THE LAST WORD
Creating a Space Where Doctors Can Be Vulnerable
We shouldn't try to carry the stress of patient care alone.
Fam Pract Manag. 2017 Sep-Oct;24(5):40.
Author disclosure: no relevant financial affiliations disclosed.
Medical school and residency train us to be emotionally removed when treating our patients. The point is not to be cold or heartless, of course, but to be impartial and objective. In reality, however, we cannot separate ourselves from our emotions. Sooner or later, we have to deal with them.
Not long ago, my colleagues and I cared for a 32-year-old female with metastatic breast cancer to the brain and bones. She had a loving and supportive family, including a beautiful young daughter, and she was fighting to live. Her family knew that she was dying, yet no one uttered a word other than “full recovery” to keep her hope alive. Medically, we knew it was only a matter of weeks if not days. The emotional aspects of caring for this patient and her family affected everyone who took care of her, and her death resonated in our hospital.
To help physicians and staff cope with these types of situations and the social and emotional issues we face in patient care, our hospital adopted “Schwartz Rounds.”1 The key features of the program are interdisciplinary communication about specific cases and free and honest discussion about our vulnerabilities. It provides a forum for the entire staff – doctors, nurses, physician assistants, psychologists, allied health professionals, chaplains, etc. – to show support and have an open dialogue with each other. Whereas traditional medical/surgical rounds focus on the delivery of good medical care, Schwartz Rounds focus on the human and emotional dimension of medicine. They are held monthly or bimonthly, depending on the volume of cases or topics identified for discussion, typically last an hour, and are led by someone trained as a facilitator.
In our hospital, we have two leaders for Schwartz Rounds – a neuropsychologist and a palliative care physician. At each session, the neuropsychologist briefly reminds us why we are there and that this is a time for expressing any thoughts, feelings, or emotions. The palliative care physician
1. Schwartz Rounds are a program of the Schwartz Center for Compassionate Healthcare (http://www.theschwartzcenter.org), founded by Kenneth Schwartz, a health care attorney who died of cancer in 1995 at age 40.
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