At that point, Ramchandran says, “Our nurse does an assessment of the patient and family and then recommends the additional services that will be most helpful. We then close the loop by talking with the clinician about the assessment and which referrals were placed.”

The leaders of the 26 services come together for PathWell conferences, meetings similar to tumor boards where patients and their care are discussed. The focus of the conference, Ramchandran explains, “is primarily on the psychosocial health and management of the patient, not the management of the patient’s disease.” As a side benefit, the conferences provide an opportunity for different services to learn from one another. For example, Ramchandran mentions a case where one service might be struggling with managing a patient’s pain in part because of co-existing cognitive changes. With PathWell it is simple to ask someone from neuropsychology to conduct an evaluation to figure out what resources the patient needs, which can make the treatment of the pain more feasible.

It is not unusual to learn that such words came from a physician whose expertise is in oncology and whose interest within that specialty is palliative care. What is unusual — and really fortunate — is how Kavitha Ramchandran, MD, clinical assistant professor of oncology, has sought to improve the patient experience both institutionally and globally.

PathWell Serves Stanford Patients

Ramchandran and her team at Stanford developed PathWell. It is an access hub in the center of 26 spokes, each spoke representing a separate service available to improve all aspects of the health of cancer patients and their families. Many of the spokes are not new; some have been around for many years. Examples of these spokes include the adolescent and young adult program, spiritual care, integrative medicine survivorship, and smoking cessation. What is new is the access hub. It’s a single point of contact so that, as Ramchandran says, “patients and caregivers will know what services are available, and those services can be matched to their specific needs.”

Prior to PathWell, after patients with cancer met with their clinical team it really was up to them to navigate a web of services to help with additional needs such as management of symptoms or psycho-social support. This often occurred when the patients and families’ ability to absorb and adjust to the reality of a serious illness was all that they could handle.

Ramchandran developed PathWell as a solution to this quandary, a way to create unique plans of care suited to each patient and family’s needs. Ramchandran explains: “Being able to understand what those needs are is foundational to cancer care, whether this is a thorough financial assessment, a psychosocial assessment, an understanding of what their spiritual needs are, or what their kids are going through. It is really looking at the whole person outside the lens of his or her disease.”

With the creation of PathWell, the focus for patients can again be on their illness. Likewise, clinicians no longer must refer patients to seven or eight services; now they can make one referral to PathWell. At that point, Ramchandran says, “Our nurse does an assessment of the patient and family and then recommends the additional services that will be most helpful. We then close the loop by talking with the clinician about the assessment and which referrals were placed.”

The leaders of the 26 services come together for PathWell conferences, meetings similar to tumor boards where patients and their care are discussed. The focus of the conference, Ramchandran explains, “is primarily on the psychosocial health and management of the patient, not the management of the patient’s disease.” As a side benefit, the conferences provide an opportunity for different services to learn from one another. For example, Ramchandran mentions a case where one service might be struggling with managing a patient’s pain in part because of co-existing cognitive changes. With PathWell it is simple to ask someone from neuropsychology to conduct an evaluation to figure out what resources the patient needs, which can make the treatment of the pain more feasible.

Ramchandran draws an analogy using some thoughts that Paul Kalanithi, author of When Breath Becomes Air, articulated before his death in 2015. Ramchandran recalls, “He talked about the little p and the big P, with the little p being palliative care as delivered by your primary care doctor and your oncologist, who ask how you are and what your goals are for the day and how your pain is. Big P is that physician saying, ‘I’m a little bit outside my scope and I need some help. I want to make sure your quality of life is as good as possible and I’m going to call the expert to come in and make sure that we’ve got everything that we need for you.’” Big P, she says, “is these 26 organizations working in collaboration. Palliative care is one component and PathWell comprises a very complex and smart group of people who have different skills and are committed to improving the patient experience in different ways.”

