Carmelina Raffetto was only 42 when she found herself the subject of teaching rounds at UC Davis Medical
Center. She needed surgery to replace a severely stenotic aortic valve. "You've got to hear this,"
the attending enthused to the gathered residents, interns and students as he leaned over to listen to
her heart. "A classic textbook case!"
Bedside rounds have long been a mainstay of medical education, including at UC Davis Medical Center.
However, if the national trend of fewer bedside interactions continues, this practice may become as obsolete
as the wooden stethoscope. Surveys in various teaching hospitals throughout the country found that time
spent in bedside teaching averages 2.5 to 12 minutes per patient. And while 85 percent of patients reported
that they liked the case presentation discussion at the bedside, only one-third of attendings and fewer
residents felt the same way. In one study, most residents felt case presentations should take 5 minutes
or less and be delivered away from the patient's bedside.
Raffetto is definitely in the camp of satisfied patients. "It was wonderful to see the doctors'
excitement in teaching," she remembers. "I felt they always included me and that I was part
of the teaching experience. And I learned a lot about my condition."
One reason residents cite for disliking the practice is the fear of making the patient uncomfortable
in such a public setting. While residents may prefer teaching rounds in the hallway, out of patients'
earshot, this practice may make patients more uncomfortable, as they wonder what might be said about them
that they can't hear. Raffetto said she remembers that everyone was always polite to her and asked permission
to question and examine her first.
This expression of respect for the patient is as important for students to observe as learning the specifics
of a disease, according to Faith Fitzgerald, assistant dean of medical humanities and bioethics. "Even
if the attending physician is less skilled in the area of expertise required for illuminating a particular
patient's case, the clinician can demonstrate skills in human interactions with the patient," she
Students and interns also tend to dislike teaching rounds in case they are put in the embarrassing situation
of their ignorance being exposed to the patient. But Raffetto was never aware of such a dynamic in her
"The focus was always on what my condition could teach," she says. "I never felt that
residents were put on the spot around me or put down like you see on TV."
Although Raffetto would just as soon never find herself hospitalized again, she felt that "on the
whole, it was a very positive experience. It was neat being a teaching tool for students."