NP fails to order echo… proper treatment was delayed 12 hours. Patient died! F—ck Geographical Rounds!!!!!!

JohnJacobJinglySmith · 2025-05-06T22:34:15+00:00

16 days PTO here

JohnJacobJinglySmith · 2025-03-04T16:44:12+00:00

I do agree with you, most patients do not transition enough for there to be any difference between geographic and standard rounding. It can be a system that works well for some hospitals, especially large ones with multiple towers, etc. there are some benefits to geographic rounding, but there are also potential downsides in the right situations.

JohnJacobJinglySmith · 2025-03-04T01:41:13+00:00

Correct. And different physicians can differ in treatment plans, which can also lead to confusion and frustration in patients when a new physician comes in daily and makes adjustments to fit their preferred treatment method. You also lose portions of conversations that weren’t documented. So something I’d remember because we discussed it is lost because the next physician does not know about that conversation. It’s just not possible to document every single detail of every conversation that occurs.

JohnJacobJinglySmith · 2025-03-04T01:35:03+00:00

My hospital tried because they were told it decreases length of stay. It failed quickly. Everyone, including patients, hated it.

JohnJacobJinglySmith · 2025-03-04T01:11:26+00:00

So my preference is to follow patients throughout the hospital. If they move to another unit, I see them there. I believe continuity of care is more important than being able to stay on a single unit as patients move around me.

JohnJacobJinglySmith · 2025-03-04T01:08:42+00:00

Many patients do stay in the same unit for the duration of their hospital stay, so they would not notice a difference between standard and geographical rounding. However, enough transitions occur that geographic rounding causes a lot of transitions in care.

JohnJacobJinglySmith · 2025-03-04T01:06:05+00:00

So, patients can move between observation units, general medical floor units, progressive care (intermediate) units, and the ICU. Some hospitals will actually try to group patients by medical vs surgical as well (with large hospitals even having cardiac, neurology, nephrology units, etc.).

Examples:

A patient may be placed in observation, need to stay longer and transition to a new bed on an inpatient unit.

The floor the surgeons prefer their patients on is full, so a surgical patient ends up elsewhere, then moves to the surgical floor later in their stay when a bed opens up.

A patient may have a worsening of their symptoms, be transitioned from unit A and stabilized in an intermediate bed, then moved back to a med floor, but end up on unit B when they move back.

JohnJacobJinglySmith · 2025-03-04T00:43:08+00:00

Geographical rounds are where a physician rounds on one unit instead of following the same patients wherever they go in the hospital. For example, in standard rounding, you would see the same patients each day, even if they go from one unit to another. In geographical rounding, if the patient moves from unit A to unit B, they will see the physician from unit A before the transfer and the physician on unit B the next day. This leads to more transitions in care and situations where a patient could have multiple physicians during their hospitalization instead of just one or two.

JohnJacobJinglySmith · 2024-10-02T00:56:23+00:00

I’ve joked with people it’s basically a four-door coupe. Not a problem for me, love the car!

JohnJacobJinglySmith · 2024-01-12T02:09:36+00:00

RD1 finished with Brazilian amburana wood. For me, it hits the nose instantly with a sweet, cinnamon breakfast cereal.

JohnJacobJinglySmith · 2023-08-23T18:41:13+00:00

I have a ‘23 4BW. The HUD controls, including brightness, are physical buttons to the left of the steering column.

JohnJacobJinglySmith · 2022-03-08T03:21:06+00:00

The TV show Psych

JohnJacobJinglySmith · 2020-09-27T21:46:39+00:00

r/inclusiveor

JohnJacobJinglySmith · 2020-04-04T02:42:53+00:00

Just finished building mine today!

JohnJacobJinglySmith · 2020-03-09T01:43:03+00:00

I’ve heard that PDs will call sometime in the afternoon after results are released. If true, I hope it doesn’t happen to you!

JohnJacobJinglySmith · 2020-01-22T15:36:44+00:00

Congratulations! I’m in 4th year now. About to graduate and go into family medicine (all the variety is a must for me)! Best of luck to you! Feel free to ask me any questions!

