Teaching rounds and change

Abstract

Some things change and other things stay the same. As I was filling out evaluations for two young trainees I had just worked with, it dawned on me that residents never seem to age, and their eagerness to learn is a constant. My mind kept drifting back to the patients we had seen together. So much has changed in the way we deliver health care over the four decades since I began my medical education. The topics I discuss on rounds these days have changed as well. Every year I seem to focus more on the ambiguity of disease and human behavior and less on the explosion of medical discovery I emphasized earlier in my career. Why? Because experience has taught me that there is a lot that residents and students need to understand in caring for patients that they cannot find in textbooks. I remember when Jeffrey, a new neurology resident, presented the story of Michael Jones on rounds. He was eager to expand on the differential diagnosis of this aging man's degenerative basal ganglia disorder. Mr. Jones had undergone countless tests in our movement disorder clinic, but his precise diagnosis remained unclear. Jeffrey had completed a quick literature search in a matter of minutes with a few key strokes of a computer. Of course, we spent time reviewing the conditions Jeffrey indicated could lead to this man's severe disability. But since there are voluminous textbook details readily available to residents, I did not have to belabor that conversation. My resident's computer search failed, however, to include any practical discussion of the increasing confusion that led to Mr. Jones' admission. He was too bewildered to verify the host of medications the clinic notes reported that he was taking; his wife was uncertain as well. She had reported that neither …