Question about rounding in IM

Discussion in 'Internal Medicine and IM Subspecialties' started by gluon999, Mar 29, 2007.

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  1. gluon999

    gluon999 Senior Member 7+ Year Member

    Aug 14, 2002
    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?
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  3. sluggo

    sluggo 2+ Year Member

    Oct 22, 2006
    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!
  4. Adcadet

    Adcadet Long way from Gate 27 10+ Year Member

    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.
  5. Mayhem

    Mayhem Scut Bear 5+ Year Member

    Apr 22, 2006
    Somewhere only we know
    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.
  6. carrigallen

    carrigallen 16th centry dutch painter 10+ Year Member

    Feb 27, 2003
    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.
  7. Discobolus

    Discobolus Dutch-American 5+ Year Member

    May 31, 2004
    Red State
    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.
  8. GuP

    GuP Senior Member 7+ Year Member

    Oct 28, 2005
    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.
  9. Mayhem

    Mayhem Scut Bear 5+ Year Member

    Apr 22, 2006
    Somewhere only we know
    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.
  10. tibor75

    tibor75 Member 5+ Year Member

    May 11, 2006
    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. :smuggrin:
  11. tum

    tum don't call it a comeback 10+ Year Member

    Mar 2, 2003
    things look very different when you're responsible and in charge.
  12. Mayhem

    Mayhem Scut Bear 5+ Year Member

    Apr 22, 2006
    Somewhere only we know
    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.
  13. Becket

    Becket Senior Member 10+ Year Member

    Sep 15, 2000
    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 :)
  14. tum

    tum don't call it a comeback 10+ Year Member

    Mar 2, 2003
    Last edited: Jan 29, 2013
  15. Mayhem

    Mayhem Scut Bear 5+ Year Member

    Apr 22, 2006
    Somewhere only we know
    People do that? Well sign me up. Our private practice attendings teach too, which means endless rounds.
  16. iatrosB

    iatrosB trying not to kill anyone 5+ Year Member

    Jun 9, 2004
    hiding from a code
    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.
  17. AmoryBlaine

    AmoryBlaine the last tycoon 7+ Year Member

    May 1, 2006
    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. :D

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