The Science of Context: Transforming Serious Illness Care Though In Situ Observation

There is an expression, often attributed to Einstein, “If I had 60 minutes to save the world, I would spend the first 55 trying to figure out what was wrong with it.” Dr. J. Randall (Randy) Curtis’ approach to improving serious illness care has been so effective for exactly this reason. Before considering how to make things better, you must first understand what is happening and how we got to our current state. For critical care, that required listening to clinician and family communication —what people actually said— while it was happening in the intensive care unit (ICU). Randy's work using rigorous observational methods helped open the doors concealing the difficult conversations between the families of critically ill patients nearing end of life and ICU clinicians. His scientific contributions have led not only to practice-changing insights and novel interventions, but also to a new generation of researchers seeking to improve serious illness care. Herein, we highlight Randy's early work using direct observation and describe the trajectory and impact of his ground-up approach to research. In parallel, we describe the influence of his approach on our own work studying serious illness care in surgery and critical care. Although neither of us has had direct mentorship from Randy, we emulate Randy's pioneering mentorship model in our work together, demonstrating his far-reaching influence.