I saw a 75 year old gentleman yesterday for the first time. The reason stated on my schedule - "high BP/monitor meds". I had a clinical clerk with me. She did a fine job with taking a complex medical history - previously healthy until last June; then a heart attack followed by a triple vessel bypass surgery. Taking about a dozen different medications. Currently asymptomatic of cardiac related complications. BP measured 5 times with our BP-Tru machine 122/46 HR of 56 regular. When I went in to see him later, he revealed that he had low mood - feeling "apathetic" about life; lost interest in things that used to give him pleasure; no longer has an appetite; passive suicidal thoughts but stated he would never act on these because of his love for his family.
How do I engage this patient in spiritual matters?
Let me begin with a confession. After almost 30 years of clinical practice, not a single patient has come forth to tell me that he had become a Christian as a direct result of my sharing my faith with him. This seminar is not about sharing your faith with your patients, at least not in the traditional sense of evangelism, the use of tools like the Four Spiritual Laws etc. What I would like to share with you this evening is about living out your Christian faith as a physician or any health care provider. And by living out your faith you will first of all grow as a disciple of Jesus Christ. You will experience His transforming power even in the exam room. You will begin to stop doing things you know you ought not to do and instead you will be able to do more of the things you ought to do. And your patients will notice. There will naturally be conversation about the spiritual side of things. It doesn't really matter whether your patient is a Christian or not. You will bring help to him by providing a complete care package - help in the body, mind and the spirit. So, practically how do you do it?
Firstly, bring Christ into the exam room or operating theater. What I mean is before you enter the room, say a very short prayer: Jesus, please come in with me. Your prayer is immediately answered! For you know that He has promised never to leave you nor forsake you. His presence has always reminded me that I have been saved by grace:
"For it is by grace you have been saved, through faith—and this is not from yourselves, it is the gift of God— not by works, so that no one can boast." (Ephesian 2:8-9)
It is a tremendous comfort knowing that what would happen in the next 15-30 minutes in the exam room is the work of a loving and gracious God, who desires to have a relationship not only with me, but with the patient to whom I have the privilege to serve. I therefore leave my pride at the door and follow Jesus into the room. This simple act of asking Jesus to come and help has brought me tremendous comfort over the years. There is so much sweetness in my heart recalling those late night deliveries of babies, or right before seeing some very difficult patients, or having to break bad news to those with whom I have such deep relationships. So get into this habit. It only takes a second just before you knock on the door.
Secondly, I greet my patient with "How can I help you?", with a smile, like someone who has just been blessed with Jesus' company! In my heart I have been practicing the line "How can I serve you?". It is not fashionable to say it out loud. It just sounds weird! But once in a while I surprise a patient by saying it out loud. I remember this patient very clearly:
Miss C, a 35 year old single mom referred by "Health-Connect" - meaning she belonged to the group of high need patients with whom the province was trying to connect to a Family Health Team. Our FHT was obligated to take a few of these, quite reluctantly despite the financial incentive. Before I was able to say my greeting she pulled out a piece of paper with a long list of problems - and told me "I don't think you will like me". I looked at her in her eyes, and said to her (as sincerely as I could) "It is my privilege to serve you!" and she broke down and cried. Over the years, she had many challenges and at times I was not sure if anyone could help her but God's grace sustained me. She has become a famous patient in my practice to this day. My team members often asked me after a visit with her "How did it go?" I would say "I overwhelmed her with my love!" which usually brought out a round of laughter but deep in my heart I knew it was true. One day she came to see my resident and told him that she no longer needed the narcotic treatment because she was now managing her back pain with the help of prayers and support from church friends!" My resident, who was also a Christian, didn't know what to say. He went on to manage her diabetes. I later asked him what went through his mind. He told me that in his medical school training he had learned that spiritual thing was off limit. What would you do differently?
