Thursday, August 09, 2007
Training Spirit-Friendly Doctors
For the past few months, I've been attending meetings at the University of Nevada Medical School of a group of people who have a small grant from the George Washington Institute for Spirituality and Health (GWISH). (I'm now listed on the grant as a research assistant, which involved completing three hours of online Institutional Review Board training. This was quite the adventure, since I have no biomedical training and was taking the biomedical module!)
The GWISH group is going into the third year of a three-year grant, with a charter to work on integrating awareness of spiritual issues into the medical curriculum. For instance, our med school, like many others, uses standardized patients (SPs), laypeople coached to provide specific medical histories, to help train medical students; the GWISH group has been working up an SP case involving spiritual issues, and is also encouraging the students to incorporate FICA questions into the medical history.
But we spent most of the last meeting talking about why the GWISH project has been, in the words of one participant, "a tough sell." The meeting had been originally intended as a welcome dinner for new family-practice interns and residents, who would be invited to contribute to the project. Only three of about eighteen showed up.
The main reason for this, of course, is lack of time and energy; if you're working eighty hours a week in a physically, emotionally and intellectually draining new job, you won't be inclined to spend your limited resources on a topic that might seem extraneous or "soft." So the question for the GWISH group became: How can we make spirituality-and-health issues seem essential, worth taking the time to learn about, rather than irrelevant? Evidence-Based Medicine (EBM) is all the rage these days, and spiritual issues, almost by definition, defy scientific inquiry. So how do we sell them to medical students and new doctors?
The most EBM-friendly doctor in the GWISH group (although of course he's also sympathetic to spirituality too, or he wouldn't be there) took it upon himself to play Devil's Advocate. The best way to sell spirituality, he told us, would be to find rigorous, double-blind scientific studies demonstrating its impact on health. No one was quite sure if that sort of evidence exists. There has been some research on the helpful role of spirituality in depression, for instance, but no one knew how extensive or scientifically bullet-proof such studies have been.
I asked if, in the absence of double-blind studies, anecdotal evidence would be acceptable. Our EBM doc allowed that it was a distant second, but would have to do if nothing better were available. One of the residents, who'd just finished a rural rotation with a family-practice doc, told us a story about how that physician offered a brief nondenominational prayer at the end of each office visit, but only for patients he already knew would welcome it. The resident was intrigued by this, and observed that the prayer process seemed to smooth any preexisting tensions and end the visit on a positive note.
With all this in mind, I'm hereby conducting an extremely informal and unscientific survey of blog readers, consisting of four questions, some with subsections. It's probably worth mentioning here that I define spirituality as "how we define the larger meaning of our lives." I'm not sure exactly how GWISH defines it, but the FICA questions should give you a good idea of what they're looking for.
1. Do you know of any research categorically demonstrating the impact of spirituality on health, or its value in medical care?
2. If you are or have been a medical student:
a) How important do you consider spirituality in medicine?
b) Have you been taught about spiritual issues in medical school?
c) If you have been taught about them, what was most valuable to you in the information you were given?
d) If you haven't been taught about them, do you wish you had been? If so, what form would you want that to take?
3. If you're a practicing physician:
a) Have you had patients for whom spirituality was a vital element of medical care? If so, can you venture a guess as to the percentage of your patients in this category?
b) Are you comfortable discussing spiritual issues with patients?
c) Do you incorporate spiritual questions or content into interactions with patients? If so, under what conditions, and in what form?
d) How do you think healthcare professionals can become more comfortable with and better informed about spiritual issues?
4. If you're a patient (and that includes all of us, right?):
a) How important is your spirituality to your health?
b) Are you comfortable discussing spiritual issues with your healthcare providers?
c) Have any of your healthcare providers raised spiritual issues? If so, in what context? Were you comfortable with their doing so?
d) Do you think healthcare professionals need to be more "spiritually literate"? If so, how?
Note: I know that nurses deal with spiritual issues also, as much as (if not more than) doctors do, but since I'm trying to get information for our medical school, I'm phrasing the questions mainly in terms of physicians. But if you're a nurse and want to give me your two cents, I'd be delighted!
You can either leave your responses in the comments section, or e-mail me privately at SusanPal at aol dot com.
Thanks so much!