Schwartz Rounds Topics & Cases

Whether you are looking for inspiration or for topics that have been successful at other member organizations, here is a searchable list to get you started:

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Abuse (7)
Caregiver as patient (5)
Caregiver roles (2)
Caregiver: self-care (35)
Challenging Patients (16)
Communicating with colleagues (5)
Communicating with Patients (32)
Compassionate Care (57)
Cultural (23)
Disaster specific (4)
Disease specific (44)
DNR (8)
Elders (6)
End of life (49)
Errors (10)
Ethics (36)
Family (25)
Organ donations (4)
Pain (7)
Patient Narratives (10)
Patient-caregiver relationship (6)
Pediatrics (13)
Rehab (3)
Sexuality (2)
Spirituality (14)
Substance abuse (2)
Suicide/self-harm (4)
Technology (5)
Time management (7)

Abuse(7)

  • Treating a young verbally abusive patient
  • I think this family is harming my patient
  • The emotional cost of domestic violence
  • Maintaining compassionate care in the face of abuse
  • Discharge to an unsafe environment
  • Impact and consequence of reporting child abuse
  • Child abuse

Caregiver as patient(5)

  • When the patient is a colleague
  • When the doctor has cancer
  • The view from the other side of the bed
  • The unexpected death of a caregiver
  • Compassionate care for colleagues in trouble

Caregiver roles(2)

  • Whose patient is it anyway?
  • What brings us to work everyday?

Caregiver: self-care(35)

  • Why caregivers don’t cry
  • What to say to patients when you don’t know what to say
  • The impaired professional
  • The cumulative effect of multiple deaths
  • Rejection
  • Personal reaction to professional care
  • Missing the chance to say goodbye
  • Losing a colleague, losing a spouse (physician couples and cancer)
  • Keeping our promises to patients
  • How do you feel when patients transfer their care
  • Focus in the midst of chaos
  • Feelings of helplessness as caregivers
  • Feelings of futility
  • Encountering patient care situations that mirror our own illness or grief
  • Dealing with self doubt
  • Dealing with a difficult discharge
  • Counter transference
  • Coping with seemingly “no win” situations
  • Coping with anger in our patients and ourselves
  • Coming back to work after losing a loved one
  • Caregiver reaction to the patient who has given up
  • When an intern’s patient dies
  • Maintaining hope
  • Accepting we can not fix it
  • Dealing with the unexpected diagnosis and death
  • Feelings of failure when things don’t work
  • Dealing with the unexpected
  • When a patient exhausts you and all you have to offer
  • How to keep stress from damaging/dismantling yourself?
  • Emotional and physical vulnerability in caregivers on the frontline
  • Compassion fatigue/burnout
  • Caregiver attitudes toward the frequently hospitalized patient
  • Care giving at work – Care giving at home – the juggling act
  • Adapting to aging throughout one’s career
  • What to do when you don’t want to go in the room

Challenging Patients(16)

  • Who knows best? Self-directed care
  • Patients with resources in the community who refuse to use them
  • When the patient is his own worst enemy
  • When patients won’t choose
  • When patient choices don’t make sense
  • The interminable patient
  • The erosion of empathy in the care of a demanding patient
  • Patients who don’t want to leave
  • Managing uncooperative/potentially dangerous patients
  • Limit setting and time management with needy patients
  • Frustration of patient non-compliance
  • Turning the other cheek: Compassionate care in the face of anger
  • Coordinating complex care for the non-compliant patient
  • Biting, swearing, screaming, and hitting
  • A difficult prenatal patient
  • A difficult patient — journey to acceptance

Communicating with colleagues(5)

  • The impact of teamwork on the patient experience from our next generation of caregivers
  • Friction at the interface of physician, nurse, and administrator
  • Experienced versus novice medical professionals – differing care approaches
  • Conflicts between members of the health care community
  • Communication breakdowns between staff and residents

Communicating with Patients(32)

