Thursday, August 21, 2003
Some Doctors Taking 'Spiritual Histories' to Aid Medical Healing
A small but growing number of physicians are taking patient "spiritual histories," according to Dr. Harold G. Koenig of Duke University.
By collecting information about each patient's religious or spiritual beliefs, he believes doctors can make more informed treatment decisions and help patients rally spiritual resources to aid healing. "Neglecting the spiritual dimension is just like ignoring a patient's social environment or psychological state, and results in failure to treat the `whole person,"' Koenig said.Koenig described the emerging technique in a manual for health care professionals, "Spirituality in Patient Care" (Templeton Foundation Press)
A spiritual history might include questions such as: Does the patient rely on religion or spirituality to help cope with illness? Is the patient a member of a supportive spiritual community? What spiritual questions, if any, does the patient find most troubling?
Dr. Robert Fine, director of clinical ethics at Baylor Healthcare Systems in Dallas, believes spiritual histories can help. He cited an example of a patient who insisted on aggressive treatment, even though her advanced breast cancer was clearly terminal and she was in terrible pain. Puzzled, her doctors called in Fine, who learned that fear of going to hell kept her from accepting the inevitable. After a conversation with a chaplain, she was able to face death peacefully.
Koenig estimated that between 5 percent and 10 percent of doctors take some form of spiritual history; he expects the number to grow as graduating students join the field. Nearly two-thirds of American medical schools in 2001 taught courses on religion, spirituality and medicine.
Koenig believes spiritual histories are especially useful with patients facing surgery or life-threatening, chronic or disabling conditions. With so much recent research pointing to potential benefits of spirituality to physical health, a spiritual history gives the doctor a practical way to harness those benefits. "If I know a person's spiritual background, I might ask something like `Would a short prayer help in this situation?" he said. "Knowing that a person is religious frees me to be more forward in using a spiritual intervention that might bring comfort."
Koenig added that the histories allow doctors to counter potential negative effects of spirituality, citing a study suggesting that patients struggling with spiritual crises tend not to heal as well. Doctors can't help, he said, if they don't know. "Sometimes just listening and validating will give comfort and will make the patient more likely to accept a referral to a chaplain who can help," he said.
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