Hospitalists and Bedside Multidisciplinary Rounding...I don't want to do it

[hightower]

I'm just looking to get some thoughts from other hospitalists or anyone who's had experience with being forced to round on a multidisciplinary team at the bedside.
I work at a small, rural hospital who is staffed by TeamHealth for its hospitalist services. I worked here prior to TH and have enjoyed working at this facility due to the lower acuity of patients, lower volume, less stress, etc. However, when TH took over, they sold the hospital on the concept of multidisciplinary bedside rounding. Essentially, they force the hospitalists to lead around a large team of care managers, nurses, pharmacists, etc from patient to patient and conduct a show in front of the patient and family where we pretend to work as a group in an effort to force people to answer their post-discharge survey questions more positively for the hospital. I HATE doing them. I don't like standing up in front of 8+ people and pretending to do my job in front of everyone. I am an introvert and need quiet and alone time in order to think and do my job, so this sort of thing is literally pointless for me because I'm not going to be making decisions or thinking in a group setting like that. It's also incredibly painful for me and I dread going to work each morning because of it. Additionally, having care managers question what I'm doing in front of patients and family is insulting. They will interrupt me and ask what the result of a lab was or something stupid like that. As if the CM needs to know what the specific numbers were for a patients creatinine! I did them for probably 6 months or more before the pandemic struck and then they were shut down due to all the COVID patients in house. I realized how much happier I was without them during that time. Now they want to restart them. I have been so far refusing to do it and used the excuse of feeling it was still unsafe. However, I'm pretty certain the hospital is now complaining to my superiors at TH about me skipping out. And I'm certain it's going to come to a head soon.

What should I do? What have others done? Is it just me or does anyone else feel these rounds are a s*** show? I feel like they are forcing me to become an actor and put on a BS corporate show for my patients which I feel takes away from the patient/doctor relationship. Not to mention that it's a process obviously biased towards extroverts. What about the introvert physicians like myself? Are we being forced out of medicine entirely?

Does anyone feel I would have any ability to win a lawsuit if I were to be fired over this? Specifically, since I brought up safety concerns about going from room to room with a large group of people during a pandemic?

I'm just at a point where I don't think I can go back to doing these rounds and fake it everyday. I hate doing these rounds that much.

[Kamban]

Large group of people standing close to each other in confined space of the small patient room puts the patient and you at risk for Coronavirus with no clinical benefit or improved outcomes. Say you won't do it for safety reasons and if they want, you can do zoom meetings with all at set times without the need for patient being present.

[EM-CCM MD]

I’m an intensivist. We round with pharmacy, RT and often social work and/or PT. I find it helpful, but it 100% depends on who you’re rounding with. Some of the pharmacists could probably round without me - they’re that good. That being said, I had a super malignant nurse educator at another place that was just obstructionist and made it all painful (“Does that patient REALLY need their CVL another day?” - “Yes, that’s why I said to leave it in another day”).

I realize you say that you hate it, but it may be that you just hate the current iteration or the other staff don’t “get it”. New things often suck and it’s also new for them. I would work with pharmacy, SW, etc to figure out what they can do to be helpful to you. Yes, you’re not a spine surgeon or sub specialist that the hospital will bow to, but the point of the team is to streamline care and (hopefully) make your job easier.

[childay]

Sounds like a waste of time for most of those people. Why would a pharmacist need to watch you listen to someone's lungs? Inefficient

[G]

not a hospitalist, but I know that some of our folks feel the way you do and take all the admit shifts. or night shifts (interesting that the vital bureaucrat jobs are not staffed 24 hours a day....)

don't focus on the introvert/extrovert thing as a reason that this isn't working for you, labeling would be too easy. if the process was useful or worthwhile or respectful, you wouldn't feel this way. frankly, from your description it sounds like a colossal waste of time/energy...but then again, I am also an introvert! I would probably have a friendly talk to the problem CM in private; if it was a problem again, I would channel my meanest chief resident/attending and probably make somebody cry or get called into the principal's office or both.

good luck. oh, make sure you have read "Quiet"...it helped me understand my introversion.

[Brains428]

https://www.healthimaging.com/topics...-communication

Reminds me of this article that wanted radiologists to be on rounds. Don't worry about me going over 20 chest xrays in 4 hours. I'm sure the hospital will be okay with their 40 MRIs just sitting in queue.

I think it's well intentioned to have multidisciplinary rounds, but it may not be applicable to the non-academic setting. The hospital can't push productivity and then put measures to decrease said productivity.

Good luck

[childay]

https://www.healthimaging.com/topics...-communication

Reminds me of this article that wanted radiologists to be on rounds. Don't worry about me going over 20 chest xrays in 4 hours. I'm sure the hospital will be okay with their 40 MRIs just sitting in queue.

I think it's well intentioned to have multidisciplinary rounds, but it may not be applicable to the non-academic setting. The hospital can't push productivity and then put measures to decrease said productivity.

Good luck

“The next phase of CIR will include reviewing imaging results directly with patients and their families at the bedside,” Salama et al. write in their discussion. “This is another opportunity to demonstrate radiology’s added value.”

LOL I can only imagine how horribly slowly that would go trying to explain an MRI or whatever

[Anne]

Not a hospitalist but my specialty has care team rounding that is pretty useful to get everyone on the same page, it is not done in front of the patient though. I agree now is not the time to resume the process as described.

If the CM asks about a lab again, I would advise them that that info is available in the EMR and that your expectation is that they review the information they need prior to rounds...now if they need medical interpretation of the labs and how that fits into the plan of care, please feel free to ask you.

