visit
The rounds ( Latin : visitare = to visit), also medical rounds , designates in the hospital the visit of the patient at the bedside by one or more doctors . The general practitioner visit by the resident doctor to his patient is also referred to as a visit .
description
In the hospital or clinic, regular rounds, which usually take place once a day (usually in the morning), play an important role in the operation of the ward, in which the diagnosis and therapy are determined for the patient. Sometimes a whole group (e.g. chief physician, ward physician, students, health and nursing staff ) takes part in the rounds.
As special forms there are, among other things, the curve visit (the name is derived from the fact that only the temperature curves and the care documentation are used and the patients are not visited personally) and the chief physician's visit ( usually once a week the chief physician informs himself about the patients in his department and teaches at the bedside).
During the consultation on the occasion of the rounds, the patient should be able to express his complaints and problems and receive information on how to proceed. On the other hand, the doctor should ascertain the progress or possible failure of the therapy on the patient and coordinate the further course of action with his staff.
During the visit to the hospital , the clinic doctor is usually accompanied by employees from the nursing service . In clinics that have medical students in their practical year , they also take part for training purposes.
Already the Muslims in the 10th century knew the visit, almost in the sense of modern holistic methods. There the patient was asked about his physical as well as his mental state of health.
Tasks of the rounds from a medical point of view
- Review of the current test results
- anamnese
- physical examination
- Documentation of the course of the disease
- Orders / ordinances (usually in writing (order sheet) or orally to an accompanying nurse)
- Transfer: internally (e.g. to the intensive care unit ) or externally (e.g. to a rehabilitation clinic)
- Medication and dosage adjustment
- diet
- therapeutic measures such as physiotherapy
- nursing measures
- Examinations such as x-rays , laboratory, endoscopies
- Requirements for consultations (examinations and advice from doctors of the same or different specialties)
- Plan operations (OP) and prepare instructions for them
- Supervision of subordinate doctors, possibly still in training (chief and senior physician visits) and training of medical students
- Discharge home or nursing home
Tasks of the round from the patient's point of view
- Providing information about
- the illness and its physical, psychological and social effects on the patient
- Diagnostic and therapeutic measure
- Instructions and help with finding your way around in the role of sick
Common problems
The analysis of visits reveals an unequal consideration of the objectives of the interlocutors ( patient-doctor relationship ). The medical objective of the round is clearly the focus, while the patient's point of view is only marginally taken into account. This creates a latent conflict.
In the rounds discussion, the focus of the medical discussion can be on the patient's physical complaints. In this case, the patient is only perceived fragmented, so that psychological and social areas are then discussed less often.
"If the doctor's perception of the patient remains incomplete, fragmented, superficial or limited to a prominent disorder symptom, the diagnosis will be inadequate."
Linus Geisler lists typical communication deficits and deficits during the rounds:
- Half of the patient's complaints are not discussed.
- Doctors receive little information about the significance of the disease for those affected and its emotional and social consequences.
- Doctor and patient disagree on the patient's primary health problem in more than half of the cases.
- The patient rounds in the hospital are essentially determined by the role understanding of the interaction partners.
- Another specific feature of the hospital rounds is that it involves communication under institutional conditions.
Thomas Bliesener simply calls the traditional visit a "prevented dialogue".
Linus Geisler points to the dialogical thinking from humanistic medicine, which is connected with speaking medicine : "Dialogical thinking was developed in the twenties of the last century by the" philosophers of dialogue "such as F. Ebner, M. Buber, F Rosenzweig, G. Marcel and V. v. Weizsäcker , to which the term "speaking medicine" is ascribed. ”(2003; see links below)
Characteristics of the visit interview
- The average visit time is three to four minutes. (The doctor's speaking time is twice as long as that of the patient.)
- On average, three people take part in the medical consultation.
- On average, the patient only asks one or two questions during the round.
- In contrast, the doctor asked the patient six to eight questions.
- On average, every second visit conversation is disrupted in its course.
See also
literature
- Klaus Dörner : The good doctor. Textbook of the basic medical attitude. Schattauer Verlagsgesellschaft, Stuttgart / New York 2001, ISBN 3-7945-2050-5 .
- Steffen Simon (Ed.): The good doctor in everyday life 2004. Deutscher Ärzte-Verlag, Cologne 2007, ISBN 978-3-7691-0480-6 . (Instructions for the basic medical attitude in clinic and practice)
Individual evidence
- ^ Karl F. Masuhr: The visit. JG Hoof, Berlin 2014, ISBN 978-3-936345-94-0 .
- ↑ Linus S. Geisler : Communication during patient rounds - an expression of our ethical values. Presentation at the ethics symposium "Economy or humanity - ethics in everyday clinical practice between stools" on March 14, 2003.
- ↑ Wolfgang Böker : Doctor-patient relationship: The fragmented patient. In: Deutsches Ärzteblatt . 100, January 6, 2003, p. A-24
- ↑ Thomas Bliesener, Karl Köhle: The medical rounds. Chance to talk . 1986, ISBN 3-531-11769-6 . (A book that emerged from a scientific examination during a visit)
- ↑ a b Linus S. Geisler: Doctor and patient in conversation - reality and ways. Lecture on May 10, 1989 in Berlin. In: Schering Health Policy Talks. Issue 7, 1989.
- ↑ a b c d e A. J. Rüdiger: The medical consultation in oncology - a field study from a formal, quantitative and qualitative point of view. Med. Dissertation, University of Greifswald, 2011.
- ↑ a b C. Jahresig, U. Koch: The doctor-patient interaction in the internal rounds of an acute hospital: An empirical study. In: K. Köhle, H.-H. Raspe (Ed.): The conversation during the medical rounds. Urban & Schwarzenberg, Munich / Vienna / Baltimore 1982, pp. 36–57.
- ↑ M. Sator, A. Gstettner, B. Hladschik-Kermer: Ever since the doctor told me 'tumor' - that's it. Doctor-patient communication at the oncological outpatient department. A linguistic pilot study on problems of communication. In: Wien Klin Wochenschr. 120 / 5-6, 2008, pp. 158-170.