Does spirituality belong in the doctor’s office?

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The Good Squad/Digital Vision/Getty Images

The Good Squad/Digital Vision/Getty Images

Life’s big questions drew Dr. Victoria Sweet to a career in medicine. “Your job is to deal with birth, suffering, and death. It just captured my imagination,” said Sweet, now bestselling author and associate professor of clinical medicine at the University of California, San Francisco.

“Medicine appealed to me because I felt it was the most real thing you could do,” she said. As a doctor, Sweet cared for people in the most difficult — or joyous — times of their lives.

However, throughout her career in medicine, Sweet said she has seen the field erode with an increasing emphasis on efficiency and profit.

According to a 2017 study, doctors now spend more than half of their time on tasks that are not face-to-face with patients. Even during in-person consultations, according to a 2020 study, much of doctors’ time is spent using electronic health records.

Sweet has seen a shift from a more holistic medicine rooted in care to an industry treating health care as a commodity. “It’s a commodification that I think completely leaves out the essentials,” she said.

What’s critical, Sweet said, is creating space for true person-to-person connection in medicine. “The essence of what happens between doctor and patient runs very deep,” she said. “This space, to me, feels sacred.”

At the 10th annual conference on religion and medicine this month, Sweet will give a plenary lecture titled “Space for the Sacred in the Care of the Sick.” The conference highlights research focused on the intersection of health care and religion, including some organizations that argue that we need to make room for both the sacred – and for spirituality – in the cabinet of the doctor.

When medical care has been spiritual care

“Modern medicine is secular,” said Gary Ferngren, a professor emeritus of history at Oregon State University who studies the history of medicine and religion. “Since the end of the 19th century, it has developed very rapidly, cutting itself off from any religious or spiritual value.”

For much of human history, societies have used religious frameworks to understand the meaning of illness and pain, Ferngren wrote. The disease could be attributed to causes such as a magical curse or divine punishment.

A more up-to-date understanding of the disease has gradually replaced these views. Doctors today are – thankfully – unlikely to prescribe an exorcism or suggest patients make sacrifices to Asclepius, the Greco-Roman god of medicine.

But Ferngren wrote that the historic presence of religion in the infirmary also provided patients with tools to tackle issues still relevant in the 21st century. At a time when health care and religion were more closely intertwined, a patient could receive not only medicine when seeing a doctor, but also consolation, comfort, and religious meaning.

“What happens at death’s door?” said Ferngren. “For a person lying in bed wondering what kind of future there is, that’s hugely important.”

Invite spiritual care into the consultation room

In fact, many patients would like to discuss spiritual matters with their health care providers: one study found that 83% of patients want doctors to ask them questions about their spiritual beliefs, especially when faced with a life-threatening illness, serious medical conditions and bereavement. .

“A high percentage of people, if hospitalized for a physical illness, would like to talk to their doctor about spiritual matters and have a conversation,” said Dr. John Graham, president and CEO of the Institute for Spirituality and Health at Texas Medical Center, co-sponsor of this month’s conference.

Graham defined spirituality as “our innate ability to connect – to connect to others, to our environment, to transcendent mystery, and to our deepest true selves”. Like Sweet, he said modern medicine’s emphasis on efficiency leaves out this larger view of patients’ well-being and their spiritual and religious needs during illness.

Meeting those needs is known as spiritual care, which Graham said most doctors don’t have the proper training to do.

When working with medical students today, Graham shares lists of questions that could open the door to a deeper conversation with patients. “They might ask, ‘In the past, when you went through a difficult problem, where did you find the strength to get through it?’ “, said Graham.

For some patients, the answer is religion. Some patients are happy to share their own religious practices, Graham said. Or they could mention a connection to nature. Others talk about meditation or a trusted family member they turned to for advice.

Each patient brings different beliefs to the conversation. And advocates believe that all individuals – including atheists – can benefit from access to spiritual care.

Even an atheist can face ‘spiritual distress’

“Atheists, religious, humanists — everyone has this spirituality or inner life, the need for meaning and purpose,” said Christina Puchalski, physician and founder of the George Washington Institute for Spirituality and Health. “If they feel a lack of that, it could be a source of spiritual distress.”

Spiritual distress has been shown to be particularly high in patients with severe, chronic illness, Puchalski said, and addressing it is critical in the case of palliative care.

“People who experience high spiritual distress — which is often linked to higher depression and anxiety,” she said. “People who have high spiritual well-being also tend to have better overall health.”

What does spiritual accompaniment look like in practice? It starts with the kinds of questions Graham discusses with medical students. Along with several colleagues, Puchalski developed the FICA Spiritual History Tool to help practitioners better understand their patients’ spiritual beliefs. It contains questions that invite patients to ask about the type of care they want, such as “How would you like me, as a health care provider, to address spiritual issues in your health care?”

However, when it comes to measuring impacts, Puchalski said clinical research on spiritual care is an area that has a lot of room for growth.

“It’s a relatively new and promising area,” she said. “When it comes to considering spiritual distress as a clinical marker, we are currently involved in building this area of ​​research.”

Is the world facing a crisis of spiritual distress?

And over the past two years, Puchalski said, the Covid-19 pandemic has sparked renewed interest in the field of spiritual care. “All of a sudden, people were dealing with really intense existential and spiritual distress,” she said, highlighting the loneliness and grief the pandemic has brought.

Millions have lost loved ones. Healthcare providers have seen patients slipping away into intensive care units at a hospital without family members present. And people all over the world wrestled with questions about death and dying.

“People have been dealing with these questions for centuries, haven’t they?” Puchalsky said. “It’s just that during the pandemic we’ve all been affected, whether we face serious illness or not.”

While research on the fallout from Covid-19 is still young, a study in Croatia found that spiritual quality of life was linked to better mental health outcomes and emotional stability amid the pandemic.

For healthcare providers, taking the time to look within can also make a difference, said Puchalski, who has established a professional development program called Reflection Rounds designed to help them do just that.

“Many of us have been called upon to serve others,” she said, pointing to the wave of burnout among healthcare workers around the world. “Serving people – it impacts us.”

But the effect of Covid-19 on spiritual well-being is not just about distress and languor. Ms Puchalski said she also sees room for positive change as people around the world seek solutions to the problems the pandemic has highlighted. She said she hopes it will spur growth as the world looks to the future.

“I see people searching for meaning and purpose,” Puchalski said. “And I see a kind of desire for kindness, which is a beautiful thing.”

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Jen Rose Smith is a writer from Vermont. To learn more about his work, visit www.jenrosesmith.com.

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