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首页> 外文期刊>The Journal of Graduate Medical Education >Attending Rounds: The HumptyDumptification of Medical Discourse
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Attending Rounds: The HumptyDumptification of Medical Discourse

机译：参加回合：医疗话语的HumptyDumptification

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“I don't know what you mean by ‘glory,'” Alice said.;Raphael Rabinowitz and colleagues2 write in this issue of the Journal of Graduate Medical Education about what they learned when they asked residents in medicine and pediatrics to talk about the purposes and functions of “attending rounds.” At first blink, their 6 seemingly straightforward questions (eg, “What did you perceive the purpose of rounds to be?”) might be expected to produce straightforward responses about an experience that all the respondents held in common. After all, “attending rounds” happen often, if not every day, in all teaching hospitals. However, despite the novel focus of the article on the perceptions of resident physician participants, the received responses merely confirmed already categorized purposes ascribed to attending rounds: patient care, clinical education, and communication with patient and family.3,4 Rounds have many purposes, some not always clearly recognized by the participants (including the patient and family), so highly disparate functions are lumped together and assigned shelter under the umbrella of attending rounds. This medley of activities (teaching; learning; devising and supervising treatment; guiding young physicians; communicating with patients, families, and professional colleagues; and generating billable documentation of professional input) emphasizes the need for a clarified definition of what educators and program supervisors imply will happen on “attending rounds.” If we want to have all of those sometimes perpendicularly opposed activities accomplished during attending rounds, then all participants (attending physicians, students, residents, even patients and families) need to know what rounds are to be about and why. Or, maybe better, what rounds will be about today, because they may differ tomorrow. In addition to the present report, a number of prior articles (many cited by Rabinowitz et al2) demonstrated that the chiefs of service, hospital finance officials, and even the individual attending physicians who carry out rounds at teaching hospitals attach very different, sometimes contrary meanings to the term “attending rounds.” Humpty Dumpty warned us of the treacherous malleability of language when he said, “You see it's like a portmanteau—there are two meanings packed up into one word.”1 The problem, as I see it, is that each of the actors in this educational drama improvise an ad hoc definition based on their different interpretations of what “rounds” mean. It may help to look at how use of the word “rounds” (in the medical sense) has changed. Early on, the word referred to the practice of physicians walking bed-to-bed, ward-to-ward, even house-to-house to visit patients on their list. Now, the majority of time on rounds is spent not seeing patients, but sitting in conference rooms or lingering in hallways.5 Eugene Stead told me that in his early days at Boston City Hospital, Soma Weiss would make “grand rounds” once a week, walking bed-to-bed to see every patient on the Harvard medical service there. This activity attracted so many interested observers that it became unwieldy, and the group moved to an auditorium to which (selected) patients were brought and presented for discussion by the assembled physicians. Now we use the same word (grand rounds) to denote exercises largely devoid of the presence of living patients, activities more akin to the bloodless and dry academic exercises that William Osler6 (whom Rabinowitz et al cite) tried to end when he declared, “No teaching without a patient for a text.” Rabinowitz et al cite a number of factors that have brought us to our present state. There is the ceaseless hurry introduced into the learner's day by duty hour restrictions, and by the rapid-fire turnover of very ill hospital patients that the present-day teaching hospital has largely become a glorified intensive care unit. There is the commodification of rounds: insurers are now billed for activities that wer
机译：“我不知道你的意思是”荣耀“，”爱丽丝说。; Raphael Rabinowitz和同事2在这个问题上写下这一问题，关于他们在医学和儿科的居民谈论时所学到的研究生教育杂志。 “参加回合”的目的和功能。起初眨眼，他们的6个看似简单的问题（例如，你认为轮次的目的是什么？“）可能有望产生关于所有受访者共同的受访者的经验的直接反应。毕竟，“参加回合”经常发生，如果不是每天，都在所有教学医院。然而，尽管文章的小调了关于居民医师参与者的看法，但收到的答复仅仅确认已经归于参加回合的分类目的：患者护理，临床教育和与患者和家庭的沟通.3,4轮有许多目的，一些并不总是被参与者（包括患者和家庭）清晰认可的，因此极大的函数在一起并在参加回合的伞下分配了庇护所。这个美妙的活动（教学;学习;设计和监督待遇;指导年轻的医生;与患者，家庭和专业同事沟通;并产生专业投入的可费解文件）强调需要澄清教育者和计划监督员的澄清定义暗示的澄清定义将发生在“参加回合”。如果我们希望拥有所有这些有时候在参加回合期间完成的反对的活动，那么所有参与者（参加医生，学生，居民，甚至患者和家庭）都需要了解哪些轮次以及为什么。或者，也许更好，今天将是什么轮流，因为他们明天可能会有所不同。除本报告外，还有一些现有文章（Rabinowitz等人引用）还表明，服务委员会，医院财务官员，甚至是在教学医院开展轮次的个人主持医生附着非常不同，有时相反术语“参加回合”的意义。 Humpty Dumpty警告我们说的语言奸诈性，“你看到它就像一个portmanteau - 有两个意义被包装成一个字。”1问题，就像我看到的那样，这是每个演员都在这个问题教育戏剧根据他们的不同解释即可提高临时定义“圆形”的意思。它可能有助于看看如何使用“圆形”（在医学意义上）发生变化。早期，这个词提到了医生步行床上床上，守卫的守卫，甚至房子，甚至是房子，在他们的名单上访问患者。现在，圆形的大多数时间都没有看到患者，但坐在会议室或在走廊中徘徊.5尤金斯特德告诉我，在波士顿市医院的早期，Soma Weiss将每周制作一次“大轮” ，步行床上床，在那里看到哈佛医疗服务的每位患者。这项活动吸引了这么多感兴趣的观察者，它变得笨拙，而该集团将被提交给那个（选定）患者的礼堂，并呈现出组装的医生讨论。现在我们使用相同的单词（大轮）来表示练习在很大程度上没有生活患者的存在，活动更加类似于威廉奥斯勒6（Rabinowitz等）宣称时试图结束的无流动和干燥的学术锻炼。没有患者为文本没有教学。“ Rabinowitz等人引用了一些带来我们现在的国家的因素。在学习者的日期限制中，乘坐不断的匆忙迅速推出，而当今教学医院的患者非常生病的医院患者的快速消防营业额主要成为一项美味的重症监护室。有一轮的商品化：运行人现在被收取的活动令人费用

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