#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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J Hospital Medicine @JHospMedicine
Tonight's #JHMChat article is on the purpose of rounds with guest authors @jeannemfarnan and @oliver_hulland - welcome! here is their paper https://t.co/K7r7ny3L2M
J Hospital Medicine @JHospMedicine
Tonight's #JHMChat article is on the purpose of rounds with guest authors @jeannemfarnan and @oliver_hulland -... https://t.co/vep3H5T6u9
Society of Hospital Medicine @SocietyHospMed
#JHMChat on the purpose of #rounds starts NOW! Join the conversation, then claim #CME: https://t.co/ca4ZbtGoRV https://t.co/MrufnmNN2A
J Hospital Medicine @JHospMedicine
Welcome to #JHMChat! I am your moderator @FutureDocs. please introduce yourself to the group. #meded folks welcome.
J Hospital Medicine @JHospMedicine
T1 coming up in a moment #JHMChat
Tony Breu @tony_breu
Excited for tonight's #JHMchat - here from Boston. Lying next to my daughter (2 yo). She's excited too!
Jeanne M. Farnan @jeannemfarnan
@JHospMedicine @oliver_hulland Hi #JHMChat!
Vinny Arora MD MAPP @FutureDocs
I’ll be moderating an age old question in #meded at #jhmchat next hour - what’s the purpose of rounds? Follow along! https://t.co/DbRQw8HAhA
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Welcome to #JHMChat! I am your moderator @FutureDocs. please introduce yourself to the group. #meded folks welcome.
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat Joining from west coast #PDX!
Rupesh Prasad @rupeshp011
Looking forward to an engaging discussion. #JHMChat
Vinny Arora MD MAPP @FutureDocs
Nothing better than hosting #JHMChat with friends :) https://t.co/DbRQw8HAhA
PeraHealth @perahealth
PeraHealth here! We are excited to join tonights #JHMChat rounding discussion! We are a predictive, real-time clinical surveillance solutions company: https://t.co/WGzK1h8dm7
OHSU IM Residency @OHSUIMRes
#JHMchat also joining from Portland, hope to represent IM residents in this discussion
J Hospital Medicine @JHospMedicine
RT @FutureDocs: Nothing better than hosting #JHMChat with friends :) https://t.co/DbRQw8HAhA
Aravind A Menon, MD @aravindamenon
#JHMChat Joining from Boston. Just finished prepping morning report for tomorrow. :)
Jeanne M. Farnan @jeannemfarnan
@oliver_hulland Hey Oliver! #JHMchat
J Hospital Medicine @JHospMedicine
@jeannemfarnan @oliver_hulland great to have you both on #JHMChat tonight!
J Hospital Medicine @JHospMedicine
@aravindamenon thx for taking the time to drop in #jhmchat
J Hospital Medicine @JHospMedicine
Welcome ! An important voice for #JHMChat https://t.co/bkRyggaoLP
J Hospital Medicine @JHospMedicine
@PeraHealth thx for joining #jhmchat
J Hospital Medicine @JHospMedicine
T1 #JHMChat While faculty & #medstudents prioritize communication & #meded in rounds, authors mention residents focused on “getting work done." How does this affect rounds?
J Hospital Medicine @JHospMedicine
T1 #JHMChat While faculty & #medstudents prioritize communication & #meded in rounds, authors mention residents... https://t.co/zQuHO80BkX
Charlie M. Wray @WrayCharles
Evening #JHMChat! Checkin in after putting dinner on the table for the 2 little ones. Looking forward to chatting about rounds w/@oliver_hulland & @jeannemfarnan
J Hospital Medicine @JHospMedicine
@aoglasser great to see you - we appreciate the west coast efforts cc @WrayCharles #jhmchat
J Hospital Medicine @JHospMedicine
RT @WrayCharles: Evening #JHMChat! Checkin in after putting dinner on the table for the 2 little ones. Looking forward to chatting about ro…
Society of Hospital Medicine @SocietyHospMed
#JHMChat T1 is live! Join our discussion on the purpose of #rounds! https://t.co/AjuAz8tOQW
Vinny Arora MD MAPP @FutureDocs
Live on #JHMChat T1 https://t.co/ja2icK8Dap
Tony Breu @tony_breu
It makes it very tough to meet everyone's expectations. Sometimes, nobody feels their met. #JHMChat https://t.co/qUCijKsTmL
Avital O'Glasser, MD FACP FHM @aoglasser
T1 #JHMchat I thought the article did a really nice job of explicitly calling out duty hours and time pressures
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T1 #JHMChat While faculty & #medstudents prioritize communication & #meded in rounds, authors mention residents... https…
Alex Auseon @ajauseon
Hi from cardiology at UIC. Just came off of consult service and am ready to hear how I can improve rounds #JHMChat
Vinny Arora MD MAPP @FutureDocs
Would be great to have guest author @oliver_hulland @jeannemfarnan input on this #JHMChat https://t.co/ja2icK8Dap
Avital O'Glasser, MD FACP FHM @aoglasser
@WrayCharles @oliver_hulland @jeannemfarnan just told the kids I had a work meeting & wouldn't be at dinner! (I actually put this on shared family calendar 1 month ago...) #JHMchat
Jeanne M. Farnan @jeannemfarnan
@JHospMedicine Competing priorities impact efficiency and expectations #JHMChat
Aravind A Menon, MD @aravindamenon
#JHMChat T1 Residents being the front line providers over a period of 3-4 years round more than attendings who are on service and med students. Leads to creation of individually structured ways to get work done
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat as an attending, that's definitely a frequent balance on rounds, esp when at max patient census
J Hospital Medicine @JHospMedicine
@tony_breu we welcome #JHMChat participants of all ages - pediatrics question coming up in T3 !
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: @JHospMedicine Competing priorities impact efficiency and expectations #JHMChat
J Hospital Medicine @JHospMedicine
RT @aravindamenon: #JHMChat T1 Residents being the front line providers over a period of 3-4 years round more than attendings who are on se…
J Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMchat as an attending, that's definitely a frequent balance on rounds, esp when at max patient census
Charlie M. Wray @WrayCharles
Personally, the only time I struggle with the "duty hour" conundrum is post-call, the rest of the time there still exists a time crunch, but I think the motivation for that is different #JHMChat... https://t.co/C12ny3dz5g
Alex Auseon @ajauseon
There are lots of choices about how to prioritize time - for what? For whom? #JHMChat
Jonathan Meldrum @jl_meldrum
.@oliver_hulland answering the big questions tonight. Is there a purpose to rounds? Is there a purpose to life? #JHMchat
Jeanne M. Farnan @jeannemfarnan
These competing priorities can impact experience of rounds, self fulfilling prophecy of ineffectiveness #JHMChat https://t.co/3qDzqsKuMj
Oliver Hulland @oliver_hulland
@jeannemfarnan @JHospMedicine Something I've learned since becoming a resident is the tension between different priorities across the spectrum of med students to residents to attendings. #JHMChat
Tony Breu @tony_breu
What's interesting is that I tell my team what I think rounds are for, but never ask them. This paper (and their prior resident work) help me see the holes. #JHMChat https://t.co/qUCijKsTmL
Vinny Arora MD MAPP @FutureDocs
Spoiler: Save this answer for T2! #JHMchat https://t.co/pB71k9gaaC
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu #JHMchat I will absolutely second that! esp when residents/students had differing priorities...
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: These competing priorities can impact experience of rounds, self fulfilling prophecy of ineffectiveness #JHMChat https:/…
Oliver Hulland @oliver_hulland
@tony_breu This is such an important point. By asking you engage with them as learners to figure out how they learn best and how to help them get their work done efficiently. #jhmchat
Aravind A Menon, MD @aravindamenon
Mostly due to availability of ancillary sources and circadian stereotypes. #JHMChat
Tony Breu @tony_breu
@aoglasser And, residents and interns have different expectations! #JHMChat
J Hospital Medicine @JHospMedicine
@aoglasser @WrayCharles @oliver_hulland @jeannemfarnan glad you have #JHMchat as a priority!
