Need to Do a Better Job
The holistic view of medicine defines health as a multidimensional construct that includes the physical, emotional, and social aspects of the patient. This view should be matched with a holistic approach to healthcare delivery that encompasses patients’ subjective illness experience, says Dr. Post.
Dr. Taylor concedes that the medical community’s recognition of patients’ spiritual needs is growing. And yet, she says, practitioners are not held accountable for delivering spiritual care, “which I think is a failing of healthcare as it is practiced today.”
Many reports have indicated patients are unhappy with the low referral rates to pastoral clinical care, adds Dr. Post.2
Assessment Essential
Incorporate a spiritual-needs assessment when taking each patient’s history upon admittance, the two bioethicists agree. This assessment usually takes the form of questions such as:
- What is your source of strength?
- Is spirituality/religion important to you? (If the patient answers “yes,” proceed to the next question.)
- How would you like us to facilitate your needs?
- Would you like a referral to pastoral care?
Once patients indicate they would like to speak with a chaplain, referral to appropriate clergy trained in pastoral care is essential.
“All physicians need to be respectful of these kinds of appeals,” says Dr. Post. “But they should feel free to make a referral to those who are, in fact, competently trained to deal with this specific area of life.”
While opposed to professional separatism, Dr. Post does argue for keeping “friendly, knee-high white fences” between physicians and pastoral counselors to maintain professional boundaries.3
Marc B. Westle, DO, FACP, president and managing partner of Asheville Hospitalist Group, PA, in North Carolina, agrees with this approach. “As a professional, I completely respect and empathize with the patient’s and the family’s spiritual needs as part of the total care of the patient,” he says. “Just as in other areas where I may not have expertise, I refer to our in-house professionals. We have an excellent chaplaincy service that we involve all the time, on a routine basis.” He says the chaplaincy service at Mission Hospital is in-house 24/7, just as the hospitalists are, and make rounds as the physicians do.
Availability of trained clergy differs from institution to institution, notes Dr. Taylor. She recently visited a metropolitan research institution where the two staff chaplains estimate there are nearly 1,000 daily patient contacts. With this many patients flowing through the facility, the chaplains rely on medical staff to triage patients’ and families’ needs so they can be referred to families who will benefit most from their help. In busy urban hospitals, pastoral coverage may not always be available, and the burden of addressing spiritual requests can fall to the hospital medicine team.
The Comfort Zone
The question of whether to pray with a patient or family member depends on the physician’s comfort with doing so.
- Rule No. 1 when it comes to the question of prayer with/for a patient or family: Clinicians should never proselytize or initiate the prayer. This can constitute a serious breach of professional boundaries.4
- Balancing the need to support patients’ emotional needs while respecting one’s integrity can be difficult. If a physician feels comfortable, it is appropriate to pray with a patient. Or, a physician can offer to sit quietly while a patient prays. If uncomfortable with this scenario, offering to keep the patient in your thoughts is one way to still be supportive while maintaining the integrity of your beliefs.3