Question about rounding in IM

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Why do many 3rd and 4th year students have a love/hate relationship with rounding in internal medicine...some use it as a big reason why they chose to pursure surgery instead of IM (don't surgeons round too?), while others liked it a lot (in terms of the thinking about/discussing the pt./lab values). I am just a MS1 now so can anyone enlighten me?

A good rounding attending can move you through rounds efficiently, ensure good patient care and teach you a lot. A bad rounder is the opposite. When you have a good rounder life is awesome and you want to be an internist; a bad rounder is, again, the opposite!

It's also a little irritating when there isn't a lot of teaching on rounds, and you are only following or know anything about a small fraction of the team's patients. A great attending will discuss the patients so everybody can follow, which makes it much better.

Yep that's my major issue. In my case, most surgery rounds I've been on were teaching rounds. IM usually has more patients so there's less time for teaching. More often than not we had business rounds, which are just a pain, but a necessary evil if we plan to leave the hospital ever.

Rounds are inefficient when the attending's attention is scattered. Unless there is a true EMERGENCY they should keep things moving along in the most efficient order, with clear decisions made about each patient, and save talking to family/chatting with other attendings until after rounds are over.

I think internal medicine attendings do have the stigma of being indecisive, requesting unnecessary consults, and fretting over inconsequential things.

I think it's ridiculous that students choose a specialty based on what occurs during their training and not in the "real world". I'm not a big fan of endless rounding, but I love IM and will tolerate the rounds for a few years knowing that when I'm in private practice it will not be that way.

I think rounding is when one can realize how good an attending truly is. When I was rotating on the medicine service, I was on a total of 3 teams. It becomes blatantly obvious which attendings are better than others.

As far as surgery rounds - in my experience, these were the worst rounds ever. They were run by chief residents and there was NO teaching. It was a bunch of monkeys walking around blurting out ins and outs and changing dressings. Surgery rounds sucked ass.

Originally Posted by Discobolus

I think it's ridiculous that students choose a specialty based on what occurs during their training and not in the "real world". I'm not a big fan of endless rounding, but I love IM and will tolerate the rounds for a few years knowing that when I'm in private practice it will not be that way.

Well, it's not "only" on what happens during training but given that I'm training at a hospital and I'm going to work at a hospital then I think there's some small amount of correlation. Besides, if there's the slightest similarity between what I'm seeing now and the "real world" then I'm probably going to dislike it. Plus, I would be a masochist because the signs were there that I'd hate it.

I'm in my final year of cards fellowship, which means for the past 7 years (IM + Cards) I've been endlessly rounding. This past month (which is my last inpatient month) I've found incredibly painful even when it's one of the "good" attendings. I think I figured out that after 7 years I'm just sick and tired of rounding when somebody else finds it convenient, taking breaks when somebody else wants a break, resuming from lunch when somebody else says so, etc etc. I know it'll be a little scary when I'm that attending come July, but the best thing will be finally making the rules for a change.

Originally Posted by Mayhem

Well, it's not "only" on what happens during training but given that I'm training at a hospital and I'm going to work at a hospital then I think there's some small amount of correlation. Besides, if there's the slightest similarity between what I'm seeing now and the "real world" then I'm probably going to dislike it. Plus, I would be a masochist because the signs were there that I'd hate it.

things look very different when you're responsible and in charge.

Originally Posted by tum

things look very different when you're responsible and in charge.

I'll concede that. At the very least, you get to steer the conversation so it will be more interesting to you (I've been taken on some journeys by attendings who decide to go off on a tangent). However, I'm truly not seeing what could change so that me not liking rounding during training will become me liking rounding in the "real world." I think if you don't like it as a student, you're probably not going to like it as an attending.

If you like IM but hate the rounding, why not just become an attending in a non-academic setting when you finish your training? The only person you'll be rounding with then is yourself

People do that? Well sign me up. Our private practice attendings teach too, which means endless rounds.

Originally Posted by Mayhem

People do that?

VERY common...more than 1/2 of the private practice docs in my area do this. The trend will just increase too, with the boom of hospitalists.

Originally Posted by gluon999

Why do many 3rd and 4th year students have a love/hate relationship with rounding in internal medicine...some use it as a big reason why they chose to pursure surgery instead of IM (don't surgeons round too?), while others liked it a lot (in terms of the thinking about/discussing the pt./lab values). I am just a MS1 now so can anyone enlighten me?

As I have said before, I think the stereotype of endless IM rounds discussing potassium is more style than substance. When med students complain about long rounds I think they are often failing to appreciate the complexity of the patients on the service.

Surgery rounds can be short b/c when you take a gall-bladder out of a basically healthy 40 year old you pretty much expect that they're going to walk out of the hospital as long as you don't smother them with their pillow.

This just ain't true when you have people on your service who are 85 with a problem list that fills a page. If it takes 3 hours to round on 12 train-wreck patients, maybe it's b/c they are complicated and not b/c your attending likes to torture his team.



Disclaimer: I'm going into EM, I just have alot of love for my IM homies. Someone has to learn about the differential of glomerulonephritis after all.