Fieldset
Definitely worth the effort

I have never been a morning person, but right now it's 7am on Sunday morning, and I'm alert and awake. And feeling articulate enough to write. This is very unusual for me.

I have never been a morning person, but right now it's 7am on Sunday morning, and I'm alert and awake. And feeling articulate enough to write. This is very unusual for me.

This week, I've been getting up early because we've started la grande tournee de salle (grand rounds) at Jude-Anne. Rounds start at 7am, with shift change, so I get up before six with the first rays of dawn to get there in time. We are eight doctors discussing all the antenatal patients admitted to the first floor: two night docs, four day docs, chief gynecologist, and me. The night doctor who was responsible for that floor presents the case, and we discuss management. (This is the format despite that fact that this doctor has likely been in the operating room all night. For example, on Friday morning, he reported having done six or seven Caesarians – he'd lost track of the exact number – and two curettages.)

It was the idea of the chief gynecologist after I posed to him the problem that patients on the first floor were often lying around for days before definitive management (usually delivery). I thought this was not good quality of care, and not good for freeing up beds to admit new people, either. We had even found a couple of cases of patients being discharged with pre-eclampsia and still pregnant: really not a good idea.

Grand rounds has proven to be really great, even after only one week. We have the opportunity to discuss things academically. It has helped me understand some of the thought processes that are different than what I have seen at home, and target my literature searches for research that might change their practice. It helps a lot that we share a medical culture, so that even if we don't agree, we have a framework for discussing it. This was not the case when I worked in Democratic Republic of Congo, where there was no concept of evidence-based medicine.

Patients are no longer lingering too long antenatally, for the most part. Beds are more available for new patients so we don't have to transfer seriously ill patients out because of lack of space. We have the opportunity to suggest and teach new techniques, such as manual vacuum aspiration instead of curettage for specific cases. We have a better sense of how well the initial evaluation and documentation is done. And we know who has a tendency to turn up late. It has turned out to produce more benefits than we'd anticipated.

It's definitely worth the early-morning effort.