|André Brouillet illustration of
“Une leçon clinique à la Salpêtrière.”
In the days when medical teaching took place mainly at the bedside, grand rounds were the accepted method by which rare or interesting cases were demonstrated to the entire hospital staff. It was a tradition that went back at least to the days of the great Jean Charcot, who exhibited his grandes hysteriques and other rare cases before the assembled medical staff of the Salpêtrière. This format persisted in US teaching hospitals as late as the 1960s, often consisting of the moderator introducing the patient to the audience, explaining that these doctors were interested in his case and would like to ask him a few questions. Most patients would be pleased and encouraged that so many doctors heard their case and perhaps would make useful suggestions about their care.
In more recent years, however, most US hospitals have abandoned this format, reflecting concerns about patients’ privacy and dignity, and perhaps also the decline of bedside teaching. Grand rounds now usually consist of a lecture with slides, sometimes preceded by a protocol read by a house officer and occasionally enlivened by the sound of strident beepers or peaceful slumbers. As the lecture may cover general issues such as payment methods, health economics, or problems with healthcare delivery, the connection to an actual patient is often quite tenuous, so that the term grand rounds has largely lost its original meaning.