  • When communication isn’t optimal
  • When the patient doesn’t want to know the diagnosis but wants the treatment
  • Establishing trust in patients new to the hospital
  • Delivering sensitive information
  • Working with competent patients who feel loss of control
  • When the trust fades – what to do?
  • Unusual patient requests
  • Treatment decisions – caught in the middle
  • The struggles of healing the psyche and body
  • Separating the diamond from the rough
  • Responding to patient complaints
  • Manipulative patients
  • It’s not about the left breast, it’s about the person too
  • I’ve got good news and you don’t want to know
  • I know something you don’t know
  • Fighting battles, winning wars…do military metaphors help patients cope?
  • Delivering bad news
  • Dealing with scary/threatening patients
  • Dealing with diagnosis denial
  • Coping with a chronically lonely patient
  • Choices no patient should have to make
  • Challenges of caring for the incarcerated patient
  • Are we connecting with our patients?
  • A long fight vs. an irreversible illness
  • How patients are heard – nurse vs. physician perspectives
  • Encouraging patient autonomy
  • A student’s perspective – from the ivory tower to the street
  • Self disclosure – to reveal or not to reveal
  • Self choice vs. conservatorship
  • Ch-Ch-Ch-Changes: patients and doctors saying goodbye
  • Private matter…public debate
  • How to care for the patient who cannot respond verbally

Compassionate Care(57)

  • My first code
  • What patient was your best teacher?
  • When you aren’t what your patient wants
  • When patients leave AMA
  • Who’s in charge?
  • When the patient is not what you’ve been told
  • When healthcare providers lose their jobs
  • Trainees on the care team and patients’ fear
  • Time critical resource allocation
  • The challenges of being an award winning hospital
  • The burden of rules and regulations
  • Surviving the learning curve
  • Respect and professionalism within care teams
  • Rallying together in spite of tragedy
  • Feeling powerless – providing futile care
  • Peer support team: supporting our patient
  • Intimidation in the workplace
  • Humor and healing
  • How caregivers react when the direction of care suddenly changes
  • Hospitalist…effect on compassionate care
  • External influences on patient care
  • Dilemmas at the interface of patient care and clinical research
  • Dealing with changes in the patient population
  • Creating an optimal patient experience
  • Confidentiality
  • Code Blue – effect on neighboring patient
  • Challenges of transition
  • Caregiving during times of institutional change and international conflict
  • Breaking down professional stereotypes
  • 4 c’s of care coordination – collaborator, communicator, coordinator, caregiver
  • When care clicks
  • The unforgettable patient
  • The impact of treatment complications
  • How does the length of stay affect patient/caregiver relationship?
  • From MASH to SCRUBS – how TV medicine affects patient expectations
  • Exploring patient histories
  • Close calls – when seconds count
  • The legendary patient: how memorable patients leave a legacy for caregivers?
  • Catastrophic illness in the young and healthy
  • Treating patients “who are not in the book”
  • Surreptitious drug ingestion
  • Integrative therapies
  • Would I want to be a patient in my own hospital?
  • When new life and the threat of death are intertwined
  • Hope and miracles
  • Bending Over Backwards. Am I flexible enough in rigid situations?
  • What happens when your partner leaves you when you have cancer
  • When psychosocial issues interfere with optimal health care
  • Season of hope
  • Homeless for the holidays
  • Happiness and sadness over the holidays
  • What makes for a compassionate patient-caregiver relationship?
  • The power of small gestures
  • Recovering compassion
  • Bringing compassion to the table in the OR
  • Putting compassion to the test: What to do when you don’t want to walk into the room
  • A portrait of addiction; the human side of it

Cultural(23)

  • International perspectives in teamwork, communication, and decision-making
  • When culture, language, and family frustrate decisionmaking
  • When blood products are not an option
  • Valuing diversity: challenges in maternal child care
  • The impact of differing belief systems
  • Racial and family conflict at the end of life
  • Race, gender, and the caregiver/patient relationship
  • Race and resident relationships
  • Race and ethnicity in health care practice
  • Patient beliefs you wouldn’t believe
  • Multicultural issues for foreign medical graduates
  • Lost in translation
  • Language in caregiver/patient communication
  • Is culturally competent care possible when communication is a problem?
  • Idiom or idiot – when you and a patient don’t speak the same language
  • Ethnicity and grieving
  • Customs, beliefs, and behaviors that complicate care
  • Cultural stories from caregivers
  • Cultural and religious differences in end of life care
  • Control of care by family caregivers in a non-English speaking patient
  • A deaf Jehovah’s witness refuses treatment
  • Brain death and culture
  • Challenges and rewards of caring for a culturally diverse elder

