On the premise one agrees spirituality is important to medicine, as I argued in yesterday's post, that's only where the story begins. There are even more questions to be raised about its management in the clinical setting. For example, who is best qualified to inquire about spirituality and, besides, isn't it an end-of-life issue? What if a patient asks their physician to pray with them and s/he is an atheist? These are real concerns and as a minister on the cusp of medical residency, I'd like to offer a perspective.
Customarily, religious or spiritual preference is noted in the intake interview and becomes part of a patient's chart. Whoever does the intake should ask, at least generically, about the significance of religion, faith, or spirituality. During times of stress, changes of life, or when treatment decisions can be affected by religious beliefs, it's especially appropriate for the physician to broach the subject. When patients come to the clinic, they anticipate seeing a doctor they know and have come to rely on. The doctor-patient relationship provides an ideal basis for talking about what health or illness means to them, personally. As I define it, such conversations reflect "spirituality" in its most basic sense.
Naturally, you'd assume spirituality to be an end-of-life concern but it surfaces at other times as well. For instance, couples who have been relatively uninterested in religion often express a desire to reconnect with family religious traditions when a newborn enters the picture. As a first-time pastor, I discovered young children in the home was associated with parents attending church regularly. Family atmosphere, the potential for children to learn moral principles, and social contact with other parents were important factors in the decision to become involved. Midlife is another time when spirituality may take on new significance. The point to remember is, spirituality and relating -- intrapersonally and interpersonally -- go hand in hand, and most of us are best at both while we're still breathing.
The question of qualifications is one that has far less importance for spirituality than the practice of medicine. Doctors are accustomed to referring patients when a specialist would be better qualified to be of help. Spirituality, however, doesn't require technical expertise to be addressed meaningfully. Patients don't expect their physician to be a theologian. What they expect is consideration, respect, and empathy. If we can't provide these qualities, we've got far bigger fish to fry than whether we can explain why bad things happen to good people. And for the record, even ministerial folk have a hard time with that one, if they're honest about it. As long as we stay in touch with our humanity, we've got all the qualifications we'll ever need.
Well, then, what about physicians counseling with integrity when their own convictions concerning spirituality are at odds with patients'? While statistics indicate physicians who are fairly comfortable bringing up spirituality tend to be persons of faith, there's absolutely no reason why this should be considered necessary or even advantageous. For one thing, it's not about what we as physicians believe or disbelieve, anyway. For another, there are a number of potential points of disagreement with patients, including music, politics, caffeine or decaf, none of which require us to alter our convictions to be medically effective. In any case, introducing spirituality into the conversation is never an occasion for us to persuade, convert, or pontificate.
Admittedly, possessing a spiritual orientation may seem helpful, but it can also create problems. The innocent presumption that you know what a patient is talking about since you're able to identify with their experience may result in failing to ask follow-up questions. Conversely, patients may withhold information believing a common experience tells you all you need to know. In situations like these, having no spiritual orientation or one that differs from your patient can be an advantage because it requires us to explain ourselves rather than err by relying on assumptions.
Finally, in the matter of praying with patients, I'm reminded of a wonderful line from the film, Oh, God (1975). John Denver's character asks God (George Burns) if they might just talk now and then, to which God says, "You talk, I'll listen." If a patient should ask their doctor to pray with them, whether or not they are persons of faith, offering to listen reverently while the patient prays is spot on. If they should ask you, as their doctor, to pray on their behalf, there is no harm in gently explaining your convictions should they differ from your patients'. By telling the truth you maintain your integrity and confirm your trustworthiness. Furthermore, your honesty tells your patient that you value them too much as persons to pretend to be someone other than who you are. The result could very well be a much stronger bond between you.
Admittedly, in this essay I haven't gone anywhere near the truly difficult and painful spiritual/ethical issues of blood transfusions and Jehovah's Witnesses, abortion, or faith-based objections to teenage birth control and HPV vaccination. My interest has been on what you might call "bread and butter" spiritual concerns, but demonstrating respect, empathy, and truthfulness is essential in any situation involving religion or spirituality. We struggle, do our best, make mistakes, fall down and get back up, mindful that where spirituality is concerned, nothing is etched in stone.
(Creative Commons image by john-norris via Flickr)
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