Filler A day in the life of a doctor

Grand Rounds

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38994.464317.DE (Published 21 December 2006) Cite this as: BMJ 2006;333:1298
  1. David Isaacs, senior staff specialist, Department of Immunology and Infectious Diseases, Children's Hospital at Westmead, Sydney, Australia (davidi{at}chw.edu.au),
  2. Stephen Isaacs, consultant, Waltham Forest Child and Family Consultation Service, London,
  3. Dominic Fitzgerald, senior staff specialist, Department of Respiratory Medicine, Children's Hospital at Westmead

    The main purpose of Grand Rounds is self aggrandisement. Grand Rounds are held weekly, or weakly, depending on the presenter. To medical students who ask sceptically why they are called Grand Rounds, the answer is because Grand Rounds sounds better than Petit Rounds.

    Grand Rounds used to be called ye Grande Olde Rounds. They were immortalised in the nursery rhyme:

    Ye Grande Olde Rounds of Yore

    They had ten thousand slides

    They took them up to the carousel

    And they dropped them on their sides.

    Now when they were down they were up

    And when they were not it was Hell,

    And with Grande Rounds almost halfway through

    They jammed the carousel.

    The modern presenter thinks a carousel is a merry-go-round, and is only worried that his or her carefully prepared and saved PowerPoint presentation has disappeared into the electronic ether.

    The chair of Grand Rounds is in a position of great power. The chair can influence the whole tenor of the weekly meeting. The chair is traditionally the oldest, most esteemed, most senior member of staff, and the person most likely to fall asleep throughout the meeting.

    A clinical case or two is presented at each Grand Rounds. The presenter is the most junior member of the medical team. Tradition dictates that the junior member has never met the patient but has been told to present the case by the consultant. It is considered character building to stand up in front of several hundred senior colleagues and expose yourself to ridicule. It is considered irrelevant that the character thus built will be a nervous wreck for the remainder of his or her medical career.

    The presented case is then masticated, ruminated on, digested, and regurgitated by senior doctors. It is considered bad form for them to prepare for their pontifications, which tradition dictates are lengthy, liberally strewn with anecdotes, and evidence-free. The end result is a hallowed form of verbal swordplay with your colleagues, in which you score palpable hits as you exhibit your own knowledge and clinical acumen while denigrating those of your colleagues. This should be done subtly and with finesse, so that the character assassination is not immediately apparent—the thrust and parry of epee rather than the coup de sabre.

    At the end of the Grand Rounds, the chair wakes up and asks for a grand round of applause to wake up the rest of the audience.

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