Disaster specific(4)

  • What happens when Johnny comes marching home and Johnny isn’t Johnny anymore?
  • Responding to the crisis of 9/11
  • Lessons from Katrina
  • Caring for the Vietnam vet

Disease specific(44)

  • Patients with dual diagnoses
  • Multidisciplinary teaming in a chronically ill dialysis patient
  • Dealing with patients whose medical conditions compromise independent living
  • The fearsome frontal lobe
  • Stroke – a new normal
  • Treating patients with somatic disorder
  • Caring for sickle cell patients
  • A perinatal saga
  • Caring for the obese
  • Care for the bariatric patient
  • When Munchausen’s Syndrome is raised
  • Special needs patients
  • Multidisciplinary care for a mentally ill burn patient
  • Managing both medical and mental health issues
  • Emotional challenges of caring for the obese patient
  • Eating disorders
  • Complex personality disorders
  • Compassionate care for the emotionally challenged patient
  • The journey of caring for a young man with AIDS
  • Challenges in contemporary HIV care
  • Active substance abuse and HIV in a seriously ill patient refusing treatment
  • Heart failure dilemmas
  • Clinician’s role in multi-generational amphetamine use
  • Capacity issues and struggles of a diabetic on dialysis
  • Caring for the patient with dementia
  • Treating a patient with breast cancer and depression
  • Caring for a patient with advanced ovarian cancer and mental illness
  • When mom has breast cancer
  • Difficult conversations: When a young mother is diagnosed with terminal cancer
  • When breast cancer strikes a man
  • Humor and boundaries – when can we laugh at cancer
  • Facing down the fear – prophylactic mastectomy
  • Communicating options in prostate cancer
  • Bank my eggs – treat my cancer
  • A physician’s life with lung cancer
  • A mother faces pregnancy with acute leukemia
  • A cancer patient’s view
  • End stage pancreatic cancer – Can miracles happen?
  • Caring for the seriously ill young cancer patient
  • The full angel: my year in cancerland
  • Difficult patient with chronic arthritis and the threat to sue
  • Do you understand me? The Alzheimer patient’s primary caregiver
  • ALS and sedation for the imminently dying
  • Caregiver attitudes and biases in caring for alcoholics

DNR(8)

  • When advance directives fail
  • Revoking DNR – Conflicts with family, patient, and caregiver
  • Putting advanced directives into action in Surgical ICU
  • Emotional impact of unsuccessful resuscitation
  • DNR and comfort care in the rehabilitation setting
  • Discussing DNR options with patients
  • CPR or DNR
  • Are we morally and legally bound by a patient’s advanced directive?

Elders(6)

  • What is elder abuse?
  • Sexuality in the elderly
  • Dilemmas in managing geriatric cancer patients
  • Coping with elders at risk
  • Compassionate care for the elderly alcoholic
  • 3 Ds affecting the elderly: delirium, dementia, and depression

End of life(49)

