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While doctors are usually very good at taking care of a patient’s
physical needs , we usually neglect to minister to our patient’s
desire for spiritual comfort. This is a deficiency we urgently
need to rectify, because a patient’s spiritual health
can have a significant impact on how they cope with their
illness. The idea that spirituality can help to heal is very
old, and traditional cultures have always relied on medicine
men, witch doctors and shamans to use spiritual interventions
in order to cure illnesses, often with remarkable results.
After all, it is through both the channels of medicine and
religion that humans have grappled with the common issues
of suffering, despair, and death , when confronted with an
illness.
Since the topic is so unfamiliar for most doctors , let’s
first start with some definitions. Unfortunately, even defining
spirituality is difficult, because it is such a nebulous and
intangible topic, and has a different meaning for everyone.
While all of us are spiritual beings, many doctors are uncomfortable
talking about spirituality because they consider it to be
too unscientific, and often confuse it with religion. The
word spirituality comes from the Latin root spiritus, which
means "breath"--referring to the breath of life.
Since a “hard” definition is impossible, let’s
settle for a “soft” one– spirituality is
the way you find meaning, hope, comfort and inner peace in
your life. Spirituality involves opening our hearts, connecting
with others, and cultivating our capacity to experience awe,
reverence and gratitude. Many people experience spirituality
through religion and each religion attempts to help ask and
answer mankind's spiritual questions. Each religion has developed
a specific set of beliefs, teachings and practices, but in
contrast to religion that is organized and communal, spirituality
is highly individual and intensely personal, and it is possible
to be spiritual with out being religious or even believing
in God . Spiritual distress occurs when individuals are unable
to find sources of meaning, hope, love, peace and comfort
in life ; and illness can often trigger spiritual distress
in patients and family members. Spiritual care consists of
relieving this distress, and involves compassion, listening
and the encouragement of realistic hope; and need not involve
any discussion of God or religion.
Addressing the patient’s spirituality should be a routine
part of health care for many reasons. (1) Religious beliefs
and spiritual needs are common among patients, and many patients
would like their doctors to address these issues (2) Religious
beliefs influence medical decision making (3) There is a relationship
between spirituality and health.
(4) Supporting a patient’s spirituality can enrich the
patient-physician relationship.
However, there are a number of barriers doctors encounter
when talking about spirituality. Clinicians practice in the
bio-medical model and pride themselves on being hard-headed
rational scientists, so that many feel that nebulous concepts
such as spirituality are unimportant and irrelevant. After
all, you can palpate an enlarged liver and auscultate the
heart, but how do you examine the soul ? Second, few physicians
are religious or spiritual themselves, which is why they often
fail to realise the importance of spiritual matters to their
patients. Since the effect of spirituality on health is often
not taught during medical training, many never consider this
area at all. Other doctors feel that the spiritual concerns
of patients are private and that physicians should not inquire
about them; and they are worried that they may offend patients
who have differing religious beliefs. The simplest solution
is to avoid discussing religious or spiritual matters, which
is what most doctors end up doing, but this is often not desirable.
It is difficult for physicians to ignore or avoid patient
spirituality , especially in India . Rather than shy away
from such discussions, you need to develop a technique to
become comfortable dealing with these issues. This is why
the American Psychiatric Association recommends that physicians
inquire about the religious and spiritual orientation of patients
“so that they may properly attend to them in the course
of treatment.” This is simple common sense – after
all , patient care is much more than disease management; and
involves addressing the needs of the whole person. Spiritual
care can play a complementary role to medical care, especially
in dealing with critically ill patients or the dying.
Physicians can easily incorporate spirituality into their
practice by assessing the patient's spirituality in order
to diagnose spiritual distress; and by providing therapeutic
interventions to alleviate this distress. For assessment and
diagnosis, the key is to learn to take a spiritual history
, to help you define the spiritual needs of your patients.
In fact, taking a spiritual history can actually provide basic
spiritual care for many patients, in that it allows patients
to voice their spiritual doubts, needs and concerns, and allows
physicians to comfort them, if they need this. More advanced
spiritual treatment can be provided by referring patients
to sources of spiritual care such as priests; temples, churches
and mosques; family and friends; and community resources (eg,
satsangs and similar support groups). Thus, many hospitals
have chapels, temples and prayer rooms today, and patients
should be encouraged to use these services.
Since the concept of taking a spiritual history is so new
for most doctors , the HOPE questions designed by Gowri Anandarajah
can prove to be very helpful, because they allow for an open-ended
exploration of an individual's spiritual resources and concerns
. A useful way to introduce these questions is by asking:
"For some people, their spiritual beliefs act as a source
of comfort and strength in dealing with life's ups and downs.
Is this true for you?"
H: Sources of hope . What are their sources of hope, strength,
comfort and peace ? This helps to define their basic spiritual
resources.
O: Organized religion. Are they a member of a religious group
? How active are they ?
P: Personal spirituality and practices. What specific aspects
do they find most helpful in their own life ? Prayer ? Meditation
? Music ?
E: Effects on medical care issues ( for example, dietary restrictions
for Jains). This can help focus the discussion back onto clinical
management
Following the spiritual assessment, you have many management
options.
1. Take no further action. Spiritual concerns often have no
clear solutions, and experienced physicians know that in many
cases there is little they can offer to their patients in
the way of medical solutions. Often the best therapeutic intervention
you can provide is your presence, understanding, and compassion,
which is in itself a spiritual response.
2. Include spirituality in adjuvant care. You can help patients
identify spiritual measures that can be useful to them in
conjunction with standard medical treatment. For example,
a patient may choose to have a picture of their guru in their
room, or listen to the Gita during dialysis , or read the
Bible before surgery.
3. Modify the treatment plan. Modifications can be made based
on a better understanding of your patient's spiritual needs.
This can include measures such as stopping chemotherapy in
a patient with terminal cancer; referring a patient in spiritual
crisis to a priest; using community cultural resources; and
teaching meditation techniques to patients with chronic pain
or insomnia.
Before you can begin to address your patient’s spiritual
needs, you first need to understand your own spiritual beliefs
. One way to promote self-understanding is to perform a formal
spiritual self-assessment by taking a spiritual history on
yourself ! Spiritual self-care is integral to serving your
patients and self-care can take the form of reconnecting with
family and friends, time alone (for meditation, playing a
sport, recreational reading, nature watching, etc.), community
service, or religious practice, such as praying.
Learning about spirituality will help you become a better
physician. It will help you find meaning in your daily work
as you appreciate the importance of your primary role –
to serve your patients. It will also help you become more
compassionate, and teach you the importance of hope , and
why you need to support your patient’s spiritual needs
. Finally, it will help to keep you humble, because it will
teach you to realize there is so much about the human body
we do not understand and cannot control – and that the
human spirit can perform miracles modern medicine still cannot
comprehend.
Finally, you should pay more attention to spirituality for
purely selfish reasons ! Spirituality is key to self-growth,
and allows us to continually be amazed at the miracle of human
life. By virtue of being doctors , we are privileged to have
a ring-side view of life’s most exciting battles , right
from birth to death , but many of us get jaded with time.
Spiritual awareness allows us to appreciate the wonders of
life, so we can continually rejuvenate ourselves and look
on each day as a brand new adventure, and lead a more meaningful
life. Spirituality allows you to get in touch with your own
humanity – the ultimate reward !
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