Round

My favorite essay from the recent Annals of Internal Medicine is "Attending Round," named after the doctors' job description.

The narrated events took place one morning in 1963, when the doctors seized the moment of looking after their patients themselves, with little assistance from others, drawing blood, preparing the slides of the urine sediment, the peripheral blood smear, and the sputum Gram stain. After conducting rounds with the nurse, the doctors rushed to look at the bone marrow biopsy. It was followed by tidying the laboratory result folders and shepherding the patients back to the ward, before the attending physician started the senior medical round.

I began to see parallels when I told my intern to poke a needle into a swollen knee and rushed to examine the joint fluid under the microscope. My intern's eye grew wide and stared at me as if I'd forgot that we could simply send out the knee joint fluid for our pathologist to trace the suspects.

"There is so much to learn by looking after our patients on our own," I reminded my intern. I mean that. The nub of the problem is we're spending less and less time in really looking after the patients. It should be obvious from all these years (but I'll say it anyway) that doctors are often destined to sit in front of the computer screen, with the dollar sign hanging sternly atop. We need to enter the diagnostic coding meticulously, prepare one protocol after another protocol, and document everything to secure the hospital accreditation. I won't argue whether these exercises would benefit the patients, but I'm pretty sure that they steal time away from hands-on personalized care of our patients.

My intern took off his glasses and squinted at the eyepiece when I rotated the polarizer. "Glittering crystals," he exclaimed. "That's gout."