LMA ‘grand rounds’ offer old-school doc talks

February 10, 2012
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LMA—Before the Internet and smartphones, doctors and nurses who cared for the same patient would have to sit down and talk to each other. The health care team would walk around hospital wards and visit patients, running through each one’s history. This was a daily routine, called “the rounds.”

The institutions in the Longwood Medical Area (LMA) have taken this old concept and adapted it for the 21st century. Once a month, Beth Israel Deaconess Medical Center (BIDMC), Brigham and Women’s Hospital (BWH) and Children’s Hospital Boston take turns hosting a conference, lecture or walking tour that addresses some medical topic of interest.

These modern “grand rounds” can mean very thorough patient histories for complicated cases, or discussions on new trends or treatments in health care. The Gazette attended a recent grand round hosted by BIDMC.

“We’re bringing people back to it,” Tom Delbanco, a physician at BIDMC, told the Gazette after the grand round. Delbanco has been involved in the LMA grand rounds since they started 15 years ago.

“Grand rounds are related to general care or a patient case or other education. It really varies,” said Russel Phillips, another physician at BIDMC. “It’s a time-honored part of medical training.”

Daily rounds, as a training tool, are at least a century old, Phillips said. The practice still survives in medical school, and it terrifies the doctors-in-training. Delbanco described to the Gazette how he had an instructor that demanded the medical students memorize all the relevant information for all the patients and the fear it created in his classmates.

Grand rounds, by contrast, have the “implication [of] collective rounds where many people assemble formally in an auditorium, usually…in distinction to ‘daily rounds’ when a small team of doctors and students walk around to see patients,” Delbanco explained.

These days, many departments throughout the LMA have their own grand rounds topics, creating enough opportunities to have a gathering nearly every month, Delbanco said.

Topics might include how to deal with a problem patient, or a young woman who asked to have both breasts removed to prevent a recurrence of breast cancer before such a practice was widely accepted.

The most recent grand round, hosted by BIDMC on Feb. 3, covered the concept of a “medical home,” where patients go to the same clinic and see the same doctors at every visit. These doctors act more like a team leader for the patient, coordinating care with specialists closely.

“It’s a wonderful opportunity to think about the future of primary care,” Phillips said. Primary care is what healthcare professionals call the equivalent of a family doctor.

Grand rounds are open to all LMA professionals in hopes of sharing information as widely as possible.

“In general, people are welcome to come, but hardly any ever do,” Delbanco said. “It’s a real problem when everyone’s busy.”

The grand round the Gazette attended, however, was standing room only with a video feed for overflow. After the hour-plus introduction, many attendees left for the rest of their day, while many more remained for a full day of discussion.

The videos, patient histories and other materials are also shared on the Journal of the America Medical Association website at jama.ama-assn.org.

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