#JHMChat Transcript
Healthcare social media transcript of the #JHMChat hashtag.
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| Profile | Tweet |
|---|---|
 | 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 |
 | Jerónimo 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… |
| 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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