Jeanne M. Farnan @jeannemfarnan
One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-their evaluation, their teaching...only residents focused on patient care as the central component #JHMchat https://t.co/3qDzqsKuMj
J Hospital Medicine @JHospMedicine
RT @tony_breu: What's interesting is that I tell my team what I think rounds are for, but never ask them. This paper (and their prior resid…
OHSU IM Residency @OHSUIMRes
@WrayCharles #JHMchat our program moved to 3+1 system years ago, but still time crunch in "drip model" of admissions/inpatient wards, esp when conferences factored in
J Hospital Medicine @JHospMedicine
RT @oliver_hulland: @tony_breu This is such an important point. By asking you engage with them as learners to figure out how they learn bes…
Lakshman Swamy @laxswamy
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
Oliver Hulland @oliver_hulland
This idea of conflicting priorities across training levels inherently makes it difficult if not impossible to satisfy everyone. #jhmchat https://t.co/xEGGrbJIZM
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
Tony Breu @tony_breu
@oliver_hulland Sounds like #AMreport ... cc: @BostonChiefs #JHMChat
J Hospital Medicine @JHospMedicine
RT @oliver_hulland: This idea of conflicting priorities across training levels inherently makes it difficult if not impossible to satisfy e…
Charlie M. Wray @WrayCharles
#JHMChat T1: begs the question, are there/should there be different priorities of rounds on different days (of call cycle)? I think we'd all agree that that occurs de facto
Avital O'Glasser, MD FACP FHM @aoglasser
@jeannemfarnan #JHMchat Q on that point-to what extend did residents describe rounds as truly being "work rounds" v "decision making rounds", ex was real-time #EHR use encouraged for order entry, etc?
Oliver Hulland @oliver_hulland
Best solution I saw as a medical student was to offload teaching to senior residents so as to have them engage as teachers and develop mastery while also freeing the attending if they need to evaluate/attend to other matters #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @WrayCharles: #JHMChat T1: begs the question, are there/should there be different priorities of rounds on different days (of call cycle)…
Jeanne M. Farnan @jeannemfarnan
Excellent point and completely untapped resource (see tweetcon egocentricity of attendings :) #JHMChat https://t.co/acLQTCMkkl
Amy Shaw @amyshawmd
Time pressure, discharge pressure... but good morning rounds incorporate little bits of #meded (e.g., ddx, reasoning, illness severity) as you go #jhmchat T1 https://t.co/VhDiAq1QEh
Tony Breu @tony_breu
@WrayCharles Yes and no. Some things should remain constant (provide time to ensure patient understands plan). Some things are plastic (amount of teaching). #JHMChat
Nancy H Stewart DO, MS @nvhstewart
Sorry I’m joining #JHMChat late tonight! Just got home from covering #ICU @JHospMedicine
Vinny Arora MD MAPP @FutureDocs
@WrayCharles I absolutely prioritize different things different days based on workload #JHMchat
Charlie M. Wray @WrayCharles
@tony_breu @aoglasser don't forget the med students... #jhmchat
Nancy H Stewart DO, MS @nvhstewart
RT @jeannemfarnan: These competing priorities can impact experience of rounds, self fulfilling prophecy of ineffectiveness #JHMChat https:/…
Nancy H Stewart DO, MS @nvhstewart
RT @WrayCharles: #JHMChat T1: begs the question, are there/should there be different priorities of rounds on different days (of call cycle)…
J Hospital Medicine @JHospMedicine
let's keep the convo going. T2 coming up in a moment on #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@WrayCharles #JHMchat I encourage my team to "run the list" and apply art of triage before start of rounds-what do we need to collectively & specifically accomplish today (DC, sick pt, etc)
Oliver Hulland @oliver_hulland
@aoglasser @jeannemfarnan Different institutions had different rounding structures with only one in the study that explicitly identified "work rounds". #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @amyshawmd: Time pressure, discharge pressure... but good morning rounds incorporate little bits of #meded (e.g., ddx, reasoning, illnes…
Jeanne M. Farnan @jeannemfarnan
Totally agree, post call is not pre call and every day cannot be the same...ROUNDS cannot be the same, is this honestly what we would create if we were doing it de novo now? Wings on an Edsel do not equal an airplane #JHMChat https://t.co/iBLZXO5nTs
Tony Breu @tony_breu
@amyshawmd Unfortunately, these types of teaching aren't often recognized by learners as "teaching". Pontification prevails. #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @oliver_hulland: @aoglasser @jeannemfarnan Different institutions had different rounding structures with only one in the study that expl…
Nancy H Stewart DO, MS @nvhstewart
This is very fascinating to me, although it shouldn’t be surprising #JHMchat @JHospMedicine #meded https://t.co/Tm49T8Dndu
J Hospital Medicine @JHospMedicine
RT @nvhs0401: This is very fascinating to me, although it shouldn’t be surprising #JHMchat @JHospMedicine #meded https://t.co/Tm49T8Dndu
Seth Trueger @MDaware
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
J Hospital Medicine @JHospMedicine
@nvhs0401 glad you made it! #JHMchat
J Hospital Medicine @JHospMedicine
RT @amyshawmd: Time pressure, discharge pressure... but good morning rounds incorporate little bits of #meded (e.g., ddx, reasoning, illnes…
J Hospital Medicine @JHospMedicine
RT @oliver_hulland: @jeannemfarnan @JHospMedicine Something I've learned since becoming a resident is the tension between different priorit…
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @amyshawmd #JHMchat agree. I have to "warn" learners that even when I'm not doing a chalk-talk, etc, teaching is happening and to keep ears/eyes open...
Tony Breu @tony_breu
@WrayCharles @aoglasser Of course not! And sometimes, rounds include: Me (attending) Resident Interns (x2) Student NP/PA Pharmacist Prince William Etc. #JHMChat
J Hospital Medicine @JHospMedicine
RT @WrayCharles: #JHMChat T1: begs the question, are there/should there be different priorities of rounds on different days (of call cycle)…
Jeanne M. Farnan @jeannemfarnan
Such a great distinction, rounds don’t necessarily need to be an information exchange-I have the info before I get there now-shouldn’t we focus on decision making and not lab reading? #JHMChat https://t.co/DAbyi6lCUY
Oliver Hulland @oliver_hulland
@WrayCharles The best attendings I worked with would set the stage and identify what they wanted to do based on the needs of the team. Especially helpful when made explicit. #jhmchat
Charlie M. Wray @WrayCharles
Works really well if you've got a senior who is engaged and wants to teach (and is good at it) #JHMChat https://t.co/LGNfJ93iUw
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @WrayCharles making sure we're paying attention? Tell the future king we say hi :) #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @WrayCharles: Works really well if you've got a senior who is engaged and wants to teach (and is good at it) #JHMChat https://t.co/LGNfJ…
Avital O'Glasser, MD FACP FHM @aoglasser
RT @oliver_hulland: @WrayCharles The best attendings I worked with would set the stage and identify what they wanted to do based on the nee…
Charlie M. Wray @WrayCharles
RT @jeannemfarnan: Totally agree, post call is not pre call and every day cannot be the same...ROUNDS cannot be the same, is this honestly…
Rupesh Prasad @rupeshp011
@WrayCharles #JHMchat :There needs to be some standardization, though could have minor variations based on the call cycle.
Jigar Contractor @jigsymd
@aoglasser @tony_breu @amyshawmd I flagpost it. I say here is how I'm thinking about this problem. Maybe this is a patient we should go to the bedside and see if they have this finding cause it will help us decide what to do next #JHMchat
OHSU IM Residency @OHSUIMRes
@oliver_hulland @WrayCharles agree, it's the best attendings who seem the most responsive, v forced/cookie-cutter agenda #JHMchat
Vinny Arora MD MAPP @FutureDocs
@aoglasser @tony_breu @amyshawmd Are chalk talks desired? Residents went to get to conference. “Service vs learning” debate #JHMchat
Sri Lekha Tummalapalli, MD, MBA @LTummalapalli
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
J Hospital Medicine @JHospMedicine
RT @OHSUIMRes: @oliver_hulland @WrayCharles agree, it's the best attendings who seem the most responsive, v forced/cookie-cutter agenda #JH
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs @tony_breu @amyshawmd seems like the med students want teaching time on core principles in the team room > residents #JHMchat
J Hospital Medicine @JHospMedicine
RT @JigsyMD: @aoglasser @tony_breu @amyshawmd I flagpost it. I say here is how I'm thinking about this problem. Maybe this is a patient we…
Lakshman Swamy @laxswamy
@WrayCharles But it is also true that in today’s world teaching is always in direct competition with pt care, efficiency. #JHMChat
Tony Breu @tony_breu
@FutureDocs @aoglasser @amyshawmd Chalk "talks" of 10-15 minutes are desired, but not on rounds. 1-2 minute bursts of teaching (framed, a la feedback) is what I aim for on rounds. #JHMchat
Jeanne M. Farnan @jeannemfarnan
Or make them be the “pre”-tending, a strategy used by our @UChicagoMed pediatrics faculty #JHMChat https://t.co/weyyMFKcyg
J Hospital Medicine @JHospMedicine
RT @tony_breu: @WrayCharles @aoglasser Of course not! And sometimes, rounds include: Me (attending) Resident Interns (x2) Student NP/PA Ph…
Amy Shaw @amyshawmd
@FutureDocs @aoglasser @tony_breu Hard to do chalk talks on morning rounds but oftentimes used well later in day to answer a relevant question #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @tony_breu: @FutureDocs @aoglasser @amyshawmd Chalk "talks" of 10-15 minutes are desired, but not on rounds. 1-2 minute bursts of teachi…
Society of Hospital Medicine @SocietyHospMed
Claim #CME following tonight's #JHMChat here: https://t.co/PG5MMkA73e
J Hospital Medicine @JHospMedicine
T2 #JHMChat Attending focus groups cited duty hours and time pressures as actively working against the purpose of rounds. How do we overcome?
