The Thinking Doctor's Ward Round

Why the ward round? For folks of a certain age the very mention of ward rounds may conjure up the image of Sir Lancelot Spratt barking orders to an entourage of junior staff following in his wake. Whilst we no longer practice in such a hierarchical world, I fear we have neglected the importance of the ward round and with it the importance of the clinical decision making process itself. If you ask a lay person what a surgeon does they will be able to answer: they operate. But what of physicians? When, as a medical registrar, I was involved in the Belfast City Hospital’s Patient Access Project, the group looking at surgical through-put easily identified the theatre session as the focus of their work (Figure 1). For acute medicine the group took a little longer, but we recognised that, for physicians, the consultant ward round was where we needed to look (Figure 2). In fact, the ward round is as core to the business of inpatient medicine as the theatre session is to the practice of surgery. However they are seldom treated with similar respect. Let us for a moment compare the two.