Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, March 04, 2010

Always See the Patient First

There's a very important rule to remember when rounding in the hospital. Personally, I would think that it's self-evident, but apparently not, according to a recent trainee in my office, who told me the following story.

Rounding on patients in the hospital has several components. In addition to seeing and examining the patient, one generally peruses the results of lab tests and other new studies, collects the most recently measured vital signs, consults with the nursing staff about the patient's status, and documents the encounter.

I well remember my student and resident days, when the major goal felt like collecting material for the progress note. After a patient had been in the hospital for some time, figuring out how to write something other than, "Continue present management" gets to be a real challenge.

It turns out that after perusing the current results of lab tests and other studies and getting the vital signs from the nurse, my new friend began writing the patient's progress note. He spoke with the current nurse who confirmed the patient's stable status, and duly noted same in his progress note-in-progress. Finally he went to see the patient...

Who was stone cold dead.

Suffice it to say, he had some re-writing to do.

Hence, the very important rule of rounding in the hospital: Always see the patient before writing the note.

Regarding today's date: thanks for all the good wishes. DS is taking me out for sushi, which is celebration aplenty.


At Thu Mar 04, 11:42:00 AM, Blogger Margaret Polaneczky, MD (aka TBTAM) said...

I assume it's your b-day? If so, Happy, Happy!

At Thu Mar 04, 12:03:00 PM, Anonymous ndenunz said...

Enjoy your California roll and any others you may want.

At Fri Mar 05, 10:34:00 AM, Anonymous RAG said...

I'm guessing this was in the VA - as that scenario has occurred more than a few times in mine. Of course the nurse note in the computerized chart that states patient was "stable" a half hour before obviously shows they weren't checking their patients (especially once rigor mortis has set in when they're finally seen).

At Fri Mar 05, 03:46:00 PM, Blogger Michael Kirsch, M.D. said...

Yes, you are a dinosaur because this is not how it's done today. I also was trained to see the pt first. Often,the patient is now seen dead last, after the xrays and labs are reviewed. In many instances, specialists like me are consulted before the primary care physician has seen the patient. I was sitting next to an ID consultant earlier this wk who told me that he was one of 6 consults on the admission orders. These consults were issued before the primary - the 'quarterback' - had come by. As a GI MD, I call this a_ _ backwards!

At Sat Mar 06, 08:56:00 AM, Anonymous Dr Lemmon said...

Yes, see patient before writing note. But see labs before patient. They always ask about their labs.

At Sun Mar 14, 04:44:00 AM, Anonymous Anonymous said...

Why not see the patient first and then look at the labs? A quick "hi" and a "I'll be right back" will let the patient know you're there, then look at the labs before you see the patient for whatever time it takes, and then do the writeup. That sequence lets you know that the patient is not stonecold dead before you do anything else.


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