J Hospital Medicine @JHospMedicine
T2 #JHMChat Attending focus groups cited duty hours and time pressures as actively working against the purpose of... https://t.co/zyG7f84hq8
John Ryan @JJRyanMD
One of the challenges of teaching on rounds is making sure it's valuable to fellows, residents, students, nurses and PharmDs who are all on rounds #JHMChat https://t.co/fF3o76krrf
Lakshman Swamy @laxswamy
RT @tony_breu: @FutureDocs @aoglasser @amyshawmd Chalk "talks" of 10-15 minutes are desired, but not on rounds. 1-2 minute bursts of teachi…
Dr I Came to Sleigh, Bell. @DrPoorman
This article and chat are ascribing these difficulties to duty hours, a dangerous intellectual shortcut #JHMchat https://t.co/5PfeFE7APG
Oliver Hulland @oliver_hulland
RT @aoglasser: @tony_breu @amyshawmd #JHMchat agree. I have to "warn" learners that even when I'm not doing a chalk-talk, etc, teaching is…
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @FutureDocs @amyshawmd I tell my team it's elevator teaching (medicine wards on 5th and 14th floors, you can watch paint dry traveling...), avoids HIPAA violations and makes use of the time #JHMchat
Joel Topf, MD FACP @kidney_boy
I’m lurking but it’s a really interesting chat. Join if you are near twitter. #jhmchat
Vinny Arora MD MAPP @FutureDocs
@tony_breu @WrayCharles @aoglasser who knew we would have royalty come up on #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @aoglasser: @tony_breu @FutureDocs @amyshawmd I tell my team it's elevator teaching (medicine wards on 5th and 14th floors, you can watc…
Avital O'Glasser, MD FACP FHM @aoglasser
@jeannemfarnan @UChicagoMed #JHMchat depends on the senior + interns' efficiency (ex notes, orders) as well as the senior-intern dyad, plus time of the year
Society of Hospital Medicine @SocietyHospMed
#JHMChat T2 is live! https://t.co/LBYCVUhXHK
J Hospital Medicine @JHospMedicine
RT @JJRyanMD: One of the challenges of teaching on rounds is making sure it's valuable to fellows, residents, students, nurses and PharmDs…
PeraHealth @perahealth
A potential disconnect on how we perceive the purpose of rounds is the actual information that is being presented regarding a patients condition during rounds, addressing the inconsistencies #JHMChat
Dr I Came to Sleigh, Bell. @DrPoorman
As if we can be good doctors and good #meded educators if there is no limit on how long residents work. #jhmchat https://t.co/ic0kbkx6Go
Tony Breu @tony_breu
Don't round till noon. And certainly not through lunch! #JHMChat https://t.co/sbBdQeKzK7
PeraHealth @perahealth
How do we keep everyone on the same page during rounds? From patient transfers to handoffs, what information regarding a patients condition is being relayed to the care team to make sure this information is effectively presented? #JHMChat
Oliver Hulland @oliver_hulland
I think this warning only needs to happen once on the first day you round with them as it helps to define/frame how you teach. https://t.co/XVbX3Gnxok
Avital O'Glasser, MD FACP FHM @aoglasser
@amyshawmd @FutureDocs @tony_breu absolutely! I like "bookmarking" or at least highlighting the question and saving more for later, or pulling article PDF and emailing before sitting down about it #JHMchat
Jeanne M. Farnan @jeannemfarnan
Absolutely, the times they are a-changin’ #JHMChat https://t.co/vmAI2BZQCc
Rob Montgomery @ramontgo
@tony_breu @WrayCharles It’s nice to provide time for patients to understand plan but that actually seems like a goal that is not met. I’ve almost never left rounds without telling patient that we will be back to explain more. #JHMChat
Charlie M. Wray @WrayCharles
@DrPoorman So true! #JHMchat
Vinny Arora MD MAPP @FutureDocs
Ok time @WrayCharles @aoglasser #JHMchat https://t.co/6Q8GTy5WPi
Dr I Came to Sleigh, Bell. @DrPoorman
Yes, education activities have suffered. But not because residents are working fewer hours. #JHMchat
Tony Breu @tony_breu
@aoglasser @amyshawmd @FutureDocs The only reason I carry note cards on rounds is to jot down ideas for later emails or brief chalk talks. #JHMChat
Jeanne M. Farnan @jeannemfarnan
I throw the “teaching flag” like an @NFL ref, like hey I’m teaching here... #JHMChat https://t.co/IM8PK31eo9
Avital O'Glasser, MD FACP FHM @aoglasser
@jeannemfarnan @NFL yes! #JHMchat
Chloe Slocum, MD MPH @chloe_slocum
RT @JHospMedicine: T1 #JHMChat While faculty & #medstudents prioritize communication & #meded in rounds, authors mention residents focused…
Oliver Hulland @oliver_hulland
Yes! I think one important takeaway from the literature is that specific rounding practices can increase the amount of teaching without increasing time of rounding. #jhmchat https://t.co/BvbEEZuZ9u
Charlie M. Wray @WrayCharles
@JJRyanMD This is true, but so hard to teach to that complete spectrum #JHMchat I often pick one type of trainee to teach to per patient. Not perfect, but gives me some structure
Jigar Contractor @jigsymd
@FutureDocs @tony_breu @WrayCharles @aoglasser isn't it Prince Harry's day? #JHMchat
Vinny Arora MD MAPP @FutureDocs
T2 i send teaching points with summary of a paper via email to offload teaching & then ask for feedback “flipped rounds” #JHMchat
Aravind A Menon, MD @aravindamenon
@tony_breu Key is prep. #JHMChat Rounding cannot be seen as the age old way of having the team gather primary data. With EMR and PACS. Everyone including attending should have reviewed primary data.
