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.

BEHIND CLOSED DOORS
During this particular M.D. Anderson round, the conversation begins, as all of the one-hour sessions do, with a brief recap of a patient case that has touched some chord or sparked a larger discussion within the hospital. Confidentiality is protected, as patient names are never used during rounds.

The doctor leading the session, James Cox, MD, chief of the radiation oncology division, describes the case of a 50-something woman who traveled from another state several years earlier to pursue aggressive treatment for lung cancer. But the combination of chemotherapy and radiation took a toll. Dr. Cox explains that, despite the woman's commitment to continuing treatment, some of the technicians involved worried that her body badly needed a break.