Bedside Presenting

Here's an article that I find interesting to share with you guys. Haven't thought of this before. May be because most of Czech patients don't understand English. But, when we go back to Malaysia, shouldn't we be more sensitive to this kind of issue?

From Student BMJ, Medscape

It's nearing the end of a long and tiring ward round. My feet ache, I can hear my belly grumbling, and I'm barely listening to the case being presented in front of me. As another student summarises the history, the consultant turns his gaze on me. "What is your differential diagnosis?" I feel my heart race as I try to fabricate a list in my head. I decide the patient is most likely to have multiple myeloma. Before I can blurt this out I catch the eye of the patient, who is listening intently. The dread of disclosing an incorrect and worrying list of diseases in the company of the patient is too much. I stand speechless with discomfort, and the consultant looks at me disapprovingly.

Many medical students have experienced similar situations, but might not have questioned how it could affect the patient. Whether it's discussing a diagnosis, delving into personal lives, or simply getting names wrong, bedside presenting might cause distress to patients in several ways. During the ward round a member of the medical team is often required to recite patient histories at the bedside within earshot of eavesdropping room mates, and in a venue that is far from private. It seems in stark contrast to how much care is taken within the NHS to keep other aspects of patient information private. Could this be interpreted as a breach of confidentiality? The typical bedside presentation has not changed much since its depiction in Doctor in the House (1954). Although a comedy, the opening scene of this film may be a familiar one for many medical students, as the consultant Sir Lancelot Spratt insensitively discusses the case at the bedside without any consideration for the patient.

Trainee doctors are taught that bedside presenting is an integral part of the ward round. It allows the doctor to see the patient as a whole, not just a disease, and provides a great learning experience for students. It's also an opportunity for patients to learn more about their condition and feel satisfied that their case is being reviewed. But poorly executed bedside presenting poses the danger of jeopardising the therapeutic relationship, if patients feel their needs are not being made a priority.