Ramchandran’s goal? “In a perfect world,” she says, “every patient will have a PathWell plan of care. It will include certain services that are right for them, and those will be incorporated automatically as they go through their process.”

An Online Course for an International Audience

In addition to this focus on palliative care at Stanford, Ramchandran also enabled people around the world to learn more about the discipline through an online course that she created, Palliative Care Always. An anticipated initial audience of 500 participants ballooned to 1,250 from more than 80 countries, and the course was greeted with considerable enthusiasm. Ramchandran and her team have summarized their work in a variety of settings, including international meetings, foundations and patient forums. Now they are thinking through how the course may impact palliative care in resource-poor settings and how it might influence health care systems in a positive way via novel access to primary palliative care.

“What was profound to me,” says Ramchandran, “was the excitement of a global connection around a shared common experience, thinking about health and wellness and living with dying, connecting with people around the world, having your stories heard, and feeling that there are people who want to share them.”

The course was relaunched in September 2016, incorporating some of the findings from the first iteration. Ramchandran notes, “We will be doing a focus on advanced communications skills and advanced symptom management, as well as a section on support for caregivers and family members, which was lacking in the original course.” The course, which is free, is also being offered for continuing education credits.

Ramchandran draws an analogy using some thoughts that Paul Kalanithi, author of When Breath Becomes Air, articulated before his death in 2015. Ramchandran recalls, “He talked about the little p and the big P, with the little p being palliative care as delivered by your primary care doctor and your oncologist, who ask how you are and what your goals are for the day and how your pain is. Big P is that physician saying, ‘I’m a little bit outside my scope and I need some help. I want to make sure your quality of life is as good as possible and I’m going to call the expert to come in and make sure that we’ve got everything that we need for you.’” Big P, she says, “is these 26 organizations working in collaboration. Palliative care is one component and PathWell comprises a very complex and smart group of people who have different skills and are committed to improving the patient experience in different ways.”

Ramchandran’s goal? “In a perfect world,” she says, “every patient will have a PathWell plan of care. It will include certain services that are right for them, and those will be incorporated automatically as they go through their process.”

An Online Course for an International Audience

In addition to this focus on palliative care at Stanford, Ramchandran also enabled people around the world to learn more about the discipline through an online course that she created, Palliative Care Always. An anticipated initial audience of 500 participants ballooned to 1,250 from more than 80 countries, and the course was greeted with considerable enthusiasm. Ramchandran and her team have summarized their work in a variety of settings, including international meetings, foundations and patient forums. Now they are thinking through how the course may impact palliative care in resource-poor settings and how it might influence health care systems in a positive way via novel access to primary palliative care.

“What was profound to me,” says Ramchandran, “was the excitement of a global connection around a shared common experience, thinking about health and wellness and living with dying, connecting with people around the world, having your stories heard, and feeling that there are people who want to share them.”

The course was relaunched in September 2016, incorporating some of the findings from the first iteration. Ramchandran notes, “We will be doing a focus on advanced communications skills and advanced symptom management, as well as a section on support for caregivers and family members, which was lacking in the original course.” The course, which is free, is also being offered for continuing education credits.

The idea for Presence began when Verghese realized two unique things about Stanford. First, all the schools share the same campus. Second, says Verghese, “We have access to an interdisciplinary kind of research that I suspect would elude other places because they don’t quite have that opportunity.”

Sensing that Stanford could leverage these interdisciplinary connections into tangible projects that could improve the patient-physician experience, Verghese presented that idea to Dean Lloyd Minor because he thought it matched Minor’s notion of precision health. “If we’re committed to precision health,” he explains, “then to me it implies we need precision at the level of the cell and the molecule; at the population level; and in the understanding of the human experience of health and wellness.”

It’s a common complaint from contemporary patients: “During routine visits to my doctors, they never make eye contact with me. Their fingers are always on their laptop keys, and their eyes are glued to the computer. It feels like we aren’t in the same room.”

