Healthcare and Spirituality PDF
Preview Healthcare and Spirituality
Healthcare and Spirituality Stephen P Kliewer D.Min. ExecutiveDirector Wallowa ValleyCenter for Wellness Assistant Professor Department ofFamilyMedicine Oregon Health &Science University and John Saultz MD Professor and Chairman Department ofFamilyMedicine Oregon Health &Science University Radcliffe Publishing Oxford.Seattle RadcliffePublishingLtd 18MarchamRoad Abingdon OxonOX141AA UnitedKingdom www.radcliffe-oxford.com Electroniccatalogueandworldwideonlineorderingfacility. _____________________________________ #2006StephenPKliewerandJohnSaultz Allrightsreserved.Nopartofthispublicationmaybereproduced,storedina retrievalsystemortransmitted,inanyformorbyanymeans,electronic, mechanical,photocopying,recordingorotherwisewithoutthepriorpermission ofthecopyrightowner. BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary. ISBN1857756223 TypesetbyAdvanceTypesettingLtd,Oxford,UK PrintedandboundbyTJInternationalLtd,Padstow,Cornwall,UK Contents Preface iv Abouttheauthors vi 1 Healing,cure,andthewholeperson 1 2 Towardamodelofintegration 24 3 Exploringspirituality 46 4 Theimpactofspirituality 63 5 Thecultureofone 84 6 Theobjectivesofintegratingspiritualityandmedicine 109 7 Firststeps,gatheringinformation 126 8 Spiritualassessment 147 9 Spiritualinterventions 166 Epilogue 191 AppendixA:Activelisteningskills 192 AppendixB:TheSpiritualInvolvementandBeliefsScale 204 AppendixC:Samplemeditations,writingexercises,anddrawingexercises 208 AppendixD:Suggestedfurtherreading 212 Index 215 Preface We are now halfway through the first decade of the twenty-first century and medicineisexperiencingaprofoundtransition.Scientificadvanceshaveempowered physicians with tools unimaginable only a generation ago and life expectancy is increasingglobally.Thehumangenomehasbeendecoded,promisingevenmore rapid technical advancement in the years to come. But there is a deep sense of discontent with healthcare. Rapidly increasing costs have made basic services inaccessible to millions of people. As medicine has become more technically sophisticated,bothpatientsandphysiciansareexperiencingalossofthepersonal healingtouch,whichhasbeensuchanimportantfundamentalofthedoctor–patient relationship. Reports have documented an alarming rate of error in healthcare systems,errorsthatharmpatientsandunderminetrust.Increasinglydisillusioned by the allopathic model of medicine, and feeling distanced from their healers, patientshaveturned morefrequentlyto alternativemodelsof healthcare,andto resourcessuchasspirituality. Many authors view the problems of uncontrolled cost, poor access, erosion of trust,andlackofsafetyasevidencethatourapproachtohealthcarerequiresradical reform. Nowhere are these problems more urgent than in the delivery of basic primary care services at the community level. Several medical specialties have undertaken extensive reviews of the current model of care and are working to address these problems. But there is a clear and widening gulf between what patientswantfromhealthcareandwhatthehealthcaresystemcanprovide.Phys- icianstendtoviewhealthcareasabiologicprocessinwhichpatientproblemsare best understood as mechanical dysfunction of one or more body systems. But patientsvisitthephysicianwithawidearrayofproblems,manyofwhichcannotbe understoodonthebasisofbiologyalone. Increasingly,thebiomedicalmodelofhealthcareisprovingincapableofmeeting theneedsofthoseweseektoserve.Thespecialtyoffamilymedicinehasaddressed thisproblemoverthepast35yearsbybroadeningthefocusofattentiontoaddress psychological,social,family,andcommunityissuesaswellasbasicbiologicdiagnosis intheprocessofcaringforpatients.Describedbysomeauthorsasa‘biopsychosocial model’andbyothersas‘contextualcare,’thenewmodelseekstoindividualizecare by addressing patient problems rather than only their medical diagnoses as the focusofcare. Intothisenvironment,weofferthisintroductorytextbook,dedicatedtoasystems approach with emphasis on also integrating spiritual issues into the process of