[Lithium]

I'm just looking to get some thoughts from other hospitalists or anyone who's had experience with being forced to round on a multidisciplinary team at the bedside.
I work at a small, rural hospital who is staffed by TeamHealth for its hospitalist services. I worked here prior to TH and have enjoyed working at this facility due to the lower acuity of patients, lower volume, less stress, etc. However, when TH took over, they sold the hospital on the concept of multidisciplinary bedside rounding. Essentially, they force the hospitalists to lead around a large team of care managers, nurses, pharmacists, etc from patient to patient and conduct a show in front of the patient and family where we pretend to work as a group in an effort to force people to answer their post-discharge survey questions more positively for the hospital. I HATE doing them. I don't like standing up in front of 8+ people and pretending to do my job in front of everyone. I am an introvert and need quiet and alone time in order to think and do my job, so this sort of thing is literally pointless for me because I'm not going to be making decisions or thinking in a group setting like that. It's also incredibly painful for me and I dread going to work each morning because of it. Additionally, having care managers question what I'm doing in front of patients and family is insulting. They will interrupt me and ask what the result of a lab was or something stupid like that. As if the CM needs to know what the specific numbers were for a patients creatinine! I did them for probably 6 months or more before the pandemic struck and then they were shut down due to all the COVID patients in house. I realized how much happier I was without them during that time. Now they want to restart them. I have been so far refusing to do it and used the excuse of feeling it was still unsafe. However, I'm pretty certain the hospital is now complaining to my superiors at TH about me skipping out. And I'm certain it's going to come to a head soon.

What should I do? What have others done? Is it just me or does anyone else feel these rounds are a s*** show? I feel like they are forcing me to become an actor and put on a BS corporate show for my patients which I feel takes away from the patient/doctor relationship. Not to mention that it's a process obviously biased towards extroverts. What about the introvert physicians like myself? Are we being forced out of medicine entirely?

Does anyone feel I would have any ability to win a lawsuit if I were to be fired over this? Specifically, since I brought up safety concerns about going from room to room with a large group of people during a pandemic?

I'm just at a point where I don't think I can go back to doing these rounds and fake it everyday. I hate doing these rounds that much.

I don't have a good solution for your specific question but I've been following your posts for years. Frankly, you seem to hate being a doctor. I am not judging it (in many ways, I empathize).
If you haven't figured out an off ramp yet, what are you doing to increase your satisfaction with your career? Have you found any nonclinical alternatives? Considered talking to a career coach? Or are you just keeping your foot on the gas doing something you hate until you can just punch out?

[CordMcNally]

Ooof, that sounds awful. What I would do would depend on how much I like living where I'm at, how easy another job would be to get, and how easy/hard it would be for TeamHealth to replace me.

[fatlittlepig]

Sounds very painful. What do your colleagues think of the rounds, the only way you’re getting rid of them is if you can find others to side with you.

[Sundance]

Sounds awful. Just gave me flashbacks to IM rounding as a resident.

I would play the covid card for now but doubt that is an issue a lone doc can fight team health on long term if that’s what they want

what a horrible situation in medicine these days.

good luck-

[hightower]

Thanks for the thoughtful responses. So, if there's one thing I've learned about these sort of situations over the years, its to not react when I'm feeling emotional about it (I was quite angry this morning). And actually, I forgot to mention that I definitely already played the COVID card a couple of weeks ago and haven't been showing up to these rounds as a result of that and they know that's why. They actually had other people in the hospital bring up the same concerns and are now meeting in person, but in a waiting room where everyone can spread out. Which is still pointless because we could do the same over the phone as we were during the whole pandemic. Another piece to this craziness is that the hospital (which has been failing financially for months even before COVID) has been bought out by a large, local healthcare system and they take over next month anyway. So, most likely, everything we do is about to drastically change soon. I spoke with my medical director today who the hospital has definitely been complaining to. He basically told me that he agrees with me 100% but that I'm outnumbered and I should just buy myself some time and make them happy for the next couple of weeks and see what happens when the new company takes over. I can get behind that for now because I'm certain they will turn everything inside out here as they take over this hospital.

It is a crazy situation in medicine these days though. In my view this is corporate medicine at its worst. Its all about "customer satisfaction." When my wife was in the hospital a couple years ago after giving birth, they did this sort of things to us there. I hated it from the patient side of things because I felt like we were being bullied into answering their surveys a certain way. I didn't feel as comfortable asking questions in that setting, nor did my wife. But, what can a lone doc do?

My colleagues hate it too, but they are in the same boat as me, afraid to stick their necks out too much or risk their income getting taken away.

[G]

what can a lone doc do?

as a lone hospitalist? nada, as you are point out. see my response over on the pandemic contract revision thread.

[hightower]

I don't have a good solution for your specific question but I've been following your posts for years. Frankly, you seem to hate being a doctor. I am not judging it (in many ways, I empathize).
If you haven't figured out an off ramp yet, what are you doing to increase your satisfaction with your career? Have you found any nonclinical alternatives? Considered talking to a career coach? Or are you just keeping your foot on the gas doing something you hate until you can just punch out?

Well, I don't want to say I hate being a doctor (though I'm sure my prior posts give people that impression). I see it as a great privilege to be where I am, but yes I've posted many times on the topic of my job for years. I certainly admit to having chosen the wrong career and I do plan on eventually punching out, but this particular position fits me well enough that I'm planning on holding on as long as I can simply to get into as good of a financial spot as possible before quitting. I think that's at least partially why I'm particularly sensitive to big changes like this because I feel like they are screwing up a decent gig for me. Ideally if I could last another 5-10 years I could pay off our mortgage (or at least save enough in taxable for it) and potentially hit 1 million in investable assets. That would give me a lot of options moving forward when looking for a new career. But, I'm well aware that I may just have to learn to roll with the punches and that life isn't always that predictable.