This patient, and all other patients, are all made in God's image. They are all loved by God, who was willing to send His one and only Son to die on the cross for their sins. He also has a purpose for them. I would do well to remember this and tell all my patients that it is my privilege to serve them. For,
"Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me." (Matthews 25:40)
Thirdly, your patients are more interested in spiritual matters than you think. Do you agree?
Mrs X was told by the Oncologist that the latest test results showed that she had ovarian cancer. Mrs X, who has since passed away, was a devout Christian. She was disappointed that the doctor, who was also a Christian, did not even ask how her faith may play a role in facing such a difficult diagnosis and choice of treatment. Should we expect the oncologist to initiate the faith topic?
There are various studies that suggest that there is such thing as the "Spiritual Gap".
- 95% of Americans believed in God but ony 64% of physicians believed in God
- 77% of the patients surveyed believed physicians should consider their spiritual needs, but only 10-20% reported that their physicians discussed religion or spirituality with them
- 96% of physicians believed spiritual well-being is important in health but only 11% frequently inquired about spiritual issues
- spiritual belief is associated with positive effects in terms of reduced CHD, high BP, stroke, most cancers, and several health status indicators.
- spiritual belief is associated with reduced all-cause morbidity and mortality.
- this association is found no matter how religion was defined or measured (i.e., as beliefs, experiences, behavior, or attitudes).
- this findings have been generally positive across all cultures
- spiritual belief is associated with higher rates of overall well being and life satisfaction
- lower rates of depressive symptoms and suicide
- lower rates of divorce and higher rates of marital satisfaction
- and lower rates of alcohol abuse and other drug abuse, including cigarette smoking and recreational drug use
Fourthly so how do you start? How about learning to take a spiritual history? Usually patients come with lots of problems and the last thing you remember to do is to take a spiritual history! By spiritual history I don't mean asking what they put down as their religion or whether they go to church - although that may be better than nothing. We often know about their smoking and alcohol status or any drug allergies but often forget that they are all spiritual beings. If you believe that your patients' spiritual history matters, what questions do you ask? Let me just say that whatever you do it must be well integrated in your usual clinical inquiries. And it really helps if you see your patients over many visits (as in family practice). And your questions should be appropriate to the problems at hand and should increase with ease as you build a robust doctor-patient relationship. Sometimes it just happens, especially among Christian patients.
I have known Mrs Y over the years. She has a lovely family who are all my patients. I don't remember exactly how we have become familiar with each others faith. So I asked her. She would have wanted to come to share this with you personally but her husband is quite ill at the moment. This is what she tells me via email:
How did you come to know that Dr. Chan is a Christian and that you feel confident to share with him your faith journey and how it has an impact on your illness and your husband's illness?
We
have had the opportunity to experience the care of some tremendous health
professionals over the years. We have been fortunate to always be serviced by
individuals with professional demeanor and sound knowledge and expertise in
their field. There are, however non-quantifiable traits that emerge in a client,
patient interaction that tell you there is something different at work.
We
don’t recall Dr. Chan overtly mentioning that he was a Christian, but we do
recall him affirming us when we told him of the support we were receiving from
our faith community after my mother passed away and I was seeing him for sleep
disturbances and associated physical ailments. We sensed he gave an endorsement
for including our faith community as part of our healing and recovery along with
his prescriptions for my physical symptoms. Without specifically saying so, it
was as if he knew what I was already thinking in that I did not want to abandon
my spiritual resolves while seeking help from him, which was greatly
appreciated.
Confirmation
that I was in the care of a physician who had great respect for divine
providence and protection came when faced with the debilitating and
heartbreaking news that my husband was suffering from a degenerative disease.
Dr. Chan prayed with us in his office and took the time to talk with us about
managing symptoms and coping with changes to my husband’s condition.
Knowing our physician is guided by faith helps me to feel as though he can be
more of a human vehicle to be used by God to work a miracle in stemming the
digression of my husband’s illness at best, or at the very least, reassuring us
that God has not left us during this dark period of time.
