Bring Schwartz Rounds to Your Hospital ASAP

By  |  October 23, 2018 | 

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 bi-monthly sessions together. These compassionate care rounds are a national initiative to help foster empathy and compassion in the healthcare setting. We gather a panel of 2-3 people involved in our patient presentation who share the details, moving quickly through the clinical details and head on towards 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 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 in 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 looking up. 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 healthcare 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 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 thirty 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 healthcare team.

Every day in the hospital provides a new ethical dilemma, frustrating case, challenging patient. Fodder for rounds.

We’ve discussed cases across the spectrum. This year more than others, it hit home. A beloved nurse coded in the hospital. Passed out during her shift: cardiac arrest. Recently, close colleagues passed away. An entire family, including two of our own doctors, gone in an instant. A favorite nurse leader succumbed to cancer too soon. Schwartz Rounds tackled some of these stories. These scenarios are some of the hardest to handle. Yet, in discussing them together, we become closer and start to heal sooner.
My favorite aspect is the variety of disciplines that shows up at these conferences. Nursing generally outshines the other disciplines, but we have therapists, pharmacy, chaplains, techs, physicians, nurses, nurse managers, all together. Even though we are all walking the hallways together, there are few times where we hear each other – when we really listen.

Case in point: the code. A patient with lung cancer. Massive hemoptysis. We were talking discharge that morning. What did we miss? This afternoon, I was calling her family to let them know she was going home soon. Now, twenty people in the room in gowns, blood everywhere. It and it was over. There was a flash of silence, and I could sense everyone about to take off their gowns, move out of the room and on to the next patient. But thankfully, a hospital chaplain hovering outside the code called for a moment to stop. She thanked the staff, thinking of the patient and the family. Reminding us to stop, breathe, name the person who passed, pause and reflect. Moments like this are what make the difference.

We often hit the holidays with a chance to reflect on all the good things that happen in the hospital. These seem to also end in boxes of tissues being passed around. As John Stone wrote in his poem, “Gaudeumus Igitur,” “For there are all kinds of/all degrees of joy/For love is the highest joy/For which reason the best hospital is a house of joy/even with rooms of pain and loss/exits of misunderstanding.”

Schwartz Rounds are now in 600 sites around the world. This survey review in 2010, of 6 sites, concluded that these conferences add to improved communication, teamwork and provide support in the healthcare setting.

I recommend you order up some Schwartz Rounds at your hospital ASAP.

3 Comments

  1. Navneet Attri MD October 29, 2018 at 12:19 pm - Reply

    I understand these are multi disciplinary rounds. Does it need special training to get these started? Are there any links/ webinars that I can watch?

  2. Richard Pittman November 7, 2018 at 3:12 pm - Reply

    Jordan, as Usual this was a very thought-provoking piece. I especially resonated with the point about how little time our daily grinds afford for thinking about the more difficult things we encounter with our patients. It seems like we always have to “lock down our emotions”, gloss over the hard stuff and keep going. thanks for staying at these posts. I assume it is not easy.

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About the Author: Jordan Messler

Jordan Messler
Jordan is a hospitalist at Morton Plant Hospitalist group in Clearwater, Florida. He previously chaired SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, most recently with Project BOOST and Glycemic Control. He went to medical school at University of South Florida, in Tampa, and completed his residency at Emory University. He recognizes the challenges of working in a hospital that lines the intracostal waterways of a spring break mecca. Requests that if you want to be selected as a mentored site, you will have a similar location with palm trees and coastline nearby. He tries to find time to sit on the beach with his family to escape the hospital’s miasma. While there, he looks forward to reading about the history of hospitals/medicine, and how it relates to quality. But inevitably will have his daughter dumping sand on him, and then has to explain to his wife why their daughter is buried up to her neck.

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