Schwartz Rounds

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‘Compassionate Care’ In U.K. After Deplorable Care, Alzheimer’s Drowning

Sometimes it takes a disaster to make things better.

For Ken Schwartz, it was a diagnosis of late-stage lung cancer at age 40 that prompted this realization: at the core of first-class health care is the compassionate, human bond between patient and provider.

Schwartz’ terrible medical ordeal — he died in 1995, ten months after his diagnosis — gave rise to the Schwartz Center for Compassionate Healthcare, and the nonprofit’s signature program, the “Schwartz Center Rounds,” which helps medical professionals better manage the tough social and emotional issues they face as caregivers. (We wrote about one particularly fraught case involving a speedy organ donation here.)

These days, Schwartz Rounds are held in about 300 hospitals and health care institutions in the U.S. and there’s currently a waiting list of sites hoping to launch the program.

Now, in Britain, the National Health Service is adopting Schwartz Rounds in dozens, and eventually hundreds, of hospitals. Why? According to a news release from the Schwartz Center, U.K. Health Minister Dr. Dan Poulter says the program is criticallly needed: “Shocking failures of care [in our National Health Service] demonstrate the need for more compassionate care right across hospitals and care homes. Schwartz Center Rounds have been shown to help hospital and care staff support each other and learn about how to deal better with tough situations, and spend more time focused on caring for patients in a compassionate way.”

According to media reports, a number of horrific health-related disasters occurred at NHS hospitals over the last couple of years. One particularly alarming case involved the drowning of an Alzheimer’s patient who was supposed to be closely monitored by care providers. Continue reading

‘Schwartz’ Becomes A Verb, Meaning To Care With Compassion

Kenneth B. Schwartz

The Boston-based Schwartz Center for Compassionate Healthcare earns well-deserved praise today on nytimes.com from Dr. Pauline Chen, who writes here:

That professional isolation — and the moral distress that goes with it — has contributed to alarming levels of professional burnout. But one organization has been working to change that by quietly focusing where others have not: on supporting caregivers in their everyday clinical work.

Inspired by the experiences of Kenneth B. Schwartz, a Boston health care lawyer who died of cancer in 1995 at the age of 40, the Schwartz Center for Compassionate Healthcare has for the last 15 years run a program known simply as Schwartz Rounds. Held on a monthly or bimonthly basis in hospitals, nursing homes, community health centers and academic medical centers across the country, these rounds, or meetings, are an opportunity for clinicians to discuss emotionally challenging cases or issues in their work.

The story goes on to describe the benefits of such sessions, from re-energized medical staffs to improved communication. We’ve written about the Schwartz Center’s work before, including Rachel’s recent post about the “compassion gap” in medicine and this video of Massachusetts first lady Diane Patricks discussion of her depression. Here’s my favorite part of today’s story:

The change even trickles down to the language of the workplace. “At some centers, ‘Schwartz’ has become a verb,” said Julie Rosen, executive director of the Schwartz Center. “To ‘de-Schwartz’ means to lose one’s compassion, and to ‘Schwartz it’ means to add conviction and compassion to a job.”

Readers, have you ever participated in a Schwartz Round? How did it affect you?

The Emotional Toll Of A Race-Against-Time Organ Donation

All the doctors agreed. There was no question that the patient, a 54-year-old man, was going to die.

He’d suffered a stroke as a result of cardiac arrest. His brain injury was irreversible. His heart rate was dropping — fast. His family had been told there was no hope. Still, for a mix of complex reasons — denial, grief, overwhelming love, miscommunication — his daughters couldn’t fathom why their father was being rushed from the intensive care unit, where earlier, the family had hoped doctors could rescusitate him, to the operating room, where a team of transplant surgeons waited to remove his kidneys and pancreas before the organs ceased to be viable for donation.

A sense of urgency was in the air, according to nurses who were there, and though by all medical measures the patient had no chance of recovering, his dying, erratic heartbeat still registered on the cardiac monitor as he was whisked toward the operating table where his organs would be harvested.

“The daughters kept saying,’This is so wrong, this is so wrong,'” said nurse Jo Fontaine, a case manager who was there.

When The Heart Stops

We hear most often about organ donation after brain death, when neural activity stops. But there is another form of donation: after cardiac death, when donation occurs after circulatory and respiratory functions cease. As demand for organ transplants has increased, donation after cardiac death has been rising rapidly, now comprising about 35% of donations in New England and 11% nationally. The trend has helped increase organ supply — but brings with it different types of challenges.

At Norwood Hospital, where the 54-year-old man died in September, organ donation after cardiac death was something new for the staff. None of the ICU team had ever experienced this type of race-against-time donation. The entire episode was so fraught that several of the doctors and nurses involved in the case agreed to come together on a recent Monday afternoon and discuss their intense emotions.

“I wasn’t ready,” said Oscar Le, a critical care doctor who was involved in the case. “The healing process that we usually go through when a patient dies, we couldn’t go through it in this case. We had five minutes. When you go home, you go home feeling a little empty.”

Dr. Le said that this patient and his family “did not have the kind of death” any of us hope for.

More Compassionate Care

Dr. Le’s comments before a crowd of about 50 doctors, nurses and other hospital staff were part of a professional venting session known as “The Schwartz Center Rounds.” Continue reading