MEASURING RESULTS
The Schwartz Center Rounds, held monthly­ or every other month, are limited to an hour and are usually over a meal. Participants gather in an auditorium, a conference room, or another comfortable setting. Schwartz officials ask a physician at the hospital to spearhead the effort. The nonprofit center pays for the food and gives a small stipend to the facilitator leading the sessions. They also provide initial training and ongoing input.

They advise clinicians to avoid, at least at first, topics that are too controversial or too gut-wrenching, including very recent patient deaths.

It's better for participants to become comfortable with the emotional and open-ended nature of the discussions, says Marjorie Stanzler, director of programs for the Schwartz Center. "There isn't a way to fix these issues," she says. "There isn't any right or wrong."

This year, the center hired an outside firm to assess whether the rounds influence ­patient treatment. Initial results won't be available until 2007, but based on informal feedback, there are numerous benefits: Hospital staffers feel less isolated; they develop a new appreciation of the work done by colleagues - after all, the chief of surgery could be sitting next to a radiology technician; and they can walk away with fresh insights.

The rounds also strive to break from the traditional hierarchy of hospitals, with physicians in a dominant role. Sally Mack, a social worker and facilitator at Massachusetts General, says the hospital's clergy proved to be instrumental during one of her rounds, in which a doctor described a patient who believed that her survival rested entirely in God's hands. "And she wanted the doctor to pray with her," Mack says. "And that was so hard for him, because he doesn't pray. And he doesn't believe in God."

THE EMOTIONAL TIGHTROPE
Clinicians frequently say it's the patients whose lives mirror their own who often resonate the most. "What's hardest for me is when I have patients with young children," says Bob Wolff, MD, a specialist in pancreatic, colon, and other gastrointestinal malignancies and who initiated the rounds at M.D. Anderson with his colleague Dr. Fisch.

Given M.D. Anderson’s role as a referral center, with patients often traveling long distances, Dr. Wolff says that he doesn’t always have the luxury of sufficient time for mourning. “For every patient that you lose, there are two or three others who are saying, ‘You need to help me right now.’?”

Dr. Fisch, when asked to reflect on the influence of Schwartz, talks about the spiel he typically gives at cocktail parties about his medical work, much of which involves end-of-life conversations.

“I say, ‘It’s not as depressing as you think. We learn a lot. We are inspired by people’s courage.’ And that’s not false. But that’s not the whole story.

“There’s a lot of loss and grief that people experience, and I experience that with them. If you are not measuring the toxicity on yourself, how do you begin to manage it?”