healthcare.Webelievethatmostpeopleconsiderthemselvestobespiritualbeings andapproachspiritualgrowthacrossanincrediblespectrumoffaithsystemsfrom traditional religious denominations to new-age spirituality. Traditional Western medicine has generally considered the spiritual to be outside of the physician’s focus of attention. Chapters 1 and 2 describe how this came to be and why such restrictions limit our ability to help many of our patients. We then seek in the remaining chapters to create a framework for talking about spiritual issues with patients. When is it appropriate for physicians to assess spiritual health in the context of delivering healthcare? How can we raise these issues with patients Preface v withoutdisruptingthefoundationoftrustinthedoctor–patientrelationship?How canwedevelopavocabularytotalkwithpatientsandfamiliesaboutspiritualityin suchawayastoenhancethequalityofthecareweprovidethem?Howcanwebest workcollaborativelywithministers,counselors,andotherspiritualprofessionals incaringforpeopleacrossthefullspectrumoftheirdistress? Thisbookiswrittentoallowphysiciansandpatientstoaddressimportantissues regardingthequalityandmeaningofallourlives.Twenty-first-centuryhealthcare willinevitablyhavetofacecomplexissuesandchallengesaboutcareattheendof life,careofchronicanddisablingillness,andcomplexethicalandmoraldilemmas. Atpresent,ourabilitytodothesethingscanbestbedescribedasrudimentary.We hopethatthisbookwillbeusefultopracticinghealthcareprofessionals.Forthem,it shouldprovideausefulframeworktoimprovetheirunderstandingofpatientsand their ability to communicate more intimately with them and their families. The book should also be useful for ministers and other spiritual professionals by providing a broader context for working with physicians and other healthcare workers. Finally, we hope this book can provide a much-needed foundation for medical students, nursing students, and seminary students, for anyone learning aboutthecaringprofessions.Itisourcontentionthatthefutureofhealthcarewillbe builtoninterdisciplinaryteamsofprofessionalsthatareequippedtoaddressthe fullrangeofhumansufferingandtriumphexperiencedbythoseinneed.Itiswith thisfutureinmindthatweofferthistext. StephenPKliewer JohnSaultz September2005 About the authors StephenPKliewerD.Min.istheExecutiveDirectorofWallowaValleyCenterfor Wellness,anonprofitagencythatprovidesmentalhealth,alcoholanddrug,and developmentaldisabilityprogramsforasmallruralcountyintheStateofOregon (USA). Dr Kliewer is also an Assistant Professor in the Department of Family MedicineatOregonHealth&ScienceUniversity(OHSU).AtOHSUDrKliewerhas been involved in curriculum development, program development and teaching. Hisareasoffocushavebeenpatientandphysiciancommunication,spiritualityand medicine,mentalhealthandprimarycareintegration,andruralissues.Todatehe has participated in the writing of 49 funded grants and was directly involved in theimplementationof40ofthosegrants.Somehighlightsofhisactivitiesinclude thedevelopmentandimplementationofacross-culturalmedicineinitiativeandthe developmentofacurriculumforpredoctoralstudentsandresidentsontheintegra- tionofhealthcareandspirituality.DrKliewerwasalsotheProjectCoordinatorfor a primary care development project in Baku, Azerbaijan, funded through the AmericanInternationalHealthAlliance(Washington,DC). DrKliewerreceivedaBAfromWhitmanCollegeinWallaWalla,Washington, graduatingwithadoublemajorinphilosophyandEnglishliterature.Hewentonto receive a Masters in Divinity from Princeton Theological Seminary in Princeton, NewJerseyandaDoctorateofMinistryfromSanFranciscoTheologicalSeminary inSanAnselmo,California.HeiscurrentlyworkingonaMastersinMentalHealth Counseling.For14yearshewasapastorinthePresbyterianChurch,USAserving three churches. In 1990 he joined NW Medical Teams International, a medical nonprofit agency involved in both disaster relief and medical development pro- jects.HeworkedforNWMTIforfouryearsandwasinvolvedinreliefanddevelop- ment projectsworldwide.Hismain areaoffocuswasthedevelopmentofhealth