Incorporating spiritual and emotional care to the dying population starts with the proper training of doctors and nurses. Although there is some evidence that the medical schools are starting to offer classes on spirituality, there is not a mandatory requirement for this. In one study published in the International Journal of Psychiatry Med.2010;40(4):391-8 ,by authors from Duke University, a survey was used to asses medical school deans in both their attitudes about and the extent to which they are addressing spirituality in their medical school curricula. The responses from surveys sent to 122 U.S.medical schools found that only 7% had mandatory required courses dedicated to spirituality in health. Although 90 % of these deans indicate that patients emphasize spirituality in their coping and health care, only 39% said that it was important. Sadly, despite acknowledgment of the importance of spirituality to patients the majority of deans were uncertain about including it in the coursework of medical student’s curriculum. In my book, Soul Service: A Hospice Guide to the Emotional and Spiritual Care for the Dying (Balboa Press,2013) our research showed that only 8 of the 122 medical and schools we contacted had mandatory training in the areas of emotional and spiritual care. Only16 had electives in this area. None of the top 50 nursing programs we contacted had any offerings.For further information please visit www.soulservice.info
Treating the terminal patient from a holistic perspective and the importance of spirituality in their care cannot be ignored. In 2007, an Archives of Internal Medicine survey reported that three out of four doctors say their patients mention spiritual issues “sometimes or often.” An AmMed News article looked at the issue of doctors praying with patients. When nearly five hundred adults were surveyed in 2003 about two-thirds of them thought doctors should know about their spiritual beliefs. One in five said they’d like their doctor to pray with them during a routine office visit, about 30% would like prayer with the treating physician in the hospital and over 50 % when they are near death. So prayer at the dying loved one’s bedside is a desire for the majority. Yet often a doctor does not feel comfortable initiating prayer due to fear of an ethical breach. Although it is certainly up to each individual doctor to determine his or her own comfort level with the degree of the level of spiritual involvement with the patient, often it does not harm to be present silently while the patient is in prayer. This can do the patient good to just have the physician there while he or she is in prayer and validates the need for the patient to feel emotionally and spiritually supported by their treating doctor.
At The George Washington Institute for Spirituality and Health (Gwish) in Washington, DC, Dr. Christina Puchalski MD, MS is making a difference. Dr. Puchalski states that “While cure may result from technical and disease oriented care, healing occurs within the context of the caring connection patient’s form with their physicians and healthcare professionals.This is why spirituality is essential to all of medicine and health care.”
“The mission of George Washington is to foster more compassionate and caring healthcare systems and restore the heart and humanity to health care. We do this by developing education programs supported by scholarly and research-based initiatives which train physicians and other health care professionals to more fully integrate spirituality in their professional work with patients. These courses provide the practical skills and tools needed by clinicians to bring spirituality to the bedside. By creating an academic field of study, we strongly believe we are improving clinical care and ultimately improving the lives of patients and their families.”
This initiative at Gwish is to create a new national approach to spirituality and medicine evaluation. They are focused on medical education curricula in six areas: knowledge, patient care, communication, compassionate presence, professional development and health systems. All areas will be concentrated in the area of incorporating spirituality in medicine. Funded by the Foundation called F.I.S.H.,which stands for Funding Individual Spiritual Health, this initiative is still in the pilot phase with seven university medical schools participating. They are:
Albert Einstein College of Medicine
KCUMB Institute for Medical Education Innovation, Kansas City
Loyal University, Chicago, Stritch School of Medicine
University of California, Los Angeles
University of Louisville School of Medicine
University of Minnesota Medical School
University of Pennsylvania School of Medicine
There is starting to be more acceptance of this more holistic approach to medical care. Upcoming is the sixth annual medical-spiritual conference in Dayton, Ohio with two MD’s, Mick Krasner and Ronald Epstein, presenting on techniques to eliminate stress to patients, medical students and health professionals.
As the more humane approach to incorporating treating the whole person not just physical symptoms takes place in physician and nurses training, there will be a more natural acceptance of this concept that is long overdue. Many thanks to those professionals who are now in the early stages of pioneering this advancement in health care.