Grand Rounds Report: Clinical Excellence Pearls

by Academy of Clinical Excellence on October 13, 2010

The Miller-Coulson Academy of Clinical Excellence Grand Rounds was a real showcase of clinical excellence. Dr. Wright discussed an elderly woman with a 2-month illness marked by erythema nodosum, fatigue, and weakness who came to the United States from Greece in the 1960s. The differential diagnosis and overall approach to the patient was expertly discussed by Dr. Zenilman (Infectious Diseases), Dr. Browner (Oncology), and Dr. Kraus (Nephrology). Dr. Duncan (Surgery) discussed his approach to the patient and his discussions with the patient and family, and Dr. Gross (the patient’s primary care provider) discussed the long-term management of the patient.

Many “pearls” emerged from the discussion, but I have chosen to list three:

1. Let the patient tell his/her story.

The answer to a seemingly complex problem often comes from the history, and that can only be understood by letting the patient tell his/her story.

2. Recognize that the patient’s preferences often must dictate the evaluation.

There may be an “ideal” diagnostic approach to a patient’s illness, but sometimes the patient may only “allow” one test, as was the case here. This made it even more important to choose a test (in this case, surgical excision of a lymph node) that was likely to be highest yield and that was acceptable to the patient.

3. Complex problems often require input and coordination from multiple providers, each contributing a different expertise.

The conference today showed the tremendous benefit of having specialists from different disciplines discuss a case together. Clearly, this provides the best care for the patient. Creating opportunities for this to occur “in real life“ is important.

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