Rethinking ward rounds

It’s the morning round in the hospital. In a dreary voice the doctor presents the patient, a 43 year old man with fever, chills, and a productive cough. He has a new diagnosis of HIV infection. He is married and has a girlfriend. The two bioethicists in the room, hitherto lulled by the long list of treatments, stir uncomfortably in their seats: there may be problems afoot. Do the wife and girlfriend know about each other? Can the team distinguish one from the other? Does the patient want to share the diagnosis with either? Should they be told of their likely exposure to HIV, even without the patient’s consent?

The purpose of oral presentations in rounds is to tell the patient’s story. It is primarily a medical story, which may start before the patient’s birth (if genetics are relevant) and extend to the future. The narrative helps the healthcare team make sense of the patient’s situation and provide safe, effective care. Although the stories should …