News Touchpoints Newsletter Press Releases Media Inquiries Press Kit In the News		In the News December 19 , 2005 Caring about compassion: Schwartz Center Rounds focus on the human side of healing From the Worcester Telegram & Gazette By Elizabeth Cooney TELEGRAM & GAZETTE STAFF ecooney@telegram.com Dr. Darshak M. Sanghavi, top, and colleagues work to bring "the human contact people want" to the hospital setting. (T&G Staff Photos/BETTY JENEWIN) The Schwartz Center Rounds panelists tackled the toughest case first. A chaplain, a doctor, two nurses and a social worker gathered at UMass Memorial Medical Center-Memorial Campus at noontime during a blizzard to weigh a question whose answer wasn't in the medical textbooks: How do you talk about miracles? And what if waiting for a miracle looks almost like torture for the patient? To protect patient and caregiver confidentiality, members of the hospital's Critical Care Unit team presented a composite of patient stories condensed into three cases. Strong words generated strong feelings as they drew a picture of an elderly patient in their care for six weeks before he died. Conflict within the family complicated his care. One relative insisted on aggressive measures while waiting for a "miracle" cure while others in the family recognized the severity of their loved one's overwhelming illnesses. Hope for a miracle won, becoming a refuge from reality in this scenario. In the second and third cases "miracle" had a different meaning for people diagnosed with late-stage cancer. One patient hoped for the miracle of strength to sustain him during treatment when nobody could say for sure how much it would help him. Another patient believed in the miracles she already had in the love of her husband and the lives of her two children. The language of miracles prompted discussion from the audience in an amphitheater at Memorial and via teleconference at the University Campus on the other side of Belmont Hill. What can caregivers do to learn what each person means by "miracle?" Was there a health-care proxy in place so the patient's wishes could be known and honored? How do different religions and cultures view miracles? "This gives us a forum to talk about aspects of patient care we don't get a chance to do in other rounds or in other forums," said Dr. Mary A. Valliere, chief of palliative medicine and the clinician leader of the monthly Schwartz Center Rounds at Memorial. The rounds take their name from The Kenneth B. Schwartz Center, a nonprofit organization named for a Boston health-care attorney who in the months before his death in 1995 from lung cancer wrote poignantly about the compassion and kindness his caregivers showed him. In his will he established a center to promote empathy and compassion in the healing process, qualities that for him "made the unbearable bearable." In 10 years the center has awarded 100 grants to other groups aligned with its mission. In 1998 it created Clinical Pastoral Education Fellowships to teach caregivers how to respond to the spiritual needs of patients. But its signature program to promote compassion has been the Schwartz Center Rounds, piloted in 1997 and expanded to 70 hospitals, five nursing homes, two community health centers and one out-patient clinic in 21 states. St. Vincent Hospital in Worcester and Heywood Hospital in Gardner are two other participants in Central Massachusetts, in addition to the two Worcester campuses of UMass Memorial. Topics vary from delivering bad news to dealing with unexpected loss to negotiating cancer treatment in young adults. "What we know from caregivers through the evaluations we hand out is that the rounds remind the caregivers of why they went into the profession," said Julie A. Rosen, executive director of the Schwartz Center, whose staff of five is based at Massachusetts General Hospital in Boston. "They make them feel that the work they do is validated and reminds them of the fact they are part of a team." Compassion can be all about making connections, certainly among caregivers but above all between caregivers and patients, said Dr. Darshak M. Sanghavi, an assistant professor in pediatric cardiology at University of Massachusetts Medical School. He wrote a white paper summarizing issues raised by the Schwartz Center Rounds called "Beyond the White Coat and the Johnny: What Makes for a Compassionate Patient-Caregiver Relationship?" "I feel like when you describe advances in medicine, you couldn't be prouder of where we are now than we ever have been in the past. Yet at the same time, people are more frustrated than ever with the type of care we give," he said. "There's a huge disconnect between the accomplishments of medicine and the human contact people want." Discussions of compassionate care often focus on the end of life. That's where the drama is, Dr. Sanghavi said. But other moments in health care matter too, he said. "It's hard to quantify the importance of a receptionist being nice to you or a physician sitting down with you for a few extra minutes to ease your mind or calling to check on you to see how you are doing," he said. "Instead we focus on benchmarks. 'Did you take your medicine? How many refills did you get?' We're creating an entire system to reinforce a particular quantitative set of outcomes which is not really what most people care about." Eric H. Schultz, president and chief executive officer of the Fallon Community Health Plan of Worcester, joined the Schwartz Center board of directors just under a year ago. He calls the group "a breath of fresh air" for its focus on the art of communication between a caregiver and patient, a quality he could always spot if not always define in his days as a physician group practice administrator. "We are all looking at how we can find creative ways to deal with the financial aspects of health care and health insurance," he said. "The Schwartz Center brings this all back to why we are doing it." In the first composite case, the man's caregivers ensured his comfort until the end. "Our job is to take care of the patient," one of his nurses said. "You do your best even though there are obstacles." Some might call that a miracle.

‘‘The secret of caring for the patient is in caring for the patient.’’ Francis Greenwood Peabody, 1847-1936