Lakshman Swamy @laxswamy
@aoglasser @tony_breu @FutureDocs @amyshawmd I'll also say this out loud: somewhere around 2h into rounds efficiency probably drops off and teaching is essentially wasted, IMHO. #jhmchat
Jeanne M. Farnan @jeannemfarnan
I’m a true moment of heresy, and as a pre-duty hours trainee, gotta say it’s not all duty hours fault :) #JHMChat https://t.co/kWlE0Vs6mj
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @amyshawmd @FutureDocs yup! ditto (plus the lasix bioavailability curve makes an appearance on the back of my patient list every time I attend) #JHMchat
Vinny Arora MD MAPP @FutureDocs
@JigsyMD @tony_breu @WrayCharles @aoglasser yes or more precisely Megan Markle’s day :) #JHMchat
Rupesh Prasad @rupeshp011
@aoglasser @tony_breu @amyshawmd Great point #JHMChat
Jeanne M. Farnan @jeannemfarnan
Hospital care and patients are more complex and require more car coordination, rounds cannot be seen as an impediment...they need to be valuable, if we build it they will round #JHMChat https://t.co/kWlE0Vs6mj
Charlie M. Wray @WrayCharles
A @jeannemfarnan classic! I'd love to throw a literal flag in the air. I'm going to take a Kleenex box with me on rounds tomorrow and improvise this...#JHMChat https://t.co/7F80igJX8H
Oliver Hulland @oliver_hulland
@WrayCharles @JJRyanMD Several of the attendings made a point to "circle back" after rounds with the medical students to specific patients to give residents time to get things done. #jhmchat
Tony Breu @tony_breu
@JigsyMD @FutureDocs @WrayCharles @aoglasser That's why he joined for rounds! #JHMChat
Jan Elizabeth Bell @SwearyPaed
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
Vinny Arora MD MAPP @FutureDocs
This is why you need to prioritize who you round on first - I see several on my own #JHMchat https://t.co/w0tADAFImn
Jigar Contractor @jigsymd
@aoglasser @tony_breu @amyshawmd @FutureDocs or even have the students/residents hit the literature and can teach by example on how to be a lifelong learner and incorporate EBM. plus gives you a chance to evaluate this skill #JHMchat
Vinny Arora MD MAPP @FutureDocs
@tony_breu @JigsyMD @WrayCharles @aoglasser 😂 #JHMchat
Lakshman Swamy @laxswamy
@jeannemfarnan The truth is that the hospital (efficiency) kind of hates rounds. Patients don't love rounding if they're too early or late (they don't pick when they see you). Is it something we do for ourselves at this point? #jhmchat
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs ditto, all part of the art of "triage", which I also make an explicit learning goal for the block with my senior (and also intern) #JHMchat
Jeronimo Cassanello @xass76
RT @tony_breu: @WrayCharles @aoglasser Of course not! And sometimes, rounds include: Me (attending) Resident Interns (x2) Student NP/PA Ph…
Shreya P. Trivedi MD @ShreyaTrivediMD
T1 #JHMchat: excellent ex. of how the mindset of residents is focused on #tasks (not entirely their fault tho). This often leaves rounds as “getting in the way” https://t.co/BInIwp9tO1
Vinny Arora MD MAPP @FutureDocs
RT @jeannemfarnan: I throw the “teaching flag” like an @NFL ref, like hey I’m teaching here... #JHMChat https://t.co/IM8PK31eo9
Jeanne M. Farnan @jeannemfarnan
More of this! I do the same, we need to do things that show house staff we value THEIR time, like prioritizing conference attendance #JHMChat https://t.co/fM77M6LHda
Vinny Arora MD MAPP @FutureDocs
RT @aoglasser: @FutureDocs ditto, all part of the art of "triage", which I also make an explicit learning goal for the block with my senior…
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs but I even use the jest to break the ice with my team--that I'm perfectly physically capable of walking to see a patient on my own if we won't finish rounds by designated start time #JHMchat
Nancy H Stewart DO, MS @nvhstewart
So true!!! I can’t tell u the number of times I’ve heard this #jhmchat #meded https://t.co/u72FUzLuHs
Dr I Came to Sleigh, Bell. @DrPoorman
So let’s be careful about what duty hours mean. They are an important step that was unfortunately made in isolation and had unintended consequences. #JHMchat
Vinny Arora MD MAPP @FutureDocs
@laxswamy @jeannemfarnan stay tuned for T3 #JHMchat
Sharmila Dissanaike @dissanaikemd
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
PeraHealth @perahealth
Incorporating technology with rounding fosters smart clinical decision making and reduces time pressure #JHMChat
Oliver Hulland @oliver_hulland
RT @jeannemfarnan: More of this! I do the same, we need to do things that show house staff we value THEIR time, like prioritizing conferenc…
J Hospital Medicine @JHospMedicine
RT @ShreyaTrivediMD: T1 #JHMchat: excellent ex. of how the mindset of residents is focused on #tasks (not entirely their fault tho). This…
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: Hospital care and patients are more complex and require more car coordination, rounds cannot be seen as an impediment...…
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: I’m a true moment of heresy, and as a pre-duty hours trainee, gotta say it’s not all duty hours fault :) #JHMChat https:…
Aravind A Menon, MD @aravindamenon
RT @jeannemfarnan: More of this! I do the same, we need to do things that show house staff we value THEIR time, like prioritizing conferenc…
Society of Hospital Medicine @SocietyHospMed
Be sure to index your tweets using the #JHMChat hashtag!
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy @jeannemfarnan #JHMchat we've got 11am as target DC time, but can be very hard to complete rounds of have transitions of care discussion w pt/family with enough time to enter orders, esp if DC on the fence
Sass @mcsassymd
RT @oliver_hulland: @jeannemfarnan @JHospMedicine Something I've learned since becoming a resident is the tension between different priorit…
Charlie M. Wray @WrayCharles
I have a patient on my service right now who literally begs us for "bedside rounding, anecdotally, I've found his care to be more expeditious than when we hallway round #JHMChat
J Hospital Medicine @JHospMedicine
RT @tony_breu: Don't round till noon. And certainly not through lunch! #JHMChat https://t.co/sbBdQeKzK7
J Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat T2 is live! https://t.co/LBYCVUhXHK
PeraHealth @perahealth
Obstacles facing effective rounding? The lack of shifting from reactive to proactive- This alone will change how we approach and improve rounding efficiency #JHMChat https://t.co/S5wrpJwL3S
Jeanne M. Farnan @jeannemfarnan
Yes, having the house staff and students have access has been hugely important in real time decision making that is informed #JHMChat https://t.co/gheALX45eT
Shreya P. Trivedi MD @ShreyaTrivediMD
@aoglasser @jeannemfarnan Great point! We should clear with which type of rounds we are talking about. #JHMchat
J Hospital Medicine @JHospMedicine
RT @oliver_hulland: @WrayCharles @JJRyanMD Several of the attendings made a point to "circle back" after rounds with the medical students t…
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy @jeannemfarnan it may also depend on when labs done, ex. couple of years ago, the medicine wards were the last ones to get phlebotomy on weekend AMs... #JHMchat
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: More of this! I do the same, we need to do things that show house staff we value THEIR time, like prioritizing conferenc…
Tony Breu @tony_breu
What's the optimum amount of time for rounds? #JHMchat
J Hospital Medicine @JHospMedicine
RT @aoglasser: @FutureDocs but I even use the jest to break the ice with my team--that I'm perfectly physically capable of walking to see a…
Rupesh Prasad @rupeshp011
@jeannemfarnan Especially with the administrative focus on early discharge and reduced LOS #JHMChat
J Hospital Medicine @JHospMedicine
RT @WrayCharles: I have a patient on my service right now who literally begs us for "bedside rounding, anecdotally, I've found his care to…
Tony Breu @tony_breu
@WrayCharles Your anecdote is backed up, mostly by @Jed_Gonzalo15 #JHMChat
Alex Auseon @ajauseon
@WrayCharles Are presentations happening in room? #jhmchat
J Hospital Medicine @JHospMedicine
RT @tony_breu: What's the optimum amount of time for rounds? #JHMchat
OHSU IM Residency @OHSUIMRes
@tony_breu at the main university, we have about 2 hours--between radiology rounds and multidisciplinary rounds, which are followed by noon conference #JHMchat
Jeanne M. Farnan @jeannemfarnan
Rounds is like a gas, it will fill whatever space you give it no matter how many patients there are #JHMchat https://t.co/sW8sXL1TWY
Vinny Arora MD MAPP @FutureDocs
RT @tony_breu: What's the optimum amount of time for rounds? #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@jeannemfarnan so. true. #JHMchat
Tony Breu @tony_breu
@Ajauseon @WrayCharles If by presentations you mean discussion of the events/plan, then yes. If you mean, soup-to-nuts H&P, absolutely not. #JHMChat
Vinny Arora MD MAPP @FutureDocs
@tony_breu @WrayCharles @Jed_Gonzalo15 and another @BradMonash study #JHMchat
Charlie M. Wray @WrayCharles
@tony_breu Had the thought today: no matter how many patients my service has, rounds always takes 2 hours #jhmchat. There has to be some theory that explains this...?
