Introduction
If you have ever been a hospital in-patient, you will know what it means to look forward to ward rounds and to fear them at the same time. On the one hand, you lie there hoping for the doctors to come round because you will hear news of your progress, and perhaps whether you can go home. On the other hand, you almost certainly know from experience that the encounter with doctors will be brief and frustrating, with little opportunity to ask all the questions you wanted, no privacy, and the annoyance of having half a dozen strangers around your bed who might well be looking bored and in a hurry to move on. It is practically impossible to get a focussed conversation for 10 min or more, discussing complex choices about your care, and with other family members present if you wish—all of which you may be accustomed to doing with your own general practitioner.
Ward rounds are a mixed blessing for doctors too. In theory, they provide a regular case review of every patient, an opportunity to teach and learn, and a way of exchanging knowledge and ideas among the professional team. However, in practice they can turn into an unthinking ritual, especially at the end when everyone is tired, or if there is pressure to discharge patients. Ward rounds are often too rushed for any real teaching to take place, and in the worst instances they allow stressed consultants to lambast their juniors publicly for things they forgot to do. Although they ought to provide a chance for doctors and nurses to communicate with each other about everyone's care, the tradition of including a nurse on every round has broken down in many places because people are so busy. In reality, doctors may often find ward rounds just as disappointing as patients do.
Given the centrality of ward rounds in patient care and medical decision-making, it seems extraordinary that people have given so little attention in past to running them effectively and ethically. This is changing, and the Royal Colleges of Physicians and of Nursing have now issued guidance for best practice on ward rounds. One of the authors of the guide is a physician in the south of England called Gordon Caldwell. He has probably spent more time thinking, writing and speaking about the failings of ward rounds, and their unrealised potential, than anyone else in the country. His main focus has been on the risks to patient safety that occur on every single ward round, and on ways of reducing these, although he is also concerned about issues of communication and patient involvement. Writing in the BMJ in 2010, Caldwell pointed out that complex decisions about patients with multiple disorders are often made on the hoof, in sub-optimal conditions, with missing information, and with frequent distractions.