STANFORD, Calif.--(BUSINESS WIRE)--He was barely out of his teens, full of youthful promise, when he and his parents arrived at Stanford Hospital. He died a year later, conquered by leukemia. Something about this kid got to the professionals who cared for him through those months, something that brought them to tears more than once as each day passed and they watched him deteriorate.
A few months later, more than 120 people found seats in folding chairs that fully packed a conference room at the Stanford Cancer Center. Others crowded in at the back, like a standing-room-only audience not willing to miss the event. In each row, boxes of Kleenex were ready. One by one, as all varieties of medical professionals—including the oncologist who initially referred the young man to Stanford—recalled this patient and others in their experience, tears flowed again. So did words that described the reality of work in health care, where answers are not always easy and where tradition has taught that showing such feelings is less than professional, even among colleagues.
At Stanford, a leadership group at the Cancer Center determined they would make a safe place for feelings “in this high intensity cauldron where all kinds of things are happening,” said Sridhar Seshadri, the hospital’s vice president in charge of the Cancer Center. “We wanted to provide a place where people could speak their emotions in a safe environment, without censure, as a catharsis. We owe it to them to give them a chance to recharge their batteries. They need a forum. They need a place to talk. They need support systems.”
Stanford is now one of just 300 hospitals in the United States following a format created by the Schwartz Center for Compassionate Healthcare in Boston. Organized after the 1995 cancer death of Boston lawyer Kenneth Schwartz, the foundation’s mission is compassionate health care, supported by greater public awareness of the emotional and psychosocial issues that are embedded in patient care. The Schwartz Rounds are the centerpiece of the foundation’s program, a variation of the process that traditionally involves doctors visiting patients. In every hospital where Schwartz Rounds have been instituted, they have become a highly valued asset. Stanford’s Schwartz Rounds are held every other month, led by a facilitator; types of cases vary—the death of a young person, a conflict within a family about what to tell a patient about a diagnosis.
“In some ways, feelings have taken second place to the illness and the technology,” said Douglas Blayney, MD, the Ann & John Doerr Medical Director of the Cancer Center. “Patients often have a support network. We in the profession don’t often have an opportunity to share with one another, to know what our colleagues are feeling and how they are coping.”
With more and more regularity, studies are revealing that those who give care need care, too, and that lack of it contributes to burnout. Finding that care, or even acknowledging a need for it, has been difficult in what many observers say has been a culture that models bravado as the proper attitude of doctors. Physician wellness programs, including one being developed at Stanford, are gradually being incorporated into employee support. “We need to teach resiliency, perspective and balance,” said Stanford Hospital’s Chief of Surgery, Tom Krummel, at a recent symposium on physician burnout.
“In Schwartz Rounds, you find counsel in everyone else,” said Julie Latini, patient care manager of the hematology/oncology unit at the hospital. “We get insight on how to cope better, ways to manage process with patients.” At a recent Schwartz Rounds, for example, a medical interpreter asked that medical teams give the interpreter a heads-up about the topic of a discussion, especially if it’s about difficult issues, and that they understand that hours of translation can be emotionally exhausting.
In the confidentiality of Schwartz Rounds, people have the freedom to talk, sometimes making requests like those of the medical interpreter, sometimes posing questions of universal value, but always addressing a basic truth of a cancer care facility. “We’re talking about how to make the unbearable bearable,” said Kavitha Ramchandran, MD, medical director of Stanford’s Supportive Oncology program, in introductory remarks she made at a recent Schwartz Round. “We want to come up with new strategies to care for ourselves better so we can care for our patients better. This is a chance for us to be open and honest with one another, to talk about the human impact on us of caring for patients with devastating illnesses.”
The feelings these caregivers share show just how deep that impact is. Guilt, surprisingly enough, is a word used often: guilt for worrying about their 16-year-old child who is learning to drive—when the parents of their patients are watching their children in the last days of their life; guilt for not being able to support colleagues well because they are overwhelmed with their own feelings; guilt for being the parent of a child who survived cancer now trying to support parents whose child will not survive.
Sometimes they talk about the conflict between rules that just don’t fit the human needs of patients and ways to respond. One day, Latini told the Schwartz Rounds group, she watched the mother of a patient, fully gowned and gloved as per infection control protocol to protect her child, sitting in her child’s room. “Her son is going to die and she can’t even touch him.”
Latini went to the hospital’s infection control staff and found a sympathetic ear. “We’ve decided we’re going to work with dying patients,” she said, “and figure out a way not to violate the policy and not to have them wear gowns and gloves.”
A nurse asked the group, “How do you have difficult conversations with a family without having emotions? Do you show emotion? If you do, is that a bad thing or a good thing?”
“I think part of the issue is thinking about your personal perspective,” another said. “What is your personal perspective on accepting the natural process of death? That can help us help the family.”
One of the physicians who treated the young patient said he had left the unit the day the young man was sent home for the last time. “I didn’t want to deal,” he said. “And the thing I’ve done to deal with this is zero—until this meeting.”
As the rounds came to a close, people stood up to say thanks. “I’m glad we have this,” said a nurse. “I’m hoping this will bring out more support for everyone.”
“My goal,” Blayney said, “is to make sure that all of us leave with ways to deal with similar situations in the future. We function as a team, and each member brings a variety of life experiences to situations and has different takes on things.”
“There’s been a sense of release that there’s a venue where people can talk about these things,” Ramchandran said. “We want this to inspire people to keep talking to each other. We want people to feel like a family, like a community, to feel less alone in their work.”
The current Schwartz Rounds are for Cancer Center physicians and other caregivers working with cancer patients, but other areas in the hospital are asking about more Schwartz Rounds, said Seshadri. “There’s no rule that you must only have one. We hope many other areas will adopt these rounds as well.”
About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. It is currently ranked No. 17 on the U.S. News & World Report’s "America's Best Hospitals" list and No. 1 in the San Jose Metropolitan area. Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. The Stanford University Medical Center is comprised of three world renowned institutions: Stanford Hospital & Clinics, the Stanford University School of Medicine, the oldest medical school in the Western United States, and Lucile Packard Children's Hospital, an adjacent pediatric and obstetric teaching hospital providing general acute and tertiary care. For more information, visit http://stanfordhospital.org/.