Lakshman Swamy @laxswamy
@WrayCharles I totally agree. But bedside isn't the standard, and how excited is that pt when you come at 7am or don't make a peep till 1pm? #jhmchat
Aravind A Menon, MD @aravindamenon
@tony_breu @WrayCharles @Jed_Gonzalo15 Once you go to bedside rounding, there is no going back!!! #JHMChat
Oliver Hulland @oliver_hulland
RT @jeannemfarnan: Rounds is like a gas, it will fill whatever space you give it no matter how many patients there are #JHMchat https://t.c…
Tony Breu @tony_breu
@jeannemfarnan Wow. Couldn't be more accurate. #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@WrayCharles @tony_breu ditto #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @aravindamenon: @tony_breu @WrayCharles @Jed_Gonzalo15 Once you go to bedside rounding, there is no going back!!! #JHMChat
Tony Breu @tony_breu
@WrayCharles Interstellar covered this, for sure. #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @jeannemfarnan: Rounds is like a gas, it will fill whatever space you give it no matter how many patients there are #JHMchat https://t.c…
Dr. Susan Love @drsusanlove
RT @aravindamenon: @tony_breu @WrayCharles @Jed_Gonzalo15 Once you go to bedside rounding, there is no going back!!! #JHMChat
Dr I Came to Sleigh, Bell. @DrPoorman
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
Charlie M. Wray @WrayCharles
@Ajauseon Yep, right there Works well for him, though in reality, not sure if it'd work for everyone... #JHMchat
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: Rounds is like a gas, it will fill whatever space you give it no matter how many patients there are #JHMchat https://t.c…
Tony Breu @tony_breu
@laxswamy @WrayCharles In my experience as a solo hospitalist, the times were never an issue. #JHMChat
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: Yes, having the house staff and students have access has been hugely important in real time decision making that is info…
Tony Breu @tony_breu
@aravindamenon @WrayCharles @Jed_Gonzalo15 Preach! #JHMChat
Aravind A Menon, MD @aravindamenon
@tony_breu @Ajauseon @WrayCharles Yes. I usually have the team introduce themselves and have a one line summary to involve the patient and get the up to speed. Great way to use rounds as forum to communicate with the patient about their own care. #JHMChat
Vinny Arora MD MAPP @FutureDocs
@WrayCharles @tony_breu see the inert gas theory by @jeannemfarnan #JHMchat
Lakshman Swamy @laxswamy
@FutureDocs This raises a tough question for me: how much are these "my" patients? If attending spends too much time, it feels like intern isn't the doctor. #jhmchat
Jigar Contractor @jigsymd
RT @jeannemfarnan: Rounds is like a gas, it will fill whatever space you give it no matter how many patients there are #JHMchat https://t.c…
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs 1st question to my senior--how do you want to structure rounds today and in what order of patients? #JHMchat
Ji Baang @jbaang
@WrayCharles @tony_breu After 2 hours, everything starts going downhill for everyone, teaching, learning, glucose level, knee pain, etc #jhmchat
Lakshman Swamy @laxswamy
@aoglasser @jeannemfarnan It's easy to get early AM DC. Just focus on them and ignore sick patients. #jhmchat
PeraHealth @perahealth
Technology and Trends: Visualizing a patient's condition over time helps to prioritize rounds, improve care delivery and improve workflow for everyone #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy @FutureDocs #JHMchat crucial point. I've gotten feedback from R/I/student that they wanted more floor to tell patient/family the final take-away points/plan of day after discussion, so that changed my style
Tony Breu @tony_breu
@aoglasser @FutureDocs I come to the conclusion that it's ok for me to dictate the structure of rounds. Resident autonomy, for me, really means they dictate the plan of care. #JHMChat
Shreya P. Trivedi MD @ShreyaTrivediMD
@tony_breu Studies on #Millennial #learners and #attention spans would favor ~15 mins or less but the goals of rounds, esp #bedside rounds, cant be accomplished in that short of a time! #JHMchat
Jeanne M. Farnan @jeannemfarnan
Absolutely! Without investment there is apathy, and prioritization a skill we too often ignore #JHMChat https://t.co/UqoQfOiJl8
Vinny Arora MD MAPP @FutureDocs
IMHO Rounds should not be not just confirm myself but assess learners - many times patient expects me to lead but I want to assess #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @FutureDocs ooooo interestingly phrased #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @aoglasser: @laxswamy @FutureDocs #JHMchat crucial point. I've gotten feedback from R/I/student that they wanted more floor to tell pati…
dailydoner @dailydonerkebab
RT @aravindamenon: @tony_breu @WrayCharles @Jed_Gonzalo15 Once you go to bedside rounding, there is no going back!!! #JHMChat
Aravind A Menon, MD @aravindamenon
@laxswamy @FutureDocs It is about finding a balance. Getting trainees to spend more time with patients is constant balance. I always let them be the first line of communication to ensure this. #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@ShreyaTrivediMD @tony_breu when we have 10 patients (max), I tell team it's ~12 min/patient. Some need less time, some need much more time... #JHMchat
Tony Breu @tony_breu
@ShreyaTrivediMD <15 minutes per patients? Sure this can be done. Must be done. #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @jeannemfarnan: Absolutely! Without investment there is apathy, and prioritization a skill we too often ignore #JHMChat https://t.co/Uqo…
Avital O'Glasser, MD FACP FHM @aoglasser
RT @FutureDocs: IMHO Rounds should not be not just confirm myself but assess learners - many times patient expects me to lead but I want to…
Oliver Hulland @oliver_hulland
@aoglasser @laxswamy @FutureDocs That ownership is important, and allows for trainees to model what they see their attendings do, and attendings to assess their trainees. #jhmchat
J Hospital Medicine @JHospMedicine
Thx for joining - pls use #JHMchat so we see your tweets! https://t.co/129hHk1csK
J Hospital Medicine @JHospMedicine
RT @oliver_hulland: @aoglasser @laxswamy @FutureDocs That ownership is important, and allows for trainees to model what they see their atte…
J Hospital Medicine @JHospMedicine
RT @aravindamenon: @laxswamy @FutureDocs It is about finding a balance. Getting trainees to spend more time with patients is constant balan…
Marty Fried, MD @Marty_Fried
@aoglasser @laxswamy @FutureDocs As a new attending, this is sometimes easier said than done… need to be purposeful about who communicates and how that happens on rounds! #jhmchat
Alex Auseon @ajauseon
@aoglasser @laxswamy @FutureDocs Fellows, Sr PGYs definitely need to practice roles. Don't have guts of @Gurpreet2015 to stand back majority of time, by trying in targeted ways #jhmchat
John Ryan @JJRyanMD
RT @WrayCharles: @JJRyanMD This is true, but so hard to teach to that complete spectrum #JHMchat I often pick one type of trainee to teach…
Charlie M. Wray @WrayCharles
Defining larger roles is important! I sometimes operate with the idea that "residents (literally) take care of patients, I take care (educate, observe, back-up) of the residents" #JHMChat https://t.co/B5Q1WbmBLY
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: Absolutely! Without investment there is apathy, and prioritization a skill we too often ignore #JHMChat https://t.co/Uqo…
John Ryan @JJRyanMD
RT @oliver_hulland: @WrayCharles @JJRyanMD Several of the attendings made a point to "circle back" after rounds with the medical students t…
Peter Higgins @ibddoctor
@FutureDocs "Fellow Fridays" give the GI fellow a chance to lead rounds, assess patient, and assess learners - more multitasking than they are used to :-) #JHMchat
J Hospital Medicine @JHospMedicine
RT @aoglasser: @laxswamy @FutureDocs #JHMchat crucial point. I've gotten feedback from R/I/student that they wanted more floor to tell pati…
JedGonzalo @jed_gonzalo15
Need to assess senior resident’s mental model for BRs at start of rotation, otherwise uphill battle. #JHMChat
Tony Breu @tony_breu
@WrayCharles Who takes care of you? #JHMChat
PeraHealth @perahealth
Coordination of patient care and prioritizing bedside rounds goes back to presenting the right information to the right person at the right time. #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@WrayCharles #JHMchat when I orient my R/I at beginning of block, I use "movie producer" analogy--the team is theirs, but I make sure bills get paid and everyone eats lunch
Oliver Hulland @oliver_hulland
RT @WrayCharles: Defining larger roles is important! I sometimes operate with the idea that "residents (literally) take care of patients, I…
J Hospital Medicine @JHospMedicine
Great point about future of rounds #jhmchat when data is coming continuously https://t.co/VzzZGgwoJo
J Hospital Medicine @JHospMedicine
T3 #JHMChat "Pediatric attdgs place more emphasis on time for patient/family communication.. than IM colleagues." Why is this and what can we learn from peds hospitalists?
