Top 10 reasons why ward rounds take forever

September 25, 2011

I know it is done out of necessity, but sometimes it feels like it’s going on for ages.

Top 10 reasons why ward rounds take longer than they should :-

The patient that can’t stop talking. Some patients decided to indulge the team in their delightful homemade recipes when all we wanted to know is whether have they opened their bowels today. A simple yes/no question becomes this soapbox for the patient to explore their culinary roots out loud. Too time consuming to listen to, too impolite to tell the patient to ‘talk to the hand’

The consultant that can’t stop talking. I have an immense amount of respect for them. I truly value their desire to teach. But when they start going on about how their game of golf went over the weekend with a play-by-play commentary in the middle of ward rounds, I can’t help but mentally sigh. The most common scenario nowadays is they get so excited about the new iPad that they can’t help but do a live demonstration on its wonders. Then proceed to discuss the specs, and the apps. It’s not a bad conversation topic, except not the junior doctors are struggling to carry the files while waiting for the consultant to arrive at the decision whether to give the Frusemide or not.

The family members that can’t stop talking. I know they have a lot of questions, I understand that and we encourage the family to air their concerns anyway. Everything is alright and appropriate, until the day when you meet a bossy family member who decides to document everything you said and do in order to jump on you the moment something goes wrong. That still isn’t so bad, until you meet one whom keeps harassing you why the patient keeps burping and demanding a medication review on the spot.

The nurses who keeps pulling you away from your ward rounds. Often it is out of necessity, but on and off you get the trigger-happy nurse whom zooms in, tells you something trivial, and then expects you to do something about it right away. When you do maintained that you’ll see to it after your ward rounds, the nurse nodded and walks off to tell the patient’s family that the doctor will be there in ‘a few minutes’. Of course, failure to turn up in a few minutes would then result in you being swamped by enquiring family members in the middle of rounds.

The wandering/lost patient. Not in the room, not in the toilet, not in the corridors. The team then has to detour back on and off to check if the patient’s back.  Some tend to return when it is close to 5pm, looking all fresh and bright as they had a ‘lovely spot of coffee in the sun’ while you’re looking like you could use a toilet break. Some are kidnapped by the physiotherapist.

The missing file/drug chart. Not at the nurses’ desk, not in the patient’s room, not in the medication room. This is not too much of a bother for a stable and well patient, unless there has been an event overnight and the patient is too sick to tell you what happened. The ward round then becomes a search party which sends the team in all directions. You will be surrounded by the files you don’t want, and never the one you need. When you do manage to locate the file, you find yourself having to wait in line while the social worker, speech pathologist, and the occupational therapist all have their turn.

There is never enough space to write your notes. The consultant is rattling off the management plan at the speed of light, including a couple of drug names which you’ve never heard in your entire life before – and then realise that you are at the last page of the progress notes with only three lines to spare. Either you squeeze your writing to the point which no one could read (including yourself), or you excuse yourself to run off to find more fresh pages to scribble on. Usually it is the latter.

Technology failure. That rare momentous occasion when the computer is lagging badly, or internal servers are down for maintenance. Your consultant wants to know the patient’s renal function before starting medication, your registrar wants to check the loading dose for the medication, and you want to know if the IT tech dude is asleep at his desk.

Coffee breaks. When a senior doctor says “I’m gonna get a cup of coffee”, no one protests. But I am pretty sure there are some of you out there whom would rather quickly get on and finish the ward rounds as soon as possible. The seniors would be sipping their favourite latte while the juniors smiling nervously to cover their anxieties over not having enough time later in the day to do the referrals.

The unsuspecting new admission. You walk into the room and see this new patient sitting up in bed, smiling back at you. You smiled back and say ‘How are you?’. In truth, no one has a clue who this patient is nor what are they here for. There are no admission notes, no previous history, and the only way to find out is to do a full admission yourself .  One new admission takes as long as approximately 10 coffee breaks. If it is a patient that can’t stop talking, then it would probably take 10 coffee breaks plus lunch as well.

And now let’s do a poll :-

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