Rattibha

1/ In the last 2 wks, #MedEdMethodsMonday reviewed benefits of #BedsideRounds, categorized challenges to teaching @ the bedside, & highlighted several strategies for facilitating learners.
This wk focuses on strategies to overcome patient-related barriers to bedside rounds.

2/ One of the goals of #BedsideRounds is to engage/include pts in their care. But what if pts:
-have sensitive medical issues
-are in pain
-don’t understand medical jargon
-don’t want to feel like “guinea pigs”
-are confrontational, upset, or “difficult” to engage

3/ Today’s #MedEdMethodsMonday #MedThread addresses:
1. Pt privacy concerns
2. Minimizing pt discomfort & maximizing engagement
3. Including the “difficult” pt
W/ help from #MedTwitter. #MedEd #MedEdPearls #FacDev #Tweetorial @MedTweetorials

4/ Patient Privacy - Discussing aspects of pt health that society traditionally stigmatized is a valid concern, but shouldn’t keep us from rounding in the room.
I worked out this PATIENTS mnemonic that helps address privacy and comfort concerns. Details following...

5/ Patients- Purpose
-“This is an opportunity for us to update you & get every1 on the team on the same page”
-Set expectations for duration w/ pts & that your learners ARE still learning
-For 1-off bedside sessions, emphasize educational purpose of session & avoid long ddx list

6/ pAtients- Ask Permission
After explaining to pt WHY you are bedside rounding, ask permission for the team to present pt’s health information @ the bedside, particularly if pt has a roommate.

7/ pAtients- Ask Permission
Clarify if the pt wishes for any health information to NOT be discussed in front of roommates or families. This is for HIPAA. Otherwise I tell pts all members of the team will be familiar with their medical history even if not presented at bedside.

8/ paTients- Take a Seat
Insure the presenter is seated. Talking @ eye level reduces power differential, improves pt perception of provider communication skills & time spent @ bedside
@JHospMedicine piece by @SusanMerel @AndrewW2000 et al from @UW_HospMed journalofhospitalmedicine.com

www.journalofhospitalmedicine.com

9/ patIents - Introduce the Team
This is a simple one:
-Introduce each team member, their role in pt care, & who the primary “face” of the team is going to be
-Introduce the pt! Including a non-medical fact about the pt humanizes the encounter

10/ patiEnts- Engage the patient
-Present TO the pt using “you” rather than “he/she” language
-Presenter intermittently confirms statements of the HPI with the pt
-Show pts labs and imaging
-Ask for pts opinions about medical decisions
-Make time for ?s
-Get teachback

11/ patieNts- No Jargon
Avoid medicalese while presenting. For learners (students & interns) working on communicating A&P, transition to formal presentation by saying, “I’m going to update the team with some shop talk, but we will summarize everything for you at the end.”

12/ patienTs- Thank the Patient
Provide a genuine, encouraging closure that helps patients feel like a valued member of the rounding experience. I find pts love hearing, “Thank you for helping me teach!”

13/ patientS - Stay flexible
Pts can be unpredictable
-Be observant and avoid pushing your teaching agenda if the pt looks uncomfortable
-Teaching exam? Don’t ask learners to repeat painful maneuvers. Have them practice on each other instead or even on you

14/ What about the pts who are talkative & tangential? Delirious? Angry or confrontational? Welcome these pts as perfect opportunities to model patient-centered communication skills for learners: the gentle redirection, NURSing the emotions, de-escalating a tense moment, etc.

15/ And remember, studies show that most pts PREFER interactions with medical teams who bedside round compared to walk rounds/card-flipping rounds
See article by Max Peters and @olletencate drive.google.com