J Hospital Medicine @JHospMedicine
Great point about future of rounds #jhmchat when data is coming continuously https://t.co/VzzZGgwoJo https://t.co/qTJWv7QjgR
J Hospital Medicine @JHospMedicine
T3 #JHMChat "Pediatric attdgs place more emphasis on time for patient/family communication.. than IM colleagues."... https://t.co/pa6YzaI2F3
Lakshman Swamy @laxswamy
@Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach patients. Hard to stand back and let intern do procedure. Always hard to stand back, but that is what being a teaching attending is all about. #jhmchat
Ji Baang @jbaang
@tony_breu @ShreyaTrivediMD I once begged for constructive criticism and finally got one. “You teach too much” #jhmchat 😅
Vinny Arora MD MAPP @FutureDocs
RT @laxswamy: @Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach…
Avital O'Glasser, MD FACP FHM @aoglasser
@JHospMedicine #JHMchat drives me nuts when flow sheets are printed at 6:30am and not reprinted before 9am....
Avital O'Glasser, MD FACP FHM @aoglasser
RT @laxswamy: @Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach…
PeraHealth @perahealth
The inconsistencies that are often associated with rounding is due to clinicians and physicians not being able to see trends within a certain time frame. This alone hinders their ability to take action sooner than later #JHMChat
Vinny Arora MD MAPP @FutureDocs
I love this @jeannemfarnan #JHMchat https://t.co/umn42pgMMz
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T3 #JHMChat "Pediatric attdgs place more emphasis on time for patient/family communication.. than IM colleagues." Why is…
Charlie M. Wray @WrayCharles
@aoglasser I like that. I might borrow this one #JHMchat
Tony Breu @tony_breu
@jbaang @ShreyaTrivediMD I've heard that as well. It may me reflect on what I was teaching, not amount. #JHMChat
Jeanne M. Farnan @jeannemfarnan
I use the captain of the ship and rudder analogy, they make the plan to sail, but I make sure they don’t hit things...I love yours! #jhmchat https://t.co/dtNFHrvhoY
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy @Marty_Fried @FutureDocs #JHMchat https://t.co/B9TjTUc1S8
Alex Auseon @ajauseon
@laxswamy @Marty_Fried @aoglasser @FutureDocs Seek the top of Miller's pyramid as much as possible for each level of learner #jhmchat https://t.co/3frxgV3Ew4
Avital O'Glasser, MD FACP FHM @aoglasser
@WrayCharles you are more than welcome to! #JHMchat
PeraHealth @perahealth
@aoglasser @laxswamy @Marty_Fried @FutureDocs #jhmchat Incorporate digital tools to improve teaching
Vinny Arora MD MAPP @FutureDocs
One benefit is you’ll be ready for anyone who cries #JHMChat @WrayCharles @jeannemfarnan https://t.co/FglkiyQKBT
Tony Breu @tony_breu
@aoglasser @laxswamy @Marty_Fried @FutureDocs @laxswamy will surely be talking about this for the next few weeks... #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
Charlie M. Wray @WrayCharles
@aoglasser @JHospMedicine There's a great study n BMJQPS about half life of these sheets. Usually 3 hours during day, 6 hrs for night. Thus, by rounds...info is often old and (?)dangerous #JHMchat
Tony Breu @tony_breu
RT @tony_breu: What's the optimum amount of time for rounds? #JHMchat
Nancy H Stewart DO, MS @nvhstewart
RT @laxswamy: @Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach…
Nancy H Stewart DO, MS @nvhstewart
THIS. #meded #jhmchat https://t.co/Vf54iv5meV
Charlie M. Wray @WrayCharles
@jeannemfarnan I use the adage "There's 9 ways to skin a cat, my job is to make sure you don't do #10" #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
T3 #JHMchat, I think with peds, the family/caregivers are an extension of the patient beyond what we see/should see in adult medicine
Daniel Wolfson @WolfsonD
#JHMChat Have we discussed what the patient feels during rounds. Attention of many or like a person under a microscope. Just saw a piece on bedside etiquette.
Vinny Arora MD MAPP @FutureDocs
👍 @UChicagoMERITS #JHMChat https://t.co/fsg87tfBH1
MERITS @uchicagomerits
👍 #JHMChat https://t.co/1XP1QnvYAf via @FutureDocs
Jeanne M. Farnan @jeannemfarnan
These are such different worlds, I would love to hear thoughts-family centered rounds abundantly easier when family present, which isn’t always the case with adults but I imagine more common with kiddos? #JHMChat https://t.co/WTRLAUsc6c
Avital O'Glasser, MD FACP FHM @aoglasser
@WrayCharles @jeannemfarnan 😂😂😂 #JHMchat
Nancy H Stewart DO, MS @nvhstewart
RT @UChicagoMERITS: 👍 #JHMChat https://t.co/1XP1QnvYAf via @FutureDocs
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: These are such different worlds, I would love to hear thoughts-family centered rounds abundantly easier when family pres…
Lakshman Swamy @laxswamy
@jeannemfarnan It is heartbreaking how often there is just no one else in adult medicine. #jhmchat
J Hospital Medicine @JHospMedicine
RT @UChicagoMERITS: 👍 #JHMChat https://t.co/1XP1QnvYAf via @FutureDocs
Avital O'Glasser, MD FACP FHM @aoglasser
@jeannemfarnan #JHMchat speaking from personal experience (when my then 8mo was admitted with RSV), the parent may be as much the patient. I barely left iso room for 48hrs, and the baby couldn't speak for himself
Anthony Provenzano @docpro89
#jhmchat as a senior resident the most difficult thing for me is mastering the "autonomy/supervision" ratio. So tempting to just do everything.
OHSU IM Residency @OHSUIMRes
RT @docpro89: #jhmchat as a senior resident the most difficult thing for me is mastering the "autonomy/supervision" ratio. So tempting to j…
Ji Baang @jbaang
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
Tony Breu @tony_breu
@laxswamy @jeannemfarnan Sure, but there we are. At 7am or 1pm, or any time before or after. #JHMChat
J Hospital Medicine @JHospMedicine
Great observation - related to T3 how can we make rounds more patient centered like pediatrics? #jhmchat https://t.co/joRGpd1FZC
J Hospital Medicine @JHospMedicine
RT @aoglasser: T3 #JHMchat, I think with peds, the family/caregivers are an extension of the patient beyond what we see/should see in adult…
Lakshman Swamy @laxswamy
@WolfsonD no patient should be treated this way. Even if you're intubated in the MICU. #jhmchat
Oliver Hulland @oliver_hulland
This #JHMChat needs more Tweetiatricians
J Hospital Medicine @JHospMedicine
RT @laxswamy: @Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach…
J Hospital Medicine @JHospMedicine
RT @aoglasser: @WrayCharles #JHMchat when I orient my R/I at beginning of block, I use "movie producer" analogy--the team is theirs, but I…
OHSU IM Residency @OHSUIMRes
@jbaang @tony_breu radiology rounds can be such a great way to jump start "decision making rounds"! #JHMchat
Ji Baang @jbaang
RT @laxswamy: @Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach…
Daniel Wolfson @WolfsonD
#JHMChat Is the patient talked about or is the patient a part of the conversation. Heard rounds like the patient isn’t in the room - part of dehumanizing process.
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Great observation - related to T3 how can we make rounds more patient centered like pediatrics? #jhmchat https://t.co/jo…
Megan Young @Megany221
RT @laxswamy: @Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach…
Tony Breu @tony_breu
@OHSUIMRes @jbaang One of the best/smartest attendings at my hospital just got feedback that "radiology rounds" were a waste of time. He was dejected. #JHMChat
Rupesh Prasad @rupeshp011
@JHospMedicine 👍#JHMChat
Jigar Contractor @jigsymd
@JHospMedicine This is really interesting. I wonder if soliciting there preference prior to rounds can guide whether we bring everyone to bedside and show them medicine or have the doctor chat with them individually. #Jhmchat
Matt Sparks @Nephro_Sparks
RT @laxswamy: @Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach…
J Hospital Medicine @JHospMedicine
Attention #tweetiatricians #jhmchat https://t.co/CrOuEXKQqy
Lakshman Swamy @laxswamy
@jeannemfarnan Need to find ways to make rounds into as close an ideal gas as possible: high temperature (energy, passion) low pressure! #jhmchat
Temple Ratcliffe @templeratcliffe
Strongly prefer "patient partnered" to "patient centered" rounds. #JHMChat
Nancy H Stewart DO, MS @nvhstewart
@laxswamy @WolfsonD I always tell my #residents and families to talk to the #patient, even when pt is intubated, as if they can hear #meded #icu #jhmchat
Jeanne M. Farnan @jeannemfarnan
SIT DOWN cc @sanjaysaint why is there no chair emoji?! #JHMChat https://t.co/68aDsuscn9
Tony Breu @tony_breu
@WolfsonD It can be both. If you tell the patient there will be thoughtful discussion, in front of them, and that we'll ensure they hear the plan, I think it works. #JHMChat
Jeanne M. Farnan @jeannemfarnan
I will never not love this...#JHMChat https://t.co/gcMu5H09gW
Lakshman Swamy @laxswamy
@nvhs0401 @WolfsonD Definitely. When my mentors have role modeled this behavior the whole team suddenly snaps to attention and acts just plain better. #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JigsyMD: @JHospMedicine This is really interesting. I wonder if soliciting there preference prior to rounds can guide whether we bring…
Vinny Arora MD MAPP @FutureDocs
RT @templeratcliffe: Strongly prefer "patient partnered" to "patient centered" rounds. #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy @jeannemfarnan #JHMchat love it. can you throw something about activation energy into that analogy, too?
