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In a study of 43 patients attending postgraduate neurology grand rounds, patients agreed that their history was described accurately (95%), they were relaxed (91%), the audience was not intimidating (84%), and that they had been well informed (70%); but only 62% found the meeting useful and 18% would have liked to have spoken more. Neurologists’ blinded ratings of their patients’ perceptions were concordant in 234 (91%) of 258 paired ratings.
“Grand rounds” evolved early in the history of neurology, and patients are still frequently presented in person at neurology clinical meetings. The most celebrated grand rounds were led by Jean-Martin Charcot (1825–93) at the Salpêtrière in Paris, now immortalised in art by André Brouillet (fig 1). In the weekly “Leçons du Mardi”, Charcot presented a patient to a large audience including not only hospital staff but also members of the general public. Although never evaluated formally, feelings about Charcot’s grand rounds were mixed:
Some considered the Salpêtrière public “exhibitions” of hysterical women patients in a state of partial nudity (and seemingly stripped as well of conventional Victorian inhibitions on comportment and speech) to go beyond the acceptable conventions of clinical demonstrations. In contrast to the silence on this issue on the part of the medical profession, condemnation came from the Church and from defenders of women. Unfortunately, the patients themselves left little direct evidence.1
These days, clinical meetings are of course confidential, and allow clinicians to present challenging diagnostic and management issues, or educate trainees (and, indeed, other consultants) about clinical neurology.2,3 But, despite the passage of more than a century since Charcot’s grand rounds, there are no published data on what patients …
Published Online First 22 December 2006
Funding: RAS is funded by the UK Medical Research Council.
Competing interests: Every author was involved with study design. RAS and JS collected the data. RAS analysed the data and drafted the article. Every author revised the manuscript critically for important intellectual content. All authors gave final approval of the version to be published. RAS is responsible for the overall content as guarantor.