Where doctors come to heal themselves

The significance of the Kleenex boxes placed on every tabletop isn’t apparent at first. But 15 minutes into this lunchtime gathering of doctors, nurses and a host of other health care workers, the reason becomes clear. This is where the people who practice medicine come to heal themselves.

These candid and often emotionally stirring meetings are called Schwartz Center Rounds. They take place every other month at Providence Portland and Providence St. Vincent medical centers, filling the room to capacity.

Unlike medical grand rounds, which share clinical information, Schwartz Center Rounds are designed to share feelings: the pain of having to watch a patient suffer; the stress of caring for someone who refuses to follow his treatment plan; and sometimes the grief of losing a patient who captured the caregiver’s heart.

“We tend to internalize how we are personally affected by a patient’s story,” says oncologist Rachel Sanborn, M.D. “Whether the interactions are good or bad, we are taught to keep that to ourselves. The sessions help validate that our emotional response is OK. We can be affected, and we can do it in a way that’s healthy.”

Each session focuses on a patient case presented by a guest panel and moderated by a clinical social worker. The topics cross subjects and disciplines, allowing caregivers to see the people they work with in a different light, and often to gain wisdom from them.

For Anna Vogel, RN, a nurse from Providence Portland Medical Center, that wisdom came during a discussion about the distress of seeing a patient appear to give up hope.

“A physician said, ‘I don’t think our patients give up hope. They just change what they hope for,’” Vogel recalls. “That helped me understand that how I think something should go is not always what the patient thinks.”

Schwartz Center Rounds were introduced in late 2011 as part of Providence Cancer Center’s involvement with the National Cancer Institute Community Cancer Centers Program. While the topics change, one cardinal rule remains: What is said in the room stays in the room.

The reasons for such strict confidentiality are obvious. Peer support works best when participants can share their thoughts unguarded. This is doubly true in medicine, where patient privacy and professional restraint carry extra emphasis. (The panelists are careful never to reveal a patient’s identity.)

“We have a certain sorrow we carry around”
The concept of these “provider support groups” comes from The Schwartz Center for Compassionate Healthcare in Boston, whose mission is to strengthen the relationships between caregivers and patients. The center is named after its founder, a health care lawyer diagnosed with advanced lung cancer at age 40.

Throughout his treatment, Ken Schwartz discovered that the most powerful healing came from simple moments of tenderness from a caregiver. In an essay he wrote before his death in 1995, Schwartz described how a nurse he barely knew came to his bed on the morning of his surgery. She held his hand, and with moist eyes, wished him luck.

“The small gesture was powerful,” he wrote. “My apprehension gave way to a much-needed moment of calm.”

Schwartz Center Rounds have since been adopted by more than 285 hospitals and other health care institutions around the country. A 2010 study found that caregivers who participated in the program developed a greater empathy for their colleagues and their patients, felt a greater sense of teamwork, and experienced less job stress.  The discussions also have led to the adoption of patient-centered policies and practices at many participating sites.

“What’s probably surprised me the most is how much emotion is tied up in our work,” says pulmonologist James Patterson, M.D., the physician lead for Schwartz Center Rounds. “We have a certain sorrow that we carry around. One thing that comes out of these discussions is an affirmation that we’re all doing our best.”

Schwartz Center Rounds are open only to hospital staff and physicians. To learn more, call Roxanne Payne, NFP, 503-215-6737, at Providence Portland or Collette Sajko, RN, 503-216-2009, at Providence St. Vincent.