Ajay K. Singh, MBBS, FRCP, MBA
October 19, 2017
“Spiritual or compassionate care involves serving the whole person—the physical, emotional, social, and spiritual. Such service is inherently a spiritual activity.” —Christina Puchalski
An interview with Christina Puchalski on integrating spirituality into medicine in BigQuestionsOnline caught my eye. So I dug a bit more into this topic.
I came across a 2001 article by Puchalski titled, “The role of spirituality in health care” that I would strongly recommend to anyone who takes care of patients. In her article, Puchalski writes: “Spiritual or compassionate care involves serving the whole person—the physical, emotional, social, and spiritual. Such service is inherently a spiritual activity.”
According to Puchalski, physicians should incorporate spiritual practice into their interactions with patients. This could happen by physician’s being “fully present and attentive to their patients…actively listen and allow their patients to share “fears, hopes, pains and dreams.” She also recommends that physicians pay attention to “all dimensions of patients and their families: body, mind, and spirit.” Puchalski supports physician’s involving chaplains as members into the interdisciplinary health care team.
Puchalski is an advocate of “compassionate care,” which she defines as physicians walking “with people in the midst of their pain, to be partners with patients rather than experts dictating information to them.” Merriam-Webster defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it.”
Puchalski writes that compassion is important because:
While patients struggle with the physical aspects of their disease, they have other pain as well: pain related to mental and spiritual suffering, to an inability to engage the deepest questions of life. Patients may be asking questions such as the following: Why is this happening to me now? What will happen to me after I die? Will my family survive my loss? Will I be missed? Will I be remembered? Is there a God? If so, will he be there for me? Will I have time to finish my life’s work?
Studies support Puchalski’s contention that physicians generally underestimate patients’ spiritual needs. Ehman and colleagues performed a self-administered survey to 177 patients in a hospital-based pulmonary clinic: only 15% were asked about spiritual or religious beliefs. Nearly two-thirds of the patients said that they would welcome a question about whether they were spiritual from their doctors while they were taking the medical history. In another study, also a survey, but in primary care clinics of six academic medical centers in three states, MacLean and colleagues report that many patients want their physician to ask them about spiritual beliefs; indeed, this desire for inquiry about spiritual beliefs increases strongly with the severity of the illness. The MacLean study enrolled 456 patients who were dying. Seventy percent of these patients said that they would welcome physician inquiry into their religious beliefs, 55% said that they would appreciate silent prayer, and 50% believed their physician should pray with them.
So what’s the bottom-line? While most physicians focus on the physical aspects of illness, a more holistic approach may be what patients want. Arguably to be complete, physicians should consider discussing spirituality with patients. Christina Puchalski concludes: “I think we can be better physicians and true partners in our patients’ living and in their dying if we can be compassionate: if we truly listen to their hopes, their fears, and their beliefs, and incorporate these beliefs into their therapeutic plans.”
Harvard Medical School CME:
Lifestyle Medicine: Nutrition & The Metabollic Syndrome
Dr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.