Vinny Arora MD MAPP @FutureDocs
RT @nvhs0401: @laxswamy @WolfsonD I always tell my #residents and families to talk to the #patient, even when pt is intubated, as if they c…
Vinny Arora MD MAPP @FutureDocs
RT @jeannemfarnan: SIT DOWN cc @sanjaysaint why is there no chair emoji?! #JHMChat https://t.co/68aDsuscn9
PeraHealth @perahealth
In order to improve patient centered rounding for healthcare providers, we need to go back to how we are presenting a patient's condition, & how are we improving visualization to better perform during rounding to give the best possible care to the patient #JHMChat
Nancy H Stewart DO, MS @nvhstewart
RT @laxswamy: @jeannemfarnan Need to find ways to make rounds into as close an ideal gas as possible: high temperature (energy, passion) l…
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @WolfsonD #JHMchat I think it also depends on knowing your patient and how they handle uncertainty...some pts may not want the 10-20 minutes of extensive DDx discussion cause you don't know the diagnosis...
Nancy H Stewart DO, MS @nvhstewart
RT @jeannemfarnan: Rounds is like a gas, it will fill whatever space you give it no matter how many patients there are #JHMchat https://t.c…
Anthony Provenzano @docpro89
RT @laxswamy: @jeannemfarnan Need to find ways to make rounds into as close an ideal gas as possible: high temperature (energy, passion) l…
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: SIT DOWN cc @sanjaysaint why is there no chair emoji?! #JHMChat https://t.co/68aDsuscn9
Charlie M. Wray @WrayCharles
Regarding @jeannemfarnan's advice to SIT DOWN...OK to sit at foot of bed? #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@jeannemfarnan @laxswamy @FutureDocs #JHMchat Tshirt idea??
J Hospital Medicine @JHospMedicine
RT @JigsyMD: @JHospMedicine This is really interesting. I wonder if soliciting there preference prior to rounds can guide whether we bring…
JedGonzalo @jed_gonzalo15
https://t.co/nglO1UXpKP - great article on making eye contact by a legend educator #JHMChat
J Hospital Medicine @JHospMedicine
RT @docpro89: #jhmchat as a senior resident the most difficult thing for me is mastering the "autonomy/supervision" ratio. So tempting to j…
J Hospital Medicine @JHospMedicine
RT @aoglasser: @jeannemfarnan #JHMchat speaking from personal experience (when my then 8mo was admitted with RSV), the parent may be as muc…
Tony Breu @tony_breu
@aoglasser @WolfsonD But it is so hard to know that about the patient, at least as a #hospitalist - I err on the side of having these debates and uncertain discussions with the patient. #JHMChat
Jeanne M. Farnan @jeannemfarnan
RT @WrayCharles: Regarding @jeannemfarnan's advice to SIT DOWN...OK to sit at foot of bed? #JHMchat
Nancy H Stewart DO, MS @nvhstewart
@aoglasser @laxswamy @jeannemfarnan Yes! And #chalktalk #teaching on the fly! #jhmchat
J Hospital Medicine @JHospMedicine
RT @Jed_Gonzalo15: https://t.co/nglO1UXpKP - great article on making eye contact by a legend educator #JHMChat
Lakshman Swamy @laxswamy
@WrayCharles @jeannemfarnan I kneel. All the time. And then when i can't do it any more after 2 min they don't mind me sitting down in a chair or wherever - the point is made. #jhmchat
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat @adamcifu speaking of making rounds patient-centered, re-read this article earlier today! https://t.co/onKr8dHmGi
J Hospital Medicine @JHospMedicine
RT @WrayCharles: Regarding @jeannemfarnan's advice to SIT DOWN...OK to sit at foot of bed? #JHMchat
Shreya P. Trivedi MD @ShreyaTrivediMD
T3: #JHMChat I am curious what #pediatric #lengthofstay, turn around, team #census are and if they differ from IM? Those factors are often cited as "getting in the way" of partnering with caregivers, educating patients, etc https://t.co/tRH2Gcqere
Jeanne M. Farnan @jeannemfarnan
@WrayCharles It’s about getting at eye level, I kneel or squat down or hunch, doesn’t need to be sitting just getting down to someone’s eye level can speak volumes #JHMChat
Society of Hospital Medicine @SocietyHospMed
Special thanks for our partners @ABIMFoundation @CostsofCare for your continued support of #JHMChat!
J Hospital Medicine @JHospMedicine
Special thanks to our #JHMChat guest authors tonight! @jeannemfarnan @oliver_hulland
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @WolfsonD #jhmchat or at least ask them their comfort level...
Jeanne M. Farnan @jeannemfarnan
@sanjaysaint more kneelers...#JHMChat https://t.co/YLNdDSqWv7
Jigar Contractor @jigsymd
@tony_breu @aoglasser @WolfsonD If the admitting MD asked, kind of like we do for code status/proxy, then that info can help the team build trust/respect from the get go. #jhmchat
Avital O'Glasser, MD FACP FHM @aoglasser
@WrayCharles @jeannemfarnan #JHMchat depends on whether or not there's a bed alarm...
Nancy H Stewart DO, MS @nvhstewart
@jeannemfarnan @WrayCharles I love this! Never saw anyone do this until I rounded w @jeannemfarnan !!! #meded #jhmchat
J Hospital Medicine @JHospMedicine
Time flies on #JHMChat which is always 1h unlike rounds- what is your closing thought on best way to improve rounds for future?
Tony Breu @tony_breu
Poll results are in! Looks like the #rounds chat should last another hour! #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @WrayCharles: Regarding @jeannemfarnan's advice to SIT DOWN...OK to sit at foot of bed? #JHMchat
Aravind A Menon, MD @aravindamenon
@tony_breu @aoglasser @WolfsonD Agree. Our patients have to see how modern day medicine works. The TV shows might paint a different picture but I stand at the bedside, rub my chin and talk out loud, sometimes to myself.#JHMChat
Jeanne M. Farnan @jeannemfarnan
RT @Jed_Gonzalo15: https://t.co/nglO1UXpKP - great article on making eye contact by a legend educator #JHMChat
Charlie M. Wray @WrayCharles
@jeannemfarnan I agree, but when I sit, I know I'll stay longer, studies show patients perceive that I stay longer -- so I always make the attempt to sit. And my knees hurt after 2 min....#JHMchat
Ji Baang @jbaang
@tony_breu @ShreyaTrivediMD I was giving lectures about topics. Now I try to teach them one thing that didn’t know, that is clinically relevant to their patient, everyday. Residents feel they are learning and that I respect their work flow. Students slightly diff story. #jhmchat
Tony Breu @tony_breu
@JHospMedicine Something I plan to do on Friday, when I start service: ask what my team wants/expects from rounds. #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Time flies on #JHMChat which is always 1h unlike rounds- what is your closing thought on best way to improve rounds for…
Jeanne M. Farnan @jeannemfarnan
@aoglasser @laxswamy @FutureDocs I’m in! #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @JHospMedicine #JHMchat--I start a 2 week block on xmas day
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Time flies on #JHMChat which is always 1h unlike rounds- what is your closing thought on best way to improve rounds for…
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Special thanks to our #JHMChat guest authors tonight! @jeannemfarnan @oliver_hulland
Nancy H Stewart DO, MS @nvhstewart
@jeannemfarnan @aoglasser @laxswamy @FutureDocs #iwantonetoo #meded #jhmchat
Jigar Contractor @jigsymd
@aoglasser @WrayCharles @jeannemfarnan this is perfect! i hope i'm not the only one who can't figure out how to turn them off no matter how many buttons i press #JHMchat
John Ryan @JJRyanMD
I tell my team that rounds are like baseball games - they get very boring after 3 hours. That way they have a goal for when we need to end #JHMChat https://t.co/o568eAIDdq
Lakshman Swamy @laxswamy
@jeannemfarnan @sanjaysaint But I only feel comfortable w this when I'm alone w the patient. When I am w the team it feels like by creating an "intimate" space w the patient, I block out the rest of team. #jhmchat
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat so many potential final thoughts, but for teaching, I have my personal goals for a 2 week block (to complement patient-specific teaching)...