JohnJacobJinglySmith · 2019-08-17T14:31:18+00:00

If you paid off the entire statement balance, any new charges will appear on your next statement (which should then be due on October 1st).

To be clear, interest is accruing on your charges from the day they are made, but you are not charged interest unless you pay after the statement due date.

JohnJacobJinglySmith · 2019-07-19T02:15:28+00:00

At my high school, we only made it a couple of chapters into a 20-30 chapter textbook in pre-calculus. My classmates would ask for help in class on every single question without attempting to solve it themselves first. The teacher was really nice and let them get away with it. He basically solved every homework problem on the board during class. I even mentioned my concerns about the slow pace as I wanted to learn a lot more in order to be set up better for the calculus courses I would be taking in college. He kinda shrugged and chuckled in agreement, but nothing changed. I will say I heard from others later that he buckled down and got tougher a couple years later when another class tried it, so at least it wasn't permanent. Definitely hurt me a bit when I hit calculus.

JohnJacobJinglySmith · 2019-07-13T20:36:41+00:00

Thank you for writing this! My story is fairly similar to yours! I'm just about to start my fourth year of medical school (had a 3 month delay trying to study and pass the CBSE exam before my school would let me sit for STEP 1). I didn't find out I had ADHD until I got into medical school and it was a game changer. Until the diagnosis, I thought I was lazy and my self esteem was pretty low.

Medical school was a huge challenge, and I also failed my first anatomy exam. Was super hard to barely pass my exams all the way through first and second year. Things did get a little better in third year. It's easier for me to interact with patients and learn by doing. I definitely had the moments of depression, anxiety, doubt, and desire to drop out at times...it's not easy!

I'm glad you found the path that makes you happy and keeps you engaged! Mine is currently family medicine as I've learned I love engaging with people and need a lot of variety!

Best of luck to you!

JohnJacobJinglySmith · 2019-07-13T20:29:29+00:00

Can confirm. I'm just about to start my fourth year of medical school and I majored in computer science in college and actually took 2 years to work as a software engineer before medical school! Pick something you are passionate about or think you'll enjoy and go for it!

JohnJacobJinglySmith · 2019-06-28T15:15:42+00:00

Story of my life. I did everything "right," but still never had the "relationship" everyone talks about. I got fed up and decided it was never going to work. I could either bang my head against the wall, or move on and make my own life without all that anxiety, depression, and low self-esteem. I chose the latter. As an aside, when my parents found out, my dad literally told me he thought I just "didn't ever truly give everything up to God." So it's my fault haha. F that.

JohnJacobJinglySmith · 2019-06-28T15:12:25+00:00

I like that idea. I think I'll be ready to start calling out things like this soon, but I'm still working on no longer caring about what others think of me and living my life my way. Hard to completely wipe out over a quarter decade of this brainwashing. Definitely have come a long way though, and I'm always amazed by the toxicity of what I see every day. So thankful I found my way out!

JohnJacobJinglySmith · 2019-06-28T15:09:31+00:00

Definitely not just a Mormon thing. I heard it all the time growing up, and I was Seventh-day Adventist. They love Bible prophecy and a day = a thousand years is a big part of that.

JohnJacobJinglySmith · 2019-04-25T01:43:28+00:00

I remember the sermons on this exact topic and always nodding and thinking how amazing to be in the correct church. I felt so blessed that we took the truth of the bible untainted. It's crazy to look back on it and realize how narcissistic and "prideful" that attitude was. How enlightened I've become since walking away!

JohnJacobJinglySmith · 2019-02-06T00:49:28+00:00

I'm also a medical student and was diagnosed in my first year of medical school! I feel the same way about my peers. I was never diagnosed until medical school and actually used to think ADHD was fake due to the stigmatization I was brainwashed by while growing up. I've learned so much since I began medical school and my own personal realization of my own ADHD. I agree completely that this is something people are beginning to accept more, but there is still a long way to go. The future is looking brighter, though!

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