  • When the patient’s last wish cannot be honored
  • Futile or heroic treatment – diverse perspectives
  • When provider and patient values conflict: comfort care/ death with dignity vs. fighting to the end
  • When is it time to stop?
  • When does the mourning begin?
  • When death is not the end
  • Tube feedings – end-of-life care
  • Timely hospice referrals
  • Thoughts about our roles as caregivers for dying patients
  • There is no place like home – or is there?
  • The role of a palliative care team
  • The patient who is determined to die
  • Terminal sedation – who directs?
  • Responding to a catastrophically ill patient
  • Removal of food
  • Nutritional support at end of life
  • Managing intractable symptoms in the end of life
  • Is there such a thing as a good death?
  • Initiating life support
  • I’m scared of dying – being vs. doing for the patient
  • Helping a patient and family transition from aggressive to comfort care
  • Does age affect end of life discussions?
  • Death during the holidays
  • Creative and compassionate conversations at death
  • Conflict of interest and secondary gain in end of life decisions
  • The great debate – physician assisted suicide
  • Communication challenges dealing with terminal illness
  • Caregivers’ role in death with dignity
  • An undocumented immigrant with end stage renal disease
  • Am I wrong to keep her at home?
  • A conversation with a family facing end of life issues
  • Listening not hearing – end of life
  • When the dying patient is your parent
  • Is the patient terminal?
  • End-of-life decisions and the ER
  • What makes discussing hospice, palliative care and end of life so difficult?
  • Too young to die
  • Preparing for the end of a patient’s life
  • Stopping a ventricular assist device – who decides?
  • Facing the death of a child
  • Caring for a young terminally ill patient
  • Infant death — its impact on patients
  • The unexpected loss of a child
  • Good deaths for children
  • High cost care at the end of life
  • A patient with liver failure – hospice/transplant issues
  • Managing a terminally ill patient with 3 children
  • Life and death issues with pregnant patients
  • When a parent of a young child is dying

Errors(10)

  • When a patient comes to you misdiagnosed
  • Respecting patient wishes and reporting error in the ER
  • Power of apology
  • Managing disclosure of an adverse medical event
  • A patient’s family describes their experience with a medical error
  • Medically induced trauma
  • When an error occurs despite our best efforts
  • Apologizing to patients
  • When the system fails the patient
  • Surviving medical trauma

Ethics(36)

  • When you do things you think are wrong
  • When technology touches ethical issues
  • What does the patient have the right to know?
  • Values conflict: a student’s perspective
  • The etiquette of giving and receiving gifts
  • Telling the truth – keeping up hope
  • Stretching the rules – is it worth it?
  • Physician-assisted suicide
  • Patients’ right to self determination
  • Moral and ethical decisions facing the pharmacy
  • Little white lies
  • Issues of counseling and ethics in a noncommunicative, illiterate patient
  • Is anything “ever just a placebo?”
  • Is a second opinion always warranted?
  • Holding peers accountable
  • Genetic testing – to test or not to test
  • Genetic screening for those with cancer susceptibility
  • Gambling on intensive care autonomy vs. professional obligation to do no harm
  • Fearless patient advocacy in the face of legal challenges
  • Ethical issues when discharging uninsured, indigent, and medically complex patients
  • Ethical issues concerning transplantation
  • Ethical dilemmas – when family members are caregivers
  • Ethical and emotional issues in hereditary cancer counseling
  • Dilemmas of disclosure of personal information
  • Decision making in patients requiring alternative feeding measures
  • Curtains have ears: privacy issues
  • Consent for clinical trials – are patients truly informed?
  • Compassionate care versus euthanasia
  • Clinical trials – are patients’ expectations realistic?
  • Case studies – physician dilemmas
  • Caring for the patient with legal/ criminal issues
  • Care of the VIP
  • Are there rules to determine who gets treated and who doesn’t?
  • Blurred boundaries
  • Patients who smoke – what’s the right response?
  • Charity care – What happens when the resources dry up?

Family(25)

  • Working with separated parents
  • When patients and family request non-beneficial care
  • When parents need as much or more
  • When parental rights conflict with responsible health care
  • When illness strikes your family
  • When family caregivers disagree
  • When families try to fix the diagnosis with food
  • When caregivers and families disagree
  • When cancer strikes two members of the same family
  • The family project: Family-staff relationships in the nursing home
  • The divided family
  • Responding to families in crisis
  • How can we change our father’s mind
  • Family centered care versus interference
  • Family centered care in child abuse
  • Families micro-managing medical care
  • Families in crisis – communicating understanding
  • Families dealing with trauma – establishing boundaries
  • Easing the burden of family decision making
  • Dealing with angry families
  • Caregiver response to the ill-prepared patient/family
  • I won’t let daddy die
  • Family refuses treatment when you believe patient can recover
  • Family presence during a code
  • The hyper vigilant family

