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The Spiritual Side of Patient CareDan Taylor, PhDVolunteer Chaplain, USA Children’s and Women’s HospitalAdjunct Assistant Professor of Medicine, USA College of MedicineDepartments of Internal Medicine and Surgery
Outline1. Review what we teach medical students and physicians.2. Review medical literature regarding patient views of spiritual discussions with physicians.3. Discuss your role in the medical community.4. Offer suggestions for relating to hospital staff while addressing the spiritual needs of patients and family members.
Williams M, Rodning C. Vitruvian Man: Metaphor of a “compleat” physician.Pharos 1997;60(3):22-27. Emotional So al c sic ia l Phy Your patient The physician balance between balance between science body and soul and humanitarianism l raSp ltu iri da Vinci’s Vitruvian Man Cu tu a medical metaphor al“Remember to cure the patient as well as the disease.” PsychologicalAlvan L. Barach (1895–1977), U.S. physician.
“For many people spirituality forms the basis ofDid you notice their definition of healing … meaning and purpose in life. The profoundly disturbing effects of illness can call into question a person’s purpose in life and work…. Healing, [the[the restoration of wholeness as opposed to restoration of wholeness as opposed to mainlymainly technical healing] answers to these technical healing], requires questions.” Foglio PR and Brody H. Religion, Faith, and Family Medicine. Journal of Family Practice. 1988 Nov; 27(5):473-74.
Francis Peabody, MD 1847-1936The treatment of a disease may be entirely impersonal; the care of apatient must be completely personal . . .What is spoken of as a “clinical picture” is not just a photograph of aman sick in bed, it is an impressionistic painting of the patientsurrounded by his home, his work, his relations, his friends, his joys,sorrows, hopes, and fears.
“The great physicians sit down, relax, and listen to thepatients story. They care (or least seem to care) about thepatients problems, and the context of those problems. Isuspect they truly care, because listening is hard work.”Centor RM. Seek first to understand. Philos Ethics Humanit Med. 2007; 2: 29.
“Pain is not just physical suffering. Suffering also involvespsychosocial issues, loss of work, family functioning, financialconcerns, fear of death and spiritual issues.” “We miss theboat when we think to take care of suffering we’ll just give amedication of some type.There is no medication for suffering.”Ann Berger, MD. The NIH Record, Vol. 56, No. 10, May 11, 2004Chief of the Pain and Palliative Care Service at NIH
Patients’ attitudes regarding whether or not physicians should address spiritualityMD should consider pt’s spiritual needs 77% (King)Want MD to ask about spiritual needs 33-70%MD should pray with patient 33-78%Would like MD to pray with them 67% (Oyama)[MDs who say pts would not want prayer] 63% (Koenig)
Patients’ attitudes regarding whether or not physicians should address spiritualityPhysician should know their spiritualbeliefs because those beliefs wouldinfluence their medical treatment 83% (McCord)Important for physician to inquire abouta patient’s spiritual beliefs 84% (Hamilton)Physician’s inquiry about spiritual beliefswould strengthen their trust in the physician 81% (Hamilton)Hamilton J, Levine J. Neo-pagan patients’ preferences regardingphysician discussion of spirituality. Family Medicine 2006;38(2):83-4.
Hospital Patient SatisfactionData analysis gathered from 1.7 million hospitalizedpatients between January and December, 2001 revealed astrong relationship between the “degree to which staffaddressed emotional/spiritual needs” and overall patientsatisfaction.Clark P, Drain M, Malone M. Addressing Patients’ Emotional and SpiritualNeeds. Joint Commission Journal on Quality and Patient Safety. 2003;29(12):659-70.
Hospital Patient SatisfactionGallup poll of hospitalized patients conducted in 2002.1. How satisfied were you with how well the staff was able to meet your spiritual needs?2. How satisfied were you with how well the staff was able to meet your spiritual and emotional needs? Analysis of the data revealed that overall patient satisfaction was highly correlated with “meeting spiritual needs” and “meeting spiritual and emotional needs.”Blizzard R. Praying for Patient Satisfaction. Gallup Poll 2002.http://www.gallup.com/poll/11116/Praying-Patient-Satisfaction.aspx?
Importance of religious/spiritual beliefs USA Departments of General and Orthopedic Surgery Agree or strongly agreeSpiritual beliefs are important to me. 93%I have relied on spiritual beliefs to guide 85%me through a major illness or othermedical condition.
Physician inquiry into patient’s religious/spiritual beliefs Agree or strongly agreeSurgeon should be aware of my 82%spiritual beliefs.Surgeon should obtain a spiritual 63%history. Gen 75% Ortho 56%
Physician inquiry into patient’s religious/spiritual beliefs would increase trust Agree or strongly agreeIf my surgeon inquired about my 64%religious/spiritual beliefs, my trust Gen 74%in him/her would increase. Ortho 57%
Assessing a Patient’s Spiritual Beliefs Yogi Berra said, “You can observe a lot by watching.”“You can learn a lot by asking [and observing]!”
Take a spiritual history to assess a patient’s spiritual beliefsIntroduce the subject before taking a spiritual history:1. Minimize patient concerns. “You’re doing fine…”2. Respect for patient autonomy. “Many patients rely on personal spiritual beliefs to help them cope with stress or illness. Would you mind if I asked you several questions about your spiritual beliefs?” “I routinely inquire about the spiritual beliefs of my patients, would you mind if I asked you several questions about your spiritual beliefs?”
Assessing a Patient’s Spiritual BeliefsF Do you have a faith that provides peace and comfort during times of stress and difficulty? How important is your faith to you? How wouldI your faith impact your medical decisions?C Do you belong to a community of faith and are they supportive of you?A How would you like for me to address your spiritual needs during this hospitalization?
Meeting the Spiritual Needs of Hospital Patients1. Many patients seek to understand their illness, and find comfort through the lens of their religious/spiritual beliefs.2. Many hospitals do not have chaplains, or have limited pastoral care staff.3. Healthcare providers often feel inadequate regarding spiritual care and welcome your participation.4. You play a vital role in meeting the needs of hospitalized patients.
Yogi Berra said, “If the people don’t want to come out to the ballpark, nobody’s going to stop them.”If you don’t want to partner with hospital staffwhen meeting the spiritual needs of patients,nobody’s going to stop you.
Points to consider when relating to hospital staff and patients.
Points to consider1. HIPAA (confidentially).2. Understand hospital healthcare workers. Busy Trained as scientists (especially physicians) May or may not possess a dynamic faith Want you to be a partner in patient care
Meeting the Spiritual Needs of Hospital Patients3. Patient Visitation Infection control Honor signs Don’t undermine hospital staff4. Develop relationships with hospital staff and be alert to ministry opportunities with other patients and staff.
“I want to thank you for making thisday necessary.” Yogi Berra
The Spiritual Side of Patient CareDan Taylor, Ph.D.Chaplain, USA Medical Center and USA Children’s and Women’sAdjunct Assistant Professor of Medicine, USA College of MedicineDepartments of Internal Medicine and Surgery