How & Why To Take A Spiritual History

If you’re a Christian healthcare provider, chances are you’re already committed to treating the whole person.  Of taking a holistic approach to quality patient care.

Recently, we’ve been going through CMDA’s all-new Grace Rx curriculum in our bible study brunches.  Last week we discussed how and why to take a spiritual history. Initially I had planned on sharing the various options for spiritual assessments with those who came, but figured others could benefit, too, so I’m putting it up here.

To give credit where it’s due, Dr Walt Larimore and Bill Peel put Grace Rx together, so I’m largely just passing along what they cover in Module 5 of their course.

Why We Should Take A Spiritual History

There are 5 main things we can learn by taking a spiritual assessment:

  1. a patient’s religious background
  2. the role that religious/spiritual backgrounds play (if any) in how they cope with illness and distress
  3. convictions that may affect, or interfere with, how we treat them clinically
  4. determining whether/not the patient is involved in a spiritual community, and, whether/not that community is supportive
  5. any spiritual needs that they may have

Evidence-Based Reasons To Take A Spiritual History

A large body of evidence suggests that taking a spiritual assessment/history is beneficial.

Here are 5 evidence-based to perform one:

  1. patient desire – about 70% of the American population views religious commitment as a central life factor, especially when dealing with illness.  Most patients want professionals to inquire about beliefs important to them.
  2. patient benefit – of studies reporting relationships between spirituality and mental and/or physical health, about 70% report positive relationships.  22% report mixed/no results, while 9% report a negative one.
  3. identification of risk factors – an inverse relationship exists between faith and morbidity and mortality.  For example, patients who ‘felt alienated from or unloved by God or attributed their illnesses to the devil were associated with a 16% to 28% increase in risk of dying during the two-year follow-up period’.
  4. may enhance healthcare – empirical literature from epidemiological and clinical studies that explore the relationship between religious factors and mental/physical health suggest that religious commitment helps prevent, improves coping with, and, facilitates recovery from illness.
  5. considered a standard of care – an increasing number of healthcare organizations are calling for greater attention to be given to spiritual issues as patients are treated and assessed.

Spiritual Assessment Instruments

Taking a spiritual assessment doesn’t have to take a lot of time, or, seem weird.  They can be delivered quickly, and, in concert with other questions designed to assess a patient’s overall health.

In addition, you don’t have to choose one instrument and stick to it rigidly.  You can use whatever questions work well for you, and, help you help your patients.

  1. Open Invite.
  2. FICA Spiritual History.
  3. HOPE Spiritual History.
  4. SPIRITual History.
  5. CSI-MEMO Spiritual History.
  6. ACP/ASIM Spiritual History.
  7. Larson Spiritual History (slide 69).
  8. GOD Questions (slide 70).  This is the one covered in the Grace Rx curriculum.

As I wrapped up this segment of the post, I stumbled upon Dr Larimore’s presentation at the 2013 Global Missions Health Conference.  This contains each one of the spiritual assessments mentioned above and may be the easiest way to access them in one place.

To Keep In Mind

When spiritual needs surface, remember to:

  • listen compassionately – regardless of where a patient is coming from
  • respect and clarify – always respect any beliefs that come up and seek to clarify as necessary
  • document – your spiritual assessment and a patient’s openness to it; the information may be helpful in future discussions

It Takes Courage

Even though a great deal of organizations (many of them secular) encourage spiritual assessments, pressures to avoid the topic and keep patient encounters brief make it hard in practice.  In addition, our own insecurities and (frankly) selfishness pose barriers, too.

Our commitment to treating the whole person, as Jesus did, can help us to press on past the barriers and include a spiritual assessment.  Doing this allows us to see where a patient is in their spiritual journey and join them – and God – in it.

Five-Minute CME: A Non-Partisan Perspective on the Affordable Health Care Act

English: Barack Obama signing the Patient Prot...

Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

With busy lives – and the rhetoric of an election year – it’s easy to lose touch with the important events taking place all around us.   At the same time, God doesn’t want us to become so focused on ourselves, or jaded, that we forget He’s put us right where we are.

Part of that means engaging with our culture and trying to stay up to date on its major happenings like the recent Affordable Healthcare Act (ACA) decision. Recently, I read this article by Dr. Manoj Jain on the ACA, and felt he did a good job at taking a fair look at the ACA’s potential impact on patients, physicians, and insurance companies.  Share your perspective on what’s happening in the comments section.

Dr. David Levy’s Intermed Sessions

In case you missed it, here are Dr. David Levy’s talks, and Q & A sessions, given at Renewal Presbyterian Church in Philadelphia, PA on March 9-10, 2012.

To access the relevant session:

1 – click on the link below, which will take you its stored location on Google documents;

2 – click “file”, then “download” (see bottom of drop-down list)

3 – either click “open with” your default media player (i.e., Windows Media Player) to listen now, or, “save file” to download so you can store/listen to the file on your computer/MP3 player later.