initiativesinruralMexico.In1994hejoinedOregonHealth&ScienceUniversity andin2003becametheDirectoratWallowaValleyCenterforWellness. DrKliewerhaspublishedonebook,CreativeUseofDiversityintheLocalChurch (TheAlbanInstitute,Washington,DC,1987),andrecentlyauthoredanarticleon medicineandhealthcarepublishedintheJournalofFamilyPractice(August2004). JohnWSaultzMDisProfessorandChairman,DepartmentofFamilyMedicineat Oregon Health & Science University. Dr Saultz received his BS and MD degrees fromOhioStateUniversity.HecompletedhisresidencyinfamilypracticeatDwight DavidEisenhowerArmyMedicalCenter,andafacultydevelopmentfellowshipat theUniversityofNorthCarolinaatChapelHill. From1986to1994DrSaultzwasthefamilypracticeresidencydirectoratOregon Health&ScienceUniversity.HeiscurrentlyChairofFamilyMedicine,Assistant Dean for Primary Care of the School of Medicine, and Director of the Oregon statewideAreaHealthEducationCenters(AHEC)Program.In2003–04,DrSaultz wasnamedaBishop/AmericanCouncilonEducationFellow. DrSaultzisaDiplomateoftheAmericanBoardofFamilyPractice,aFellowofthe AmericanAcademyofFamilyPhysicians,andamemberoftheSocietyofTeachers ofFamilyMedicine. Abouttheauthors vii Dr Saultz was the 1993–94 President of the Association of Family Practice Residency Directors and he was the 1996–97 President of the Oregon Academy ofFamilyPhysicians.DrSaultzhasservedontheResidencyReviewCommitteefor Family Practice from 1999–2005 and on the Accreditation Council for Graduate MedicalEducationfrom1992–98. DrSaultzistheauthorofTheTextbookofFamilyMedicine:definingandexamining thediscipline.Hiscurrentresearchinterestsincludecontinuityofcareinthedoctor– patientrelationship,medicaldecisionmaking,andthefutureoffamilymedicine. CHAPTER 1 Healing, cure, and the whole person Icannotgotocurethebodyofmypatient,butI forgetmyprofession,andcalluntoGodforhissoul. ThomasBrowne,ReligioMedici Shehadbeenhispatientforover20years.Anelderlywomanwithseverearthritis, shewasthepianoteacherforgenerationsofchildreninhersmallruralcommunity. Sheservedastheaccompanistforvariousschoolchoirsandhadbeen,foraslongas anyone could remember, the pianist and organist for her church. Now her con- ditionhadworsenedtothepointthatherdeformedhandsnolongerallowedherto playherinstrument.Duringaroutinevisitherphysiciannotedtheprogressionof herdiseaseandempathizedwithher.‘Iknowthatthepainassociatedwithyour conditionsisreallyaproblem.IwantyoutoknowthatIwilldoeverythingIcanto makeyoucomfortable.’Herresponsehadaprofoundimpactonherdedicatedand sensitive physician. ‘Doctor, you don’t understand. It is not the pain that is a problem.TheproblemisthatInolongerknowwhoIam.’ Thiswomanhadnofamily.Shehadnospouse,nochildren,nograndchildren. Outsideofherworkasateacherandperformer,shehadnoactiveinvolvementin the community. If she was not ‘the piano teacher,’ the ‘school accompanist,’ the ‘churchorganist,’whowasshe?Howwasshetobedefined?Clearlyherdisease involvedmorethanthemerepresenceofaphysicalailment.Thecomplexityofher conditioninvolvedthetotalityofwhoshewasasahumanbeing. Asweexplorewhatitmeanstoprovideeffectivehealthcaretothewholeperson, oneofthefirstissueswemustaddressisthenatureofpersonhood.Whatarethe facetsofahumanbeing,andhowdothesefacetsandcomplexitiesimpacthowwe practicehealthcare?Themodernclinicalmodel,asitemergedfromtheEnlighten- ment and the consequent development of the scientific method, diminished the importanceofthewholepersonandnarrowedthefocusofmedicinetoanalmost one-dimensionalplane.InthebookPatient-CenteredCare,IanMcWhinneyrelates theclinicalmethodasdescribedbyLaennec,aFrenchclinicianwritingintheearly 1800s.Laennec,whoisknownasthediscovererofauscultationandinventorofthe stethoscope,didanexhaustive12-yearstudyofchest-relateddisease.Heattributed his discoveries to proper observation and described his methodology as follows (fromDel’auscultationmediate):1 Theconstantgoalofmystudiesandresearchhasbeenthesolutionofthe followingthreeproblems: 1 Todescribediseaseinthecadaveraccordingtothealteredstatesof theorgans.
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