You learn on rounds what you don't in textbooks

Rounding is an activity that involves seeing all patients admitted under a doctor at a hospital charting out their plan for the day as well as communicating with relatives Various disciplines come together to coordinate care helping colleagues share and discuss ideas It is also an invaluable education for resident doctors to learn how decisions are madeThe genesis of the term is credited to legendary physician Sir William Osler one of the founders of the highly regarded Johns Hopkins Hospital in the United States The original building had an octagonal ward where a team of physicians would tour patients bedsides calling it rounds On days when Dr Oslermdashknown for his encyclopaedic knowledge and tough questioning of residentsmdasharrived the sessions were dubbed grand roundsAs residentsintraining in a highvolume neurosurgery department rounds comprised of an activity we dreaded Each resident was in charge of a ward that housed between 12 and 15 patients It was his duty to workup patients for surgery and then manage their postoperative care until they were discharged This included writing a detailed history and performing an examination sending off and following up on investigations and scans doing minor bedside procedures and meticulously documenting daily progress and preparing detailed discharge summaries with monastic ferocity While two or three patients would get discharged daily an equal number would be admitted too keeping the total constant This work was interspersed with attending surgeries in the operating room and handling emergencies in the casualty or elective cases in the outpatient clinic As soon as the day began it was already overRounds started at 8 am sharp with resolute religiosity We plodded through the night to prepare for them and if wed slept at all wake up by 5 am to shave and bathe and check on every one of our patients before we could present the latest update to the head of the unit For new admissions neurological findings had to be demonstrated and a clinical diagnosis offered a process that involved rigorous questioning and railing by the head and an embarrassingly public demonstration of how little we knew whether it was our first day of training or the lastIt was anyones guess as to who would be at the receiving end of the bosss rebukes each morning One of the resident doctors was permanently nicknamed Kelloggs as he was routinely part of Sirs breakfast Sir was a stern man terse in his communication and a thorough disciplinarian Not one to brook mediocrity he had a proclivity for perfection We would be imbued with fear when he walked into the ward easily forgetting everything we had spent the entire night preparing for He walked with his hands behind his back and spoke very little acknowledging you mostly with a downward forward bending of the head occasionally combined with a prophetic raising of the armHe needed to ask just one pertinent question to know whether we had thoroughly examined the patient or were simply confabulating something that comes naturally to residents He used to nod even when we answered incorrectly making us believe that we were right not knowing that the amplitude of the nod was directly proportionate to the ludicrousness of the answer And so we continued to say more and more of what was wrong digging a deep dark hole for ourselves our colleagues squirming in the background hoping that we would just please stop talking He would finally convey to us what he thought of our answer by drawing a large recursive circle in the air with his index finger Only after the first few times did I realise that I was a gargantuan zeroOn other occasions when the blunder was more serious the sign language was less indirect The index finger pointed to the exit corridor of the ward and you were jettisoned One could not argue the verdict While in a sense this came as a relief to the exiting doctor because he could go and grab some muchneeded breakfast the pressure really was on the next in line who had to take over and present a ward he was not in charge of The bottom line was that every resident needed to know about all 45 patients in the unit because you never knew whose exit was scheduled and whenAfter about 90 minutes of rounds our heart rates normalised with hot chai We grumbled about why he needed to stress on every triviality Why did we need so many checklists and protocols Why was there a need for multiple levels of crosschecks Why were we asked so many questions only to spend the rest of the day finding answers when there was barely enough time to brush or batheAs is the case with every true disciple the rigour ingrained by the master revealed itself only years later when I was on the other side of the fence degree in hand now solely responsible for my patients outcome I became obsessive about every lab value the nittygritty of every symptom getting down to the brass tacks of all the possibilities we could be dealing with and tightening all the nuts and bolts before the patient was wheeled into surgery One inadvertent glitch can often make the difference between life and deathI once walked into the operating room to find that an incision had been marked with a marking pen on the right side of the head for a patient who had a leftsided brain tumour Someone had flipped the scan on the viewing box by mistake probably in a hurry to get the case started once it was in the OR If it werent for this zealous devotion to detail counterchecking all that had already been confirmed each and every time and several times a day we would have opened the wrong side of the head that dayEvery day we come across several instances in practice where we recall what our teachers and mentors taught us Every tough lesson learnt on our rounds unbeknownst to us then becomes poignant and relevant todayWe dont feel a sense of personal prejudice anymore simply the hunger for excellence and a common desire to universally elevate standards in the care of our patients Not a day goes by without us acknowledging the value of our teachers in our professional betterment recognising it in our heads but mostly in our heartsThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals Keep scrolling to read more newsCatch up on all the latest Mumbai news crime news current affairs and a complete guide from food to things to do and events across Mumbai Also download the new midday Android and iOS apps to get latest updates MidDay is now on Telegram Click here to join our channel middayinfomedialtd and stay updated with the latest news