Health care providers feel this disconnect, too, as they find themselves in front of glowing screens rather than at the bedside; it is a situation that contributes to high rates of burnout.

It is also a subject of great interest to Abraham Verghese, MD, whose recent National Humanities Medal citation reads in part: “To Abraham Verghese, for reminding us that the patient is the center of the medical enterprise.” What’s often missing from today’s patient-physician relationship, says Verghese, is presence, and it has become the name — as well as the driving force behind — a new Stanford center called Presence: The Art and Science of Human Connection. Presence looks to foster research, dialogue and collaboration across the Stanford campus to bring about measureable improvement in the medical experience for patients and physicians. A particular focus will be medical error.

There’s a lot to learn, Verghese says — and maybe a few things to unlearn. That’s where collaboration comes in. The center will work with Stanford’s seven schools to discover novel ways to champion humanism in modern medicine. Executive Director Sonoo Thadaney, MBA, described several current projects: “We’ve partnered with the Stanford Center for the Advanced Study in the Behavioral Sciences to support one fellow, and with the Graduate School of Business to create the Innovative Health Care Leaders Program. Presence is also incubating a new global Society of Bedside Medicine, under the joint leadership of Stanford, Johns Hopkins, University of Alabama, University of Edinburgh and others.”

The idea for Presence began when Verghese realized two unique things about Stanford. First, all the schools share the same campus. Second, says Verghese, “We have access to an interdisciplinary kind of research that I suspect would elude other places because they don’t quite have that opportunity.”

Sensing that Stanford could leverage these interdisciplinary connections into tangible projects that could improve the patient-physician experience, Verghese presented that idea to Dean Lloyd Minor because he thought it matched Minor’s notion of precision health. “If we’re committed to precision health,” he explains, “then to me it implies we need precision at the level of the cell and the molecule; at the population level; and in the understanding of the human experience of health and wellness.”

Verghese and Thadaney recently discussed their vision for the use of technology in medicine in less obtrusive ways. Verghese spoke of “harnessing the technology for the human experience, which means having the electronic medical record, for example, understand our ritual and serve us. Currently, our rituals are disrupted as we struggle to accommodate the computerization of what was a very heavy ritual-dependent field.”

Thadaney concurred, adding, “One of the things we talk about is that any human experience — whether it’s between a patient and physician or anyone else — is an analog experience. And by attempting digitization of it, we over-simplify it and weaken the crucial narrative. We’re looking to harness existing and future technologies to enhance the human experience in medicine to be more human-centric.”

While it is early to speak about legacy, Verghese finished with some hopes for the future of Presence: “I’m hoping that some years from now we might have made a particular impact on a certain kind of medical error. Perhaps we identify a critical element to be cognizant of in a particular story, or we develop a signature checklist of high-yield things to look for in the setting of a particular symptom. Or it might be that what transpires in a clinic in 2026 will be shaped by work done with our colleagues in psychology or business or anthropology.”

Verghese and Thadaney recently discussed their vision for the use of technology in medicine in less obtrusive ways. Verghese spoke of “harnessing the technology for the human experience, which means having the electronic medical record, for example, understand our ritual and serve us. Currently, our rituals are disrupted as we struggle to accommodate the computerization of what was a very heavy ritual-dependent field.”

Thadaney concurred, adding, “One of the things we talk about is that any human experience — whether it’s between a patient and physician or anyone else — is an analog experience. And by attempting digitization of it, we over-simplify it and weaken the crucial narrative. We’re looking to harness existing and future technologies to enhance the human experience in medicine to be more human-centric.”

While it is early to speak about legacy, Verghese finished with some hopes for the future of Presence: “I’m hoping that some years from now we might have made a particular impact on a certain kind of medical error. Perhaps we identify a critical element to be cognizant of in a particular story, or we develop a signature checklist of high-yield things to look for in the setting of a particular symptom. Or it might be that what transpires in a clinic in 2026 will be shaped by work done with our colleagues in psychology or business or anthropology.”