Bedside case presentations: why patients like them but learners don't.

Abstract

To determine current attitudes of patients, medical students, housestaff, and clinical faculty toward bedside case presentations. Survey using multiple-choice questionnaire and open comments for students, housestaff, and faculty, and a structured interview of patients. Major teaching hospitals on the campus of a midwestern medical school, staffed by full-time faculty. 136 medical students, 58 housestaff, 66 faculty, and 73 patients. 85% of patients liked the case presentation discussion at the bedside, but 95% of both students and housestaff felt more comfortable with such discussion away from the patient. Attending faculty were about evenly divided in preference, with the younger staff preferring the conference room setting. Most patients (88%) opposed rounds in the hallway. Duration of rounds of one to two hours was felt desirable by most, but 50% of students preferred a duration of less than one hour. For length of new patient case presentation, 60% of learners again favored brevity, less than 5 minutes. Bedside rounds are an opportunity to sharpen diagnostic skills and to demonstrate the art of medicine. They are undervalued by learners and younger faculty but appreciated by patients. The authors recommend that faculty improve bedside rounds by assessing team members' educational needs, by cultivating sensitivity and respect for the needs of all parties, and by assuring pertinence and brevity of bedside discussion.