Organ donations(4)

  • When your patient is an organ donor
  • The lost transplant
  • Organ procurement – ethical dilemmas
  • Mismatched donor transplants

Pain(7)

  • Whose pain is it anyway? Caregiver, patient, family interpretation
  • Unrelieved suffering
  • The chronic pain patient – caring in the face of skepticism
  • I can’t feel your pain
  • Chronic management of the patient with non-malignant disability pain
  • A patient’s request for controlled substances
  • The person behind the pain – a patient’s perspective

Patient Narratives(10)

  • Coping with a lifetime of disease – a young adult’s perspective
  • A young woman’s journey from childhood to adulthood
  • I shouldn’t have had to beg for a prognosis
  • Nursing stories
  • In their own words – patient commentary on what we do right and wrong
  • Dealing with uncertainty: a patient’s perspective
  • Clinical narratives
  • “Wit” offers wisdom and lessons for caregiving
  • BOATING (hospice patient play w/music)
  • Positive for BRCA2 – A patient’s story

Patient-caregiver relationship(6)

  • The “24/7” caregiver – caring for patients and your own loved ones
  • When the patient reminds you of yourself/own family “the patient could be me”
  • When doctor-patient relationships become personal
  • Straining the caregiver/patient relationship
  • Maintaining professionalism
  • Provider-patient relationships (can we be friends?)

Pediatrics(13)

  • Working through multiple psycho/social factors in treating a child psychiatric inpatient
  • Who is responsible for this child – filing a 51A
  • When parents must deal with birth and death of a newborn
  • Transition from pediatric to adult care
  • The challenge of working with a younger patient in a nursing home setting
  • Supporting a patient during intensive care in the ICU
  • Pediatrics: health care as a parent, patient, or child – dilemmas
  • Complex child – simple parents
  • Children’s behavioral health – when the team meets the system
  • Challenges to compassionate care in the neonatal ICU
  • Caring for a young person in a coma
  • Adolescent health: when law conflicts with good judgment
  • A child with irreversible brain damage – decision making, legal, ethical, family and other

Rehab(3)

  • Transferring the cancer patient to rehab
  • Rehab and psychiatric issues: Can we successfully treat both
  • Coping with feelings that arise when rehab goals are unclear and comfort is difficult to achieve

Sexuality(2)

  • Sexuality and medical illness
  • Sexual boundaries in the patient provider relationship

Spirituality(14)

  • The relevance of rituals
  • The essence of spiritual care – a nurse’s perspective
  • Spirituality/faith and patient care
  • Spirituality as a resource
  • Patients who choose to forego medical therapy and choose spiritual/natural healing
  • Losing faith in God
  • Life support as a test of faith
  • I’ve lost God – dealing with spiritual crises in cancer patients
  • Faith and medicine
  • Can medicine override religious beliefs?
  • The centrality of religion and spirituality in cultural competence/sensitivity for medical professionals
  • Religion and autonomy
  • When medical advice and religious conviction conflict
  • How we respond to our patients’ request to pray?

Substance abuse(2)

  • Treating pain in patients with substance abuse problems
  • A patient with depression, drug abuse, and feeding tube

Suicide/self-harm(4)

  • The chronically suicidal patient
  • Suicide of a patient under our care
  • Caring for the patient who practices self harm
  • Adolescent overdose – I really didn’t mean it

Technology(5)

  • Technologists – caught in the middle
  • Providing high cost, cutting edge, non-reimbursable care
  • New technology and difficult decision making
  • Does the internet help or hinder patient care
  • The potential perils of social media in healthcare

Time management(7)

  • I’m late I’m late for a very important date
  • How responding to economic pressure compromises treatment and caregiver morale
  • Balancing expediency and sensitivity in patient care
  • Are we too busy?
  • Advocating for the patient in a fast paced environment
  • 210 calls in 60 hrs
  • When we just can’t stand by