Now if you are really stuck, I have a tool which I have never used but do believe that it will help you when you are totally stuck, like the FIFE (Feelings, Ideas, Functioning, Expectations) which you have learned in your communication skills training. It's called the HOPE Assessment. I have the reference for it if you want.The HOPE Assessment (Handout)
H: Sources of Hope, meaning, comfort, strength, peace, love and connection
O: Organized religion
P: Personal spirituality and Practices
E: Effects on medical care and end-of-life issues
H Questions:
We have been discussing your support systems. I was wondering, what is there in your life that gives you internal support?
What do you hold on to during difficult times?
What sustains you and keeps you going?
For some people, their religious or spiritual beliefs act as a source of comfort and strength in dealing with life’s ups and downs; is this true for you?
O Questions:
Do you consider yourself part of an organized religion? How important is this to you?
What aspects of your religions are helpful and not so helpful to you?
Are you part of a religious or spiritual community? Does it help you? How?
P Questions:
Do you have personal spiritual beliefs that are independent of organized religion? What are they?
Do you believe in God? What kind of relationship do you have with God?
What aspects of your spirituality or spiritual practices do you find most helpful to you personally? (e.g., prayer, meditation, reading scripture, attending religious services, listening to music, hiking, communing with nature)
E Questions:
Has being sick (or your current situation) affected your ability to do the things that usually help you spiritually? (Or affected your relationship with God?)
Are you worried about any conflicts between your beliefs and your medical situation/care/decisions?
Are there any specific practices or restrictions I should know about in providing your medical care? (e.g., dietary restrictions, use of blood products)
Finally, what about prescribing spiritual therapy or treatment. The first and most important treatment is YOU. Yes you are the biggest pill according to Dr. Michael Balint. You are most certainly contributing to what is known as the Placebo effect in the scientific sense. Your living faith will encourage patients to trust the greater healer Jesus Christ who is ever so pleased to help in the most amazing way, always even better than what we ask. You must be receptive to the stage your patient is in - do not preach. Let the spirit guide you.
The second most important treatment is prayer. You and your patient together plead for God to help. I often pray with my patients. In all my years when I asked my patient whether I could pray the answer has always been yes. I often tell my patients I have been praying for them and sometimes it can lead to deeper conversation:
Mrs A had terminal adrenal cancer and I was doing my palliative care visits to her home. I told her I had been praying for her and asked her what I might ask God on her behalf. She, a devout Catholic, asked me to pray that she may be accepted by God when she meets Him. I was able to explain the truth from scripture how it was her faith and not her work that she would be accepted. For.
"God demonstrates his own love for us in this: While we were still sinners, Christ died for us." (Romans 5:8)
Prayer brings benefits to both you and your patients.
"Let us then approach God’s throne of grace with confidence, so that we may receive mercy and find grace to help us in our time of need." (Hebrews 4:16)
I know some of my patients pray for me!
Mr. & Mrs B moved from Kingston to retire here in Hamilton. Through CMDS directory their original family doctor in Kingston recommended them to see me. I was honored to accept them into my practice. They both had serious health issues. From time to time I asked them "How am I doing?". I was delighted to hear (with a great big grin on their face), "We have been praying for you!".
Yes I am truly blessed that some of my Christian patients are praying for me, to do God's work faithfully.
Lastly, this is one reason I think memorizing scripture really helps. When I sense that an encouragement from scripture is warranted there is always something I can say, better than my own words, that will help my patient. Sometimes, I am even surprised by my patients response!
Mrs Z is a deacon in her church. After a lengthy visit managing her uncontrolled diabetes and hypertension, just on our way to the door, I said to her "May I leave you with a blessing, "I lift up my eyes to the mountains— where does my help come from?"...
And she finished the rest of these great verses from Psalm 121,
" My help comes from the Lord,
the Maker of heaven and earth." (Psalm 121:1-2)
She left with both of us knowing that we are good in God's mighty hands!
Let me encourage you with this scripture I learned just this past weekend:
"Each of you should use whatever gift you have received to serve others, as faithful stewards of God’s grace in its various forms." (1 Peter 4:10)
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