If you are not doing Schwartz Rounds, get them started. ASAP.
I recently completed a 4-year tenure as physician moderator for our hospital’s Schwartz Rounds. An amazing team at my hospital helped pull the bimonthly sessions together. These compassionate care rounds are a national initiative to help foster empathy and compassion in the health care setting.
We gather a panel of two to three people involved in our patient presentation who share and move quickly through the clinical details, and head on toward the thornier ethical issues, emotional triggers, and responses. The best sessions are when the audience’s voice is heard for the bulk of the time.
The emotional cadence flows from boiling in frustration, drowning in tears, followed by comfort, and ending in thoughts for the next session. It is a more powerful arc than an episode of the television program “This is Us.” Largely, because this was us. This was real life. Real-time catharsis in the hospital.
In the daily grind, we often skip the step of processing our frustration, sadness, and anger, moving right on to the next patient and walking into the next room with that stoic layer of equanimity. I walk the hallways and find I grab my phone to catch up on emails, walking to the wrong floor because I’m not paying attention. Always something to do, someone to talk to, a family to call, pagers going off, phone calls. When do we sit and reflect?
These Schwartz Rounds are those moments of reflection – a slowdown in the day to think more deeply about the case. We talk about everything and anything. We have discussions with opposing views:
“Everything should have been done!”
“How did you not stop care?!”
“I agree with the doctors.”
“I can see the patient’s view more clearly now.”
Our first Schwartz Rounds tended to be end-of-life stories, particularly regarding the family mantra of “Do everything.” The health care team watches the suffering of a patient, a family, in a seemingly futile situation. Conversations around the end of life, choices, and quality of life are cut short daily by family members who simply recite, “Do everything.”
After several of these sessions, a case swings us in the other direction. The elderly gentleman with treatable cancer, who could easily survive another 20 years, declines treatment. “I’m fine, doc; I’ve lived long enough.” His wife at his bedside, shaking her head, tells us, “I don’t know why he wants to give up. He’s been as stubborn as a mule since the day I met him.” I spend 30 minutes convincing him to stay. The nurse does the same. Now we have a patient with a “Do nothing.” The patient’s decisions conflict with the family and the health care team.
Every day in the hospital provides a new ethical dilemma, a frustrating case, a challenging patient. Fodder for rounds.
Read the full post at hospitalleader.org.
Dr. Messler is a hospitalist at Morton Plant Hospitalist group in Clearwater, Fla. He previously chaired SHM’s Quality and Patient Safety Committee and has been active in several SHM mentoring programs, most recently with Project BOOST and Glycemic Control.
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