[Information or confusion. A formal quantitative analysis of ophthalmology ward rounds]

The daily ward round is the main opportunity for communicative interaction between physician and patient during a patient's hospital stay. We analysed to what extent the round was capable of fulfilling the patients' needs for information and emotional support, using the ophthalmologic ward of a university hospital as an example.

For a period of 4 months in 2006, doctor-patient-interactions in an ophthalmologic ward round were recorded with a dictating machine. Fifty physician-patient interactions between 50 patients and five different physicians were selected according to uniform criteria. After the recordings were transcribed, the interactions were evaluated using formal quantitative speech analysis. We examined the patients' subjective perceptions by means of a standardised questionnaire.

The average doctor-patient interaction lasted just under 4 min. The formal quantitative analysis of the effective verbal communication between physician and patient indicated an asymmetry to the advantage of the physician, who spoke 73% of the words (Chi 245.48 words). The patient remained rather incommunicative during the course of the conversation. Medical terms were used in only 0.53% of the direct doctor-patient dialogue. The ward round conversation was characterised by numerous personnel internal dialogues. During much of the rounds (46% of the time), the patients were unable to participate actively in the conversations. As a result, information could not reach the patients. Requests to speak were initiated 83% of the time by the physicians and only 33% of the time by the patients. Nevertheless, the patients indicated high (22%) and very high (66%) satisfaction with the ward rounds.

In the future, the ophthalmologic ward round should satisfy the criteria of patient-centric conversation. Therefore, the informational value of the daily ward round must be increased, and organisational and structural changes must be made to promote direct conversation between the patient and the eye specialist. A team conference before and after the physician-patient interaction would allow a focus on team-referred and patient-referred interests within the ward round.