SMALL ACTS
Kenneth Schwartz's lung cancer diagnosis was a shock; he was a nonsmoker. Once he became ill, he never returned to work at his high-powered law firm, focusing his energy­ on treatment and time with family and friends instead.

He easily connected with people - at least 1,000 attended his funeral - and his journey through the health-care system was no different, says his wife, Ellen Cohen. She recalls how her husband became acutely aware of the power of human interaction as he underwent tests and procedures. "He realized that someone looking at him wrong or taking time to pat his shoulder - those things meant a lot," she says. "They could make or break his day."

Schwartz's plans to create a center were unknown, even to his closest family, until he asked attorneys to gather in his hospital room. Despite having difficulty breathing, Schwartz made his vision clear, expressing his desire to launch an initiative focused on the patient-caregiver relationship, Cohen says.

For years, the rounds were largely a Northeast effort, piloted first in 1997 at Massachusetts General Hospital Cancer Center in Boston, where the Schwartz Center is still located. But the concept continues to gain traction. By this fall, 100 health-care facilities in 25 states were hosting the rounds, involving some 25,000 clinicians annually, nearly all of whom work in hospitals. M.D. Anderson, which joined in early 2005, was the first site west of the Mississippi, according to Schwartz Center officials.

Beyond employee assistance programs and conversations in the hallway, few outlets for reflection are available to most hospital clinicians, says Tom Lynch, MD, chief of oncology at Massachusetts General Hospital Cancer Center and a physician who treated Schwartz. In today's fast-paced environment, even pausing for lunch in the doctor's lounge is usually infeasible - if such a lounge exists at all, says Dr. Lynch, also vice chair of the Schwartz Center board. "We don't have a place to put the emotional and cultural and other nonclinical parts of our interactions with patients," he says.

Through the years, the Schwartz topics addressed behind closed doors have been as disparate as the hospitals involved. One session at Massachusetts General focused on the stresses that spouses and other family members face when hospital clinicians bring their jobs home with them. At the University of Rochester Medical Center, a patient with terminal cancer was asked to attend. "He talked about what it was like to know you are dying," says the New York facility's physician leader, Timothy Quill, MD. "Then he talked about what he was most hoping for and what he was most afraid of."

M.D. Anderson physicians say they wanted­ to assist their doctors-in-training (called fellows or residents) to better hone their communication skills. But experienced physicians quickly learned that they could benefit as well. "I think it has personally helped me to be more honest with myself about [the hard side of] what I do," says Michael Fisch, MD, an oncologist at the Houston cancer center and one of the physicians who help lead the rounds.