Friday night’s talk on addressing spiritual concerns and forgiving others

Friday night Q & A

Saturday morning’s talk on joy and handling disappointment with God/others

Saturday morning Q & A

Many thanks to Chris Chong for recording these sessions.  Enjoy!

Time To Grieve & Hope: When Patients Die, In All Of Life

Jesus Wept

Image by Pro-Zak via Flickr

Passed down from generation to generation of providers, it’s nearly a mantra among medical trainees:

“Don’t get too involved with your patients.  If you do, you’ll burnout and you won’t make good, objective clinical decisions.”

There’s real truth in this, of course, which is what gives the mantra its power.  I don’t want to dismiss that; it matters, and needs to be dealt with wisely.  But is that the end of it?  Should providers just “move on” fully and immediately from their patient interactions?

Dr. Pauline Chen, it seems, is among those who would say “no.”  In this short article for the BBC, she suggests instituting a five-minute pause for silence in the event of a patient’s death would be very beneficial for medical teams:

I believe that instituting the five-minute pause for silence after a patient dies will change the way doctors, nurses and other caregivers approach death.

First, it will give closure, as well as respect, to the relationship between that patient and his or her caregivers.

Second, the conscious pause, the act of taking time out, will establish a ritual. And rituals, consistently practised, offer great comfort at difficult moments.

Finally, the five-minute silence will allow caregivers to acknowledge their own feelings.

I agree with her.

More importantly, as Christians, we have the example of the Great Physician, who visibly cared – even cried – over his patients on several occasions.  He wept before raising Lazarus from the dead (John 11:35), and then again when he realized that Jerusalem’s destruction was a done deal because of its refusal to acknowledge Him as Savior and King (Luke 19:41-44).

It’s striking that, in both cases, Jesus gets “emotionally involved” even when the outcome is a foregone conclusion.  In the first case, the patient would be resurrected(!) just moments later.  In the other case, the patients were terminal with no hope of recovery.  Why bother caring?  Why not just move on and do something more productive?

You might be thinking, “I like this idea of the five-minute pause.  Healthcare providers get so hardened and we (or “they”) need to reconnect with our emotions.”  You might think this is mainly a medical thing.

In reality, though, this is an all-of-life thing.  If we dig deeper, we resist real emotional involvement and vulnerability in everyday moments that have nothing to do with healthcare.  A family member pokes fun of us and says they’re “just joking”, but we let it go and tell ourselves we don’t care.  We see a homeless person on the street, but don’t allow ourselves to be sad or consider helping.  We want to speak up in class or at the party, but don’t because we’re afraid – on some level – of rejection.

The same heart that leads nurses and doctors to race away after a patient dies lives in all of us.  However much we’d like to bury it, the fact is that we live in a broken world, and, we ourselves are broken.  In ways that are sometimes obvious, sometimes obscure, we like to distance ourselves from that reality.  Myself included.

Don’t get me wrong.  I like the idea of the five-minute pause.  A lot.  One physician I know held a thirty-second moment of silence after one patient’s death in his ER.  When he looked up at its end, nearly everyone was in tears.  Later, they confided in him that it was so powerful and he had many profound discussions about things that really mattered.  I hope that, if you have the opportunity, you’ll implement something like this in your setting.

At the same time, my heart is to see us, as Christians, go deeper.  And not just in moments of high drama, but in the mundane moments that make up the real story of our lives.  We need the courage to feel and acknowledge the brokenness and sadness – however large or small – that comes at us each day.  When we do that, as Dr. Chen suggests at the end of her article, that frees us up to care for others who are hurting.

But where does that courage come from?

The bible sketches out the answer, especially in the Gospels.  When Jesus entered our world and died on the cross in our place, he fully acknowledged just how bad it really is.  No sugar-coating, no pretending.  He had to leave heaven and perish at the hands of his creation!  But that wasn’t the end – he rose again in three days and promised that everyone who believes in him will join him someday in a world where everything that’s wrong will be made right.

So, following his example, I can admit just how messed up things are.  How wrong it is that the patient I was working on just died.  How wrong it is that my friend didn’t come through for me again.  And how wrong it is that I don’t care much about the people all around me.

But that’s not where we stop.  Even though I can’t fix so much of what I see around or in me, I don’t have to despair.  I can do my best, but at the end of the day God has to do the fixing.  And he’s promised to.  Without a doubt.  When we look at the cross and empty tomb, we can face the suffering in our lives with both honesty and hope.

Let me close by asking you to join me in reflecting on two questions:

First, what are those areas in your life where you’re not dealing with brokenness?

Second, what would it look like for you to start being more honest and hopeful?

If we ask him, God will show us what to do and give us the help we need to do it.

Doctor-Patient Relationship: The Power Of Touch

Dr. Abraham Verghese gives this insightful TED talk on recovering the power of touch, and personal interaction, in the doctor-patient relationship.  You may recognize Dr. Verghese as the author of the best-seller Cutting For Stone.

Thanks, Sylvia Duggan, for passing this along!