The Spiritual Sideof Patient Care

Dan Taylor, PhDVolunteer Chaplain, USA Children’s and Women’s HospitalAdjunct Assistant Professor of Medicine, USA College of

MedicineDepartments of Internal Medicine and Surgery

Outline

1. 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.

What We TeachMedical Students and

Physicians

Phys

ical

Spiritual

Social

Emotional

Psychological

Cultura

l

da Vinci’s Vitruvian Mana medical metaphor

Your patient

balance betweenbody and soul

balance betweenscience

andhumanitarianism

The physician

Williams M, Rodning C. Vitruvian Man: Metaphor of a “compleat” physician. Pharos 1997;60(3):22-27.

“Remember to cure the patient as well as the disease.”Alvan L. Barach (1895–1977), U.S. physician.

“For many people spirituality forms the basis of 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 restoration of wholeness as opposed to mainly technical healing], requires answers to these questions.”

Foglio PR and Brody H. Religion, Faith, and Family Medicine. Journal of Family Practice. 1988 Nov; 27(5):473-74.

Did you notice their definition of healing …

[the restoration of wholeness as opposed to mainly technical healing]

The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal . . .

What is spoken of as a “clinical picture” is not just a photograph of a man sick in bed, it is an impressionistic painting of the patient surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes, and fears.

Francis Peabody, MD 1847-1936

“The great physicians sit down, relax, and listen to the patient's story. They care (or least seem to care) about the patient's problems, and the context of those problems. I suspect 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 involves psychosocial issues, loss of work, family functioning, financial concerns, fear of death and spiritual issues.” “We miss the boat when we think to take care of suffering we’ll just give a medication of some type.

There is no medication for suffering.”

Ann Berger, MD. The NIH Record, Vol. 56, No. 10, May 11, 2004

Chief of the Pain and Palliative Care Service at NIH

Review of Medical Literature

Patients’ attitudes regarding whether or not physicians should address spirituality

MD 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 spirituality

Physician 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 regarding physician discussion of spirituality. Family Medicine 2006;38(2):83-4.

Hospital Patient Satisfaction

Data analysis gathered from 1.7 million hospitalized patients between January and December, 2001 revealed a strong relationship between the “degree to which staff addressed emotional/spiritual needs” and overall patient satisfaction.

Clark P, Drain M, Malone M. Addressing Patients’ Emotional and Spiritual Needs. Joint Commission Journal on Quality and Patient Safety. 2003;29(12):659-70.

Hospital Patient Satisfaction

Gallup 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

Spiritual beliefs are important to me.

I have relied on spiritual beliefs to guide me through a major illness or other medical condition.

Agree or strongly agree

93%

85%

Physician inquiry into patient’s religious/spiritual beliefs

Surgeon should be aware of my spiritual beliefs.

Surgeon should obtain a spiritual history.

Agree or strongly agree

82%

63%

Gen 75%

Ortho 56%

Physician inquiry into patient’s religious/spiritual beliefs would increase trust

If my surgeon inquired about my religious/spiritual beliefs, my trust in him/her would increase.

Agree or strongly agree

64%

Gen 74%

Ortho 57%

Yogi Berra said,

“You can observe a lot by watching.”

“You can learn a lot by asking [and observing]!”

Assessing a Patient’s Spiritual Beliefs

Take a spiritual historyto 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 Beliefs

Do you have a faith that provides peace and comfort during times of stress and difficulty?

How important is your faith to you? How would your faith impact your medical decisions?

Do you belong to a community of faith and are they supportive of you?

How would you like for me to address your spiritual needs during this hospitalization?

F

I

C

A

Your Role in the Healing Process

Meeting the Spiritual Needsof Hospital Patients

1. 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 staff when meeting the spiritual needs of patients, nobody’s going to stop you.

Points to consider when relating to hospital staff and

patients.

1. 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

Points to consider

Meeting the Spiritual Needsof Hospital Patients

3. Patient Visitation

Infection control

Honor signs

Don’t undermine hospital staff

4. Develop relationships with hospital staff and be alert to ministry opportunities with other patients and staff.

“I want to thank you for making this day necessary.”

Yogi Berra

The Spiritual Sideof Patient Care

Dan 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