A Good Case for the
Schwartz Center Rounds®

After one year of implementing the Rounds, Maimonides Medical Center has the following observations on what makes “a good case.”

• The case gets others to talk about their own experience.
  The purpose of the Rounds is not to stay on the ins and outs of the presented case, but to discuss the audience’s experience with the overarching theme. A good case gets the audience to see the panelists’ point of view and empathize with how it was for the caregivers. The participants then feel prompted to share what they felt or did in similar situations.
  
• The case involves interdisciplinary conflict and cooperation.
  When the case focuses mostly on physicians, for instance, the rest of the staff is less engaged and may feel excluded. The actual care of patients is a complex, multifaceted, and unscripted scenario that has many challenges, choice points, and possible outcomes. A good case builds a dramatic arc that holds the large group’s attention and draws in diverse opinions and enthusiastic responses.
  
• The case raises issues that usually are not discussed but would be helpful to hear about others’ perspectives and practices.
  What are the taboos that occur in your practice, the sticky issues that are judgment calls? What are the situations that people can take issue with and might handle quite differently? A good case does not duplicate a root cause analysis, Grand Rounds, or treatment planning meeting. Instead, it gets to what is going on in the caregivers’ minds and hearts that impacts how decisions are made and results achieved. There is no need to agree or reach consensus, a stimulating discussion is preferred, with the flow depending on the topic.
  
• The case draws on our humanity and compassion as providers.
  Maybe we made a human error, but we still feel guilty and it’s hard to forgive ourselves. Or no mistake was made but the patient course is untoward and we feel remorse and loss. Or the patient’s diagnosis or personality or cultural bias makes it challenging for us to be professional; they just get under our skin. Or we are unprepared for the way in which administration, the community, or our colleagues in a different profession respond to our approach. The good case has a theme that is easy to generalize from and relate to. It isn’t a problem to solve or a policy issue, nor should it be too politically sensitive, complicated, or criminal. Instead, it’s an unfinished lesson on a past event that has the potential for enduring value for learning.