Things We Do for No Reason™: Card Flipping Rounds

Abstract

Inspired by the ABIM Foundation's Choosing Wisely® campaign, the “Things We Do for No Reason™” (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent “black and white” conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.

Point/Counterpoint: Should patients be presented before entering the room during ward rounds?

“…At times, teaching points and discussion work best outside of the patient's room. However, others have espoused the benefits of bedside presentations on rounds 7,8 . Styles of rounding that take place away from the patient's bedside include alternate styles such as card flip (occurring solely in the rounding room), table rounds (discussing first in a room and then going to see the patients), or hallway (occurring outside the patient room) rounds.…”

“…17 Open communication, including sensitive issues, during bedside rounds rather than behind patients' backs builds patient trust. 7,18 Bedside rounds are the perfect training grounds for trainees and supervisors to hone the skills of humility, honesty, respect, and compassion that patients expect from them.…”

“…At the bedside, we focus on patient‐centered aspects of care and teaching such as communicating bad news, explaining the course of care, showing how to elicit information, and demonstrating physical examination findings. While bedside rounds attract enthusiastic advocacy, the studies focus primarily on one aspect of rounds—the patient experience 7–10 . Little is known about the learners' experiences and perspectives.…”

“…They value and better trust in the healthcare team when they observe explicit acknowledgments of uncertainty and, when necessary, the supervising physician teaches their trainees or proposes alternative care plans in collaborative and encouraging ways 17 . Open communication, including sensitive issues, during bedside rounds rather than behind patients' backs builds patient trust 7,18 . Bedside rounds are the perfect training grounds for trainees and supervisors to hone the skills of humility, honesty, respect, and compassion that patients expect from them.…”

“…However, others have espoused the benefits of bedside presentations on rounds. 7,8 Styles of rounding that take place away from the patient's bedside include alternate styles such as card flip (occurring solely in the rounding room), table rounds (discussing first in a room and then going to see the patients), or hallway (occurring outside the patient room) rounds. Having this time outside the patient's room allows for a more nuanced discussion (e.g., presentation style, physiology, management, etc.)…”