From there, the group of more than 50 hospital clinicians embarks on a wide-ranging conversation. First, they discuss the challenges of treating a fellow clinician; the woman was a nurse. Then they talk about the stress involved when not everyone on the medical team agrees on the best course of treatment. They wonder if a patient might admit concerns to a social worker or a radiology technician - concerns that might never be voiced to a physician.

Dr. Fisch then asks if any clinician has encountered the opposite scenario: a patient refusing a clearly beneficial treatment. That's when Dr. Komanduri weighs in, speaking from the back of the room. He had developed a good rapport with the patient in question, which was in part what made the refusal so puzzling, he tells the group. And the man had a highly treatable form of cancer.

Dr. Komanduri pauses at times as he speaks. "Our relationship really had to evolve," he recalls, "from one where I felt like he was making the wrong decision to one where I had to live with the decision he had made without saying, 'I told you so.'?"

The man relapsed about two years later, and the Hodgkin's disease returned. He didn't survive. Did they ever, asks Dr. Fisch, discuss the radiation decision? "It was the elephant in the room," Dr. Komanduri answers. "I felt like any mention would have been devastating to him."

Plus, he points out, it will never be known if the radiation would have made a lifesaving difference.

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.