I joined about 2000 others at the annual Kenneth Schwartz Center for Compassionate HealthCare dinner last night. Kenneth Schwartz was a health care lawyer who died at age 40 of lung cancer in 1995. He was a tireless advocate for compassionate care – and worried openly that efforts to lower health care costs would interfere with how much time physicians got to spend with their patients. He published a seminal article, “A Patient’s Story” in the Boston Globe. Creation of the Schwartz Center is one of his legacies.
The Schwartz Center helps hospitals and other care organizations establish Schwartz Rounds to discuss cases where there was opportunity for a higher level of compassion – much as traditional “morbidity and mortality” rounds allow clinicians to reflect on how care could have been improved. Schwartz rounds are now held in 375 hospitals in the US and 120 in the United Kingdom. The cases discussed usually represent missed opportunities. Compassionate care isn’t important only for the dying – one of the physicians at my table talked about a Schwartz Rounds topic of children who are hospitalized during the holidays
The annual dinner is an opportunity for storytelling – narrative helps really. The dinner featured a middle school lacrosse player diagnosed with glioblastoma. She was supported by her friends, her family, and a nurse who has since bonded with the family. Medical care couldn’t save her life, but what she wanted from what was left of her life was to remain a full member of her middle school community. She achieved that.
Atul Gawande talked about the importance of asking patients what they really want. He told the heartbreaking story of a dying woman whose only wish was that she could bring her grandchild to Disney World. Unfortunately her caregivers asked this question when her disease had progressed too far. A few months earlier she could have had her wish. She died in the hospital two days later. Here’s a link to the Frontline film based on Atul’s book, Being Mortal.
The Schwartz Center honors one compassionate caregiver each year – and this year is the first that the Center sought nominations from across the country. The award was given to a pediatrician who runs the palliative program at the University of Mississippi. He told of an infant who died of meningitis – and how he felt impotent as a physician, but the family was grateful for his empathic tears. He also reported that when he attended a child’s funeral, the funeral director told him that he was the first physician he had ever seen at the graveside.
I’m pretty sure compassionate care means we’ll spend less in the medical system – less on futile interventions, and less on care people really don’t want. There is good evidence that improved communication lowers the risk of malpractice action. Giving providers “room” to be compassionate, especially enough time, can be a challenge as we try to constrain health care cost increases – but we must not inhibit clinicians from displaying their natural empathy.
Compassionate care is what all of us want – whether we are close to death, or even when we feel that our mortality is far away. The Schwartz Center rounds have helped increase compassionate care given by thousands of providers, and the awards have helped shine the light on providers who serve as a model to us all.
Addendum The NPR Hidden Brain podcast has a 20 minute segment on compassion from late October that’s worth a listen. Turns out that being compassionate isn’t just good for the beneficiaries of compassion -- it actually leads to increased happiness for the person showing compassion. A virtuous cycle indeed.
The managing health care cost number will return with the next post.
