“The trouble with not having a safe space within medicine is that for those outside of medicine, our stories are almost too much to bear.”
― Dr. Rana Awdish, In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope
As we adopt a “new normal” of living alongside the COVID-19 pandemic, many of us are attempting to recreate the way of life and sense of self we had pre-pandemic. However, no one is the same anymore. We have all fundamentally changed and been stretched by the collective trauma of the past few years. While this has offered fresh perspectives and a chance to reevaluate priorities, it has also left deep scars that have been left unattended as we push on with our work surviving on the fumes of exhaustion.
We each walk around feeling alone, as if no one else is bearing the weight of expectations, disappointments, and loss. We return to the same hospital, clinic or room which seems so unchanged because the walls cannot betray the grief that they have contained. We are surrounded by people, sounds and the cadence of movement but something remains out of sync. We are isolated among a sea of many.
Healthcare workers are in a critical moment of divergence- some are struggling with the decision to retire early, leave their jobs or the profession altogether. But imagine what could happen if we came together as a healthcare community in moments of pain, sadness, joy, happiness, and the other universe of feelings we experience on a daily basis. Imagine the connection, camaraderie, support, and relationships that could be created when we bear witness to our internal journeys and shared humanity. Imagine if burnout, compassion fatigue and moral distress weren’t individual matters but collective discussions of paramount existential significance.
In 1995, the Schwartz Center for Compassionate Healthcare (SCCH) was founded in honor of the compassionate care received by Kenneth Schwartz, a patient who was diagnosed with cancer and ultimately passed away in the prime of his life. A key feature of the SCCH is Schwartz rounds which is a grand rounds style interdisciplinary, interprofessional venue for deliberate, expertly facilitated panel conversations around “challenging emotional or psychosocial issues they face in caring for patients and families.1” Schwartz rounds require broad participation and attendance from all levels of staff and clinicians- housekeeping, security, nursing, food services, physicians, physical therapists, social workers, learners, technicians, lab sciences, etc. Schwartz rounds are egalitarian, brave, and vulnerable spaces without the usual hierarchy of medicine or the hospital where participants can share and tap into the similarities of their emotional experiences. They can offer perspective, support, and their own stories. This is not a space to problem solve but to take part in community building and meaning making.
Schwartz rounds start with a reminder of the purpose of the time together which serves as a punctuation mark from the rest of the day. Discussions can be centered on a topic or a case with a pre-selected panel of presenters. Sample topics might include: “it’s ok to cry,” “the patient I’ll never forget,” “my best day,” or “the power of apology.” Cases can include particular experiences with a family or patient that were emotionally troubling, joyous or even bittersweet. The panel of presenters is given time to present their stories which privileges the psychosocial and emotional components over the medical, scientific, or technical aspects of care. The facilitators mediate the interaction among all the participants, draw out similar emotions or stories and move the discussion to deeper levels of understanding, connection and meaning.
Schwartz rounds are not a one-and-done event. They are conducted on a regular basis throughout the year and contain a structure of an organizing committee and specific roles to ensure success. As the model has been adopted globally in over 450 healthcare organizations,1 multiple studies have shown benefits of Schwartz rounds in empathy, burnout, connection, reduced feelings of isolation, improving compassion and team building among multiple participant groups from medical students, nurses, staff, physicians, mental health workers and beyond.2-4
With the myriad of challenges facing current and future healthcare workers, Schwartz rounds can be a transformative tool for cultural change and connection. As Kenneth Schwartz once remarked of this healthcare team, “the smallest acts of kindness made the unbearable bearable.” Let’s ensure that we are caring for the carers so they can continue to find meaning and joy in their work and give every patient the compassion they deserve.
References:
- https://www.theschwartzcenter.org/media/2019/06/Building-Compassion-into-the-Bottom-Line.pdf
- Smith J, Stewart MG, Foggin E, Mathews S, Harris J, Thomas P, Cooney A, Stocker CJ. Assessing the benefits and usefulness of Schwartz Centre rounds in second-year medical students using clinical educator-facilitated group work session: not just “a facilitated moan”! BMC Med Educ. 2020 Aug 17;20(1):271. doi: 10.1186/s12909-020-02199-x. PMID: 32807145; PMCID: PMC7433116.
- Allen D, Spencer G, McEwan K, Catarino F, Evans R, Crooks S, Gilbert P. The Schwartz Centre Rounds: Supporting mental health workers with the emotional impact of their work. Int J Ment Health Nurs. 2020 Oct;29(5):942-952. doi: 10.1111/inm.12729. Epub 2020 May 15. PMID: 32413204.
- Maben J, Taylor C, Dawson J, Leamy M, McCarthy I, Reynolds E, Ross S, Shuldham C, Bennett L, Foot C. A realist informed mixed-methods evaluation of Schwartz Center Rounds®in England. Southampton (UK): NIHR Journals Library; 2018 Nov. PMID: 30431750.
-Premal Patel MD, MSc
Dr. Premal Patel is a board-certified Internal Medicine Physician and an Associate Professor in the Department of Medicine at the University of Texas Medical Branch (UTMB). She also serves as the Clinical Director and Practice Transformation Coach for UTMB’s AIDS Education Training Center and is Co-Director of the Mindfully Evolving Thriving & Advocating Course.
“The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of the University of Texas Medical Branch.”