Kristen Schaefer

Q&A with Kristen Schaefer, MD

May 29th, 2020

Kristen Schaefer, MD is a Senior Physician in the Department of Psychosocial Oncology and Palliative Care at the Dana-Farber Cancer Institute and Assistant Professor of Medicine at Harvard Medical School. She currently serves as Director of Medical Student Education for the DFCI Division of Adult Palliative Care and Course Director for Practical Aspects of Palliative Care

In July, 2020 Dr. Schaefer will leave her current position at DFCI to become an Associate Medical Director at Care Dimensions in Waltham, MA. In this new position, Dr. Schaefer will maintain her HMS faculty appointment and continue her roles as Co-Director of the HMS Aging Patient and End of Life Care Curricular Theme and as an HMS representative to the statewide medical school collaborative within the Massachusetts Serious Illness Coalition.

Tell us about your background.

I was born in Chicago, Illinois in the 1960s, which I’ve always considered to be an important time and place to have come into this world.  I have a twin brother, and soon after we born, my mother was diagnosed with type 1 diabetes and my parents were recommended to avoid further pregnancies, so they always celebrated the blessing of having the two of us. I really value being a twin – my peers know me to playfully reference this often, especially when I’m seeking mutual understanding and connection (that said, my husband also reports that I am the only adult he knows who says ‘That’s not fair!’ on a regular basis).  

My father was a lawyer and my mother a social worker and therapist and growing up I developed a deep sense of social justice and wanting to make a difference. I went to Sidwell Friends, a Quaker high school in Washington, DC, and graduated from Princeton University where I studied Anthropology and East Asian Studies and wrote my senior thesis on Mao Zedong’s Barefoot Doctor Program. There were no doctors in my immediate family, but I came to medicine with personal knowledge of the impact of serious illness and a keen interest in seeing medicine and healing through a cultural lens.

I graduated from Harvard Medical School in 1994 and completed a general internal medicine residency at San Francisco General Hospital, University of California San Francisco. I then worked as a primary care physician on amazing interdisciplinary teams on the Navajo Reservation for the Indian Health Service, in a community health center in Washington DC for primarily Spanish-speaking women, and as a clinician educator at George Washington University and Georgetown University Hospital.  

I always felt lucky to have found my soul mate and life partner Tad Gallion at a young age, and we have been blessed with wonderful children, Em (23 yo), Claire (16 yo), and our sweet son Will, who was born unexpectedly ill and died in 1999 when he was six weeks old. That experience deeply affected our family and also ultimately informed my sense of calling and courage to practice palliative care.

Why did you decide to work in palliative care?

I am on the tail end of the generation of clinicians that were practicing palliative care before we knew to call it that! Coming of age as a physician in Boston and San Francisco during the AIDS epidemic was a huge influence. My experiences as a medical student volunteering on the Interdisciplinary AIDS Program at Cambridge City Hospital provided foundational insight into the power of a longitudinal interdisciplinary team and the importance of social activism in the face of serious illness. I also remember as a senior medical student being assigned to do my first hospice visit; after a long climb up Mission Hill, I arrived at the hospice residence to find no doctors there. That day, with my patient and his nurse as my teachers, I fell in love with the mission and practice of hospice care. I was then privileged to train at San Francisco General Hospital among primary care clinicians, scientists, nurses, mental health and community health workers, and peers who had dedicated themselves to the dual mission of conquering HIV and caring for patients dying of AIDS.

I first learned about palliative care in 2004, walking with my friend from medical school, Eva Chittenden, pushing our babies in strollers under the cherry trees in Washington DC during Sakura, a celebration of effervescent beauty when the cherry blossom petals are falling from the trees. Eva turned to me and said, Kristen I think you would like palliative care, and I asked her why. She explained the work that she was doing at UCSF and how she treasured her colleagues and the patient- and family-centered mission, which reminded her of the way that I had approached my career as a primary care physician. Based on her recommendation, I took Palliative Care Education and Practice in 2006, and then in 2008 transitioned to my current faculty position at DFCI. The rest, as they say, is history! 

What would you like the public to know about your work?

I think the public’s experience of our healthcare system, like my own, is often dominated by a sense of fragmentation and worry. The focus of my work has been to teach palliative care communication skills and to develop innovations in clinical practice to mitigate this sense of brokenness.

At Harvard Medical School, we are working really hard to train students to reflect on patients’ and families’ experiences and needs related to serious illness and to define and teach core medical student palliative care skills. Several years ago, I was proud to lead a group of co-investigators in a survey project of a representative sample of palliative care educators across the country to define core medical student and resident palliative care competencies. We hoped the results would serve as the collective wisdom and voice of educators in our field, and happily it is still cited to this day and used widely as a framework for planning education for medical students and residents.

One of my greatest joys is leading and teaching in courses for practicing clinicians, and our Practical Aspects of Palliative Care course delivers high quality interprofessional palliative care education to a delightful audience from around the world each year. I am also lucky to be faculty alongside my Vital Talk and Serious Illness Communication Program colleagues, as we continuously innovate our approach to teaching serious illness communication.

In my clinical work, I have served as the liaison to the Brigham and Women’s Advanced Heart Disease team since 2008, and most recently as the inaugural Medical Director of our innovative HeartPal program embedded within the BWH Advanced Heart Disease Team. Together we have successfully begun to integrate subspecialty palliative care into patients’ routine interdisciplinary heart failure care, and our patients, their families and we as clinicians seem all the better for it. 

What is the most helpful advice that you have received?

This sounds strange, but a cardiology mentor Dr. Lynn Stevenson, a senior and very esteemed heart failure cardiologist, once offered me a piece of advice that was admittedly initially off-putting, but ultimately such important feedback. I was speaking with her on my way to give a talk at a national cardiology conference and she offered her observation that palliative care clinicians sometimes walk with a downtrodden posture as though they are carrying the weight of the world on their shoulders. She gently followed with "Kristen, that does not fly very well with cardiologists." She advised me instead to always "walk like the wind is at your back" and to try to convey in my body language my intent to make a positive difference. She wasn’t telling me to be inauthentic, and I knew that her advice was coming from a place of appreciation and wanting to support my work. In the end the advice - to attend to cultural norms of fields outside of palliative care, and to use the power of non-verbal communication to invite positive regard - has made me a better consultant. 

In your spare time, what do you like to do for fun?

In my free time, I like walking my dogs, hiking, listening to music (and singing along), reading, and lying in my hammock to look at the trees and the sky. I’ve practiced meditation and yoga on and off throughout my adult life. My big creative outlet is cooking, and the weeks that I’m off service I cook every day. I love being a mom, even though it’s the hardest job I’ve ever had, and I treasure time spent connecting with friends and family.