J Hospital Medicine @JHospMedicine
RT @JJRyanMD: I tell my team that rounds are like baseball games - they get very boring after 3 hours. That way they have a goal for when w…
J Hospital Medicine @JHospMedicine
RT @tony_breu: @JHospMedicine Something I plan to do on Friday, when I start service: ask what my team wants/expects from rounds. #JHMChat
J Hospital Medicine @JHospMedicine
Thx for joining #JHMChat tonight! https://t.co/xmobtQWAn3
J Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMchat so many potential final thoughts, but for teaching, I have my personal goals for a 2 week block (to complement pati…
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat one of the is discussing @alfandremd's "The Parallels between Parenting and Patient Care" as it related to at least one patient https://t.co/nzhGh6QqBT
Nancy H Stewart DO, MS @nvhstewart
@jbaang @tony_breu @ShreyaTrivediMD I just heard today by an attending “#residents need lectures” ; no, they need #teaching #meded #jhmchat
Sanjay Saint @sanjaysaint
@JHospMedicine @jeannemfarnan @oliver_hulland Really liked your article! I'm turning it into slides I can use in an upcoming talk. #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat the other is using this video to teach egophony https://t.co/L9b22txRI3
Rupesh Prasad @rupeshp011
@JHospMedicine Patient centric #Jhmchat
Charlie M. Wray @WrayCharles
My final thoughts: as a young attending still trying to "figure it out", I'm reassured by the fact that rounding is a universal struggle - even among the greats #JHMChat
Vinny Arora MD MAPP @FutureDocs
@aoglasser Who knew You are west coast @jeannemfarnan?? #JHMChat https://t.co/wFf996yVEb
J Hospital Medicine @JHospMedicine
Mark your calendars! #JHMChat resumes in New Year on 1/8/18 9p ET with special guest @WolfsonD for Trends in Troponin-Only Testing & Impact of #ChoosingWisely https://t.co/M4iIdQygg9
Jeanne M. Farnan @jeannemfarnan
Ask and involve all stake holders, learners, patients, inter-professional providers, they are all on the team...and apparently @DukeCambridgeUK #JHMchat https://t.co/lRXo0kctKW
J Hospital Medicine @JHospMedicine
Mark your calendars! #JHMChat resumes in New Year on 1/8/18 9p ET with special guest @WolfsonD for Trends in... https://t.co/9LQxkHOfXa
J Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMchat @adamcifu speaking of making rounds patient-centered, re-read this article earlier today! https://t.co/onKr8dHmGi
Jigar Contractor @jigsymd
RT @WrayCharles: My final thoughts: as a young attending still trying to "figure it out", I'm reassured by the fact that rounding is a univ…
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: @WrayCharles It’s about getting at eye level, I kneel or squat down or hunch, doesn’t need to be sitting just getting do…
Rupesh Prasad @rupeshp011
RT @WrayCharles: My final thoughts: as a young attending still trying to "figure it out", I'm reassured by the fact that rounding is a univ…
Tony Breu @tony_breu
@WrayCharles It's amazing how different rounds look for me now compared with when I started as an attending #JHMChat
Aravind A Menon, MD @aravindamenon
@laxswamy @jeannemfarnan @sanjaysaint I would argue that to be a missed opportunity to model this. If not rounds when are the trainees going to see and learn this.#JHMChat Having learnt this myself from rounds with the best.
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs @jeannemfarnan #JHMchat perhaps this gives away my east coast heritage & @UChicago undergrad experience?
Jeanne M. Farnan @jeannemfarnan
@FutureDocs @aoglasser Great minds :) #JHMchat
J Hospital Medicine @JHospMedicine
RT @WrayCharles: My final thoughts: as a young attending still trying to "figure it out", I'm reassured by the fact that rounding is a univ…
Avital O'Glasser, MD FACP FHM @aoglasser
@JJRyanMD #JHMchat this is apparently why I don't like baseball...I'm bored WAY before the 3 hour mark...
J Hospital Medicine @JHospMedicine
RT @jeannemfarnan: Ask and involve all stake holders, learners, patients, inter-professional providers, they are all on the team...and appa…
J Hospital Medicine @JHospMedicine
RT @tony_breu: @WrayCharles It's amazing how different rounds look for me now compared with when I started as an attending #JHMChat
Charlie M. Wray @WrayCharles
@tony_breu And I'm sure they'll continually change #JHMchat
Healthcare discovery @HealthTypes
RT @jeannemfarnan: One interesting finding was that students and faculty were very egocentric in their beliefs, rounds were about them-thei…
J Hospital Medicine @JHospMedicine
Thx for joining #JHMChat! https://t.co/5ksRsRiAJo
Avital O'Glasser, MD FACP FHM @aoglasser
RT @WrayCharles: My final thoughts: as a young attending still trying to "figure it out", I'm reassured by the fact that rounding is a univ…
Marty Fried, MD @Marty_Fried
Make it a T-Shirt! #JHMChat https://t.co/OxEcpPpWVa
Charlie M. Wray @WrayCharles
RT @JHospMedicine: Mark your calendars! #JHMChat resumes in New Year on 1/8/18 9p ET with special guest @WolfsonD for Trends in Troponin-On…
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat along those lines, read your resident + student evaluations! They've definitely helped me craft my rounding style over the years. Also, reflect with fellow attendings! https://t.co/WPcOsjhQ2i
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Mark your calendars! #JHMChat resumes in New Year on 1/8/18 9p ET with special guest @WolfsonD for Trends in Troponin-On…
Rupesh Prasad @rupeshp011
Thanks for great pointers. Hoping if another hour discussions the same topic #JHMChat
J Hospital Medicine @JHospMedicine
RT @SHMLive: Special thanks for our partners @ABIMFoundation @CostsofCare for your continued support of #JHMChat!
Nancy H Stewart DO, MS @nvhstewart
@Marty_Fried Interestingly this was from a junior attending! Wonder what he thinks the retention rate of lectures in #icu would be... #meded #jhmchat
Society of Hospital Medicine @SocietyHospMed
Don't forget to claim #CME following #JHMChat: https://t.co/mDWTDDgFGx
J Hospital Medicine @JHospMedicine
RT @SHMLive: Don't forget to claim #CME following #JHMChat: https://t.co/mDWTDDgFGx
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: Don't forget to claim #CME following #JHMChat: https://t.co/mDWTDDgFGx
Lakshman Swamy @laxswamy
RT @nvhs0401: THIS. #meded #jhmchat https://t.co/Vf54iv5meV
Nancy H Stewart DO, MS @nvhstewart
Thanks for another great #jhmchat !! I love this group!! #meded
Larry Hurtubise @hur2buzy
RT @aoglasser: #JHMchat along those lines, read your resident + student evaluations! They've definitely helped me craft my rounding style o…
Joanna Holland @joannalh
RT @laxswamy: @Marty_Fried @aoglasser @FutureDocs Hard to stand back and let senior teach interns. Hard to stand back and let intern teach…
Nancy H Stewart DO, MS @nvhstewart
RT @JHospMedicine: Mark your calendars! #JHMChat resumes in New Year on 1/8/18 9p ET with special guest @WolfsonD for Trends in... https://…
Ji Baang @jbaang
@WrayCharles @jeannemfarnan When student talks to patient standing up, I grab a chair and let them sit down. I ask the patient what they liked better, most prefer the student sitting down. Then I talk about that study and the benefits of sitting down including knee pain relief #ebm #jhmchat
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