What I learnt from doing the rounds

Any hospitalised patient will have experienced the ward round: the great camel train of clinical staff that appears beside your bed, talks rapidly over and about you, then vanishes. Ward rounds exist primarily for patient care, but they do have another important function: they remain the cornerstone of medical teaching.

When I was a student, the ward round was the educational activity we feared above all others. Instead of being ignorant discreetly, on a chair in clinic or at the back of the lecture theatre, rounds required you to display your ignorance in front of an audience. On a teaching round you could count on the consultant, the registrar, the senior house officer, the house officer and at least one other student who had read more than you. For additional publicity you might get one of the nurses, the pharmacist, the physiotherapist, the occupational therapist and – in one hospital I worked in – the cleaner, an elderly man who had built up a substantial body of medical knowledge. Whenever you arrived at a patient’s bed, he was already there, dusting the curtain rail or mopping under a chair; when the round moved on he would take you aside for a quick debrief: “Did you get full smoking history?”

Of course, teaching rounds do not just bring together every member of what medicine currently likes to call the “multidisciplinary healthcare team”; they are also about – and impossible without – the patient.

As a student, you crept along hoping that someone might teach you something. Unfortunately, teaching rounds have a habit of disintegrating into what are called “business” rounds, which are concerned solely with patient care, due to the workload within most hospitals. Doctors are generally keen to teach, but their ability to do so depends on how many people have been admitted, and how sick they are; if the round has to see 20 new patients, the consultant is unlikely to have time to demonstrate the classical signs of liver failure.

A non-teaching teaching round requires everyone to walk around the hospital for half a day, fantasising about food, water and sitting down. At every bed the doctors huddle to exchange inaudible information. If you are lucky, you get to look at the obs chart and read out the patient’s temperature so that the house officer can document it in the notes. If you are unlucky, Sister will tell you off for not washing your hands after touching the obs chart. But almost worse than not being taught something was being taught something.

This was because then you would not only have to try and solve a medical problem, but also demonstrate your ability to examine someone, and your understanding of their illness, and on a cruel day interpret an X-ray or an ECG on top. Perhaps the consultant would ask you to “examine this patient’s chest and tell me what you find”. Your patient would either have been handled by many previous students, in which case he would know far more than you – if you were lucky, he might whisper advice: “it’s a thoracotomy scar!”; “say you can hear crackles!” – or he would be unaware of what was going on himself, and strain to catch every word. This aspect of teaching rounds is unfortunate, as medical students prefer rare and dramatic diagnoses over common, treatable ones, and tend to issue lists when nervous or excited, “Something malignant? Invasion of the brachial plexus? Horner’s syndrome?” The first thing we learnt was simple, though: without the kindness of patients, we could not learn.

Sophie Harrison is a hospital doctor in South Yorkshire