BY VICTOR S. SIERPINA, MD, ABFM, ABIHM, Director, Medical Student Education Program, WD and Laura Nell Nicholson Family Professor of Integrative Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor
I walked away from my medical school interview with the Dean at the University of Illinois Abraham Lincoln School of Medicine in 1975 with both a sinking and an elated feeling. Perhaps it was standard there at the time for the Dean himself to meet with students interviewing for admission, or perhaps only with certain students. I was clueless which was probably helpful to my anxiety level. In any case, during our interview, he asked why I wished to become a physician. I told him truthfully that God had called me to the healing arts as a profession, and that I hoped to enter into medical missionary work. I remember him shaking his head during the interview while rendering his opinion that being a doctor and dealing with patients’ spiritual issues gave “too much power” over their lives. He did not think it would work. Bad idea, he thought.
Ouch, so much for my medical school interview! In fact, I was accepted and graduated, class of 1979. The Dean, despite his disagreement with my stated motivations, apparently did not hold them against me. That sinking feeling, you now understand. Elated? Well, I actually felt oddly peaceful and believed deep in my heart that this was my direction, my energy, my path. It was an altruism rooted in faith that had delivered me from a number of foolish adolescent transgressions and more. Whatever was to come, at least I had stated my truth on my path.
However, the intersection of spirituality and medicine remains challenging.
“Religious and spiritual beliefs and practices are important in the lives of many patients, yet medical students, residents, and physicians are often uncertain about whether, when, or how, to address spiritual or religious issues. Physicians in previous times were trained to diagnose and treat disease and had little or no training in how to relate to the spiritual side of the patient. In addition, professional ethics requires physicians to not impinge their beliefs on patients who are particularly vulnerable when seeking health care. Complicating it further, in our nation’s culture of religious pluralism, there is a wide range of belief systems ranging from atheism, agnosticism, to a myriad assortment of religions and spiritual practices. No physician could be expected to understand the beliefs and practices of so many differing faith communities. “ (TR McCormick 2014)
Cartesian dualism that spirit and body are two separate entities was a devil’s bargain between the organized church and emerging science in the 1700’s. The artificial division of authority continues to infect our paradigm of healing to this day and impedes our solving the challenges described by McCormick.
On a hopeful note, the Medical School Objectives Project in 1999 listed the following as expected competencies of graduating medical students in the communication issues regarding cultural and spiritual issues:
• The ability to elicit a spiritual history
• The ability to obtain a cultural history that elicits the patient’s cultural identity, experiences, and explanations of illness, self-selected health practices, culturally relevant interpretations of social stress factors, and availability of culturally relevant support systems
• Understanding that the spiritual dimension of people’s lives is an avenue for compassionate caregiving
• The ability to apply the understanding of a patient’s spirituality and cultural beliefs and behaviors to appropriate clinical contexts (e.g., in prevention, case formulation, treatment planning, challenging clinical situations)
• Knowledge of research data on the impact of spirituality on health and health care outcomes, and on the impact of patients’ cultural identity, beliefs, and practices on their health, access to and interactions with health care providers, and health outcomes
• An understanding of, and respect for, the role of clergy and other spiritual leaders, and culturally-based healers and care providers, and how to communicate and/or collaborate with them on behalf of patients’ physical and/or spiritual needs
• An understanding of their own spirituality and how it can be nurtured as part of their professional growth, promotion of their well-being, and the basis of their calling as a physician.
However, as a medical educator, I still do not see these competencies consistently taught in our medical schools, nor do our students feel comfortable with their skills in these areas.
Those of us who have been at the bedside of patients in life, death, and the transition between know that patient values, beliefs, their faith community all are integral in how they handle end of life decisions. They impact the many choices for wellness and illness leading to those later stages. Spirituality and religion are clearly about life as well as death. We as physicians, nurses, or other healing professionals can and need to learn to converse comfortably on these matters so we can give comfort to our patients in their most trying times. Our chaplains and community clergy have a key role in patients’ spiritual issues, but we should not as health professionals abandon ours. Indeed we ought to urge increased skillfulness and awareness amongst those we teach by modeling best practices for them.