, I am privileged to have picked up yet another interesting gesture by some patients.

My patients just hate waiting. Well I guess most human being dislike waiting, in particular, waiting for no reason. Nonetheless, I think waiting in a queue to be seen by a non-stop performing doctor is a justified act... suffice to say.

It was a fine morning clinic session. I was seeing a long queue of patients. Some were stable enough to be seen quite fast. Some would need more meticulous consultation and hence more time spent. There was this 68-year-old uncle, who was an ex-teacher, came for follow-up for his chronic stable angina.

I had just finished seeing the 32th patient. Owing to the lack of manpower, the folders were arranged in a row near the entrance to my room, and I'd have to walk in front to pick up the next folder and call the corresponding patient by myself. I had noticed some peculiar stigmata when I saw that this 68-year-old uncle had switched his 36th folder to the top, covering the 33rd.

Honestly, I wasn't happy at all. I then told him:" I'm sorry uncle, it's not your turn yet".

He quickly retorted me:" You know how long have I been waiting? I'm an old man. I can't stand waiting for too long!"

I said:" I understand that you've been waiting. But the queue is moving. I'm afraid you'd just need to wait for your turn." I added:"Most of my patients here with heart illness are elderlies anyway!"

He retorted further:" You don't talk to me like this young man. I was a faithful government servant that served this country before you were even born! I deserve to be treated nicely! You are very rude you know young man"

Somehow my conscience told me that any further arguments would not be fruitful anyway. To me, we were seeing things in 2 extreme perspectives.

I quickly glanced through the 33rd patient's folder who I should be seeing in queue. I was instantly struck by an inspiration...;)

I called the 33rd patient by name and summoned her into my room.

She was a 82-year-old lady with history of multiple embolic stroke being followed up for chronic persistent AF with anticoagulation. Her daughter was wheeling her in on a wheelchair!

I told her that this 68-year-old senior gentleman was trying to jump into her queue, because he couldn't stand waiting anymore.

She became agitated and almost cried:" I was waiting for a long time also. Doctor, can you please see me first?"

That 36th uncle, red-faced, walked away. He didn't say a word, not even a word of apology.