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.

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Serving In Academic Medicine

In a previous post, I said I’d share some takeaways from our two speakers at our local healthcare retreat.  This is the first of those two posts, and it concerns the message given by Dr. Smith (name changed to keep a lower profile), who works at a local teaching hospital.  I think you’ll find his comments helpful as you think about serving Christ in an academic environment.

To begin with, Dr. Smith emphasized that he strives to be, first and foremost, a Christian rather a physician who’s also a Christian.  In an environment where everybody has a title, simply bearing the name of Christ well – and finding your identity there – is what really counts.  This is also in contrast to being a Christian Nice Guy, a (genuine) believer who smiles and does whatever you ask him to, but fails to live courageously and clearly for Christ.  In both cases, the courage to live distinctively comes from finding our value and security in what God, not the people around us, say.  This is much easier said than done, and something we need to come back to routinely as we preach the gospel to ourselves moment-to-moment.

Dr. Smith has also found the academy to be a great place for sharing his faith, both directly and indirectly.  Physicians serving in this environment typically wear a number of hats, which affords opportunity for interactions not only with other Christians, but also with patients, students and residents, colleagues and staff who do not share his faith perspective.

Here are a few specifics that I found insightful:

  • In general, working hard and being competent (not necessarily the brightest or best) are important.  This not only honors God, but gives you a platform for talking about God when the opportunities arise.  No one will want to hear about Who you serve if they don’t respect how you serve.
  • Patients.  Patients are often at a place of physical vulnerability, which often creates an openness to spiritual discussion.  Physicians should be ready to discuss these things with permission and respect, but also boldness.  Spiritual histories (see below) are often a great starting point in this regard.
  • Students, residents.  While on service, Dr. Smith often has medical students and residents with him as he sees patients, presenting key opportunities to offer not only clinical, but spiritual, instruction.  He always takes a simple spiritual history, something he is ready to justify by pointing to the scientific literature, which shows that dealing with spirituality results in better health outcomes, is desired by most patients, and is in accordance with medical “best practices.”  Dr. Smith also uses specific teaching times to talk about these matters, and will invite students/residents to pray with/for patients who show interest in spiritual matters.
  • Colleagues, supervisors.  Again, character and competency are especially important here since respect won’t come through being further along in your training.  Boldness and risk are required since academic physicians have a reputation for being negatively inclined toward faith.  As an example, Dr. Smith shared how he’s going to hand out an appropriate Christian book to one of his colleagues and see what God does with that.
  • Staff.  Often, you’ll find other believers among staff who can challenge and encourage you.  Dr. Smith, for instance, learned that two janitors were already sharing Christ with some of his patients, which really spurred him on to be more straightforward himself.

The specifics of any particular calling within academic medicine vary greatly, so these tips are starting points that need to be thoughtfully applied.  At the same time, they are great guidelines that should be relevant in most situations.  If God is calling you to serve in the academy, He can use you there to make a powerful impact.