Modern health care is technologically rich but spiritually poor, conference is told
Stephen Graham Wright, a nurse, minister and professor who has devoted much of his career to restoring spirituality to health care in England, was in Vancouver for a weekend conference sponsored by University of B.C. Interprofessional Continuing Education and attended by 300 people from around the world.
Referring to the Arthurian legend in which a king rapes one of seven virgins guarding seven wells and then hoards the water for himself -- an act that gradually turns the countryside into a wasteland -- Wright says the modern health-care system has similarly wasted away, starved for the human touch.
Back when health care was provided by the churches, it was based on the idea of compassionate care for others, he says. There was little technology and the workers devoted much of their time to providing comfort to the patients.
But as medicine aligned itself with science, it developed many cures and treatments for patients. That was good. But the focus of health-care professionals changed to treating diseases rather than people.
"The assumption is that people can be cared for, satisfied and nurtured purely through the scientific realm," Wright says.
But it creates a profound disconnect among health-care workers in which patients are seen as "the appendix in bed three" or "the liver in bed nine," he says in an interview. He adds that it hasn't been good for the workers either, who suffer increasingly from burnout.
Wright argues that the loss of the soul is the single biggest omission of modern health care, increasing dropout rates among both patients and staff and pushing costs to the limit.
"There is a growing sense around the western world that something is missing in modern health care," he says. "It is technologically rich but spiritually poor. People don't just get better by having the machines working efficiently or the right drugs put in. There is more to it than that.
"The question is how can you restore this sense of connection so that health-care workers can really be there for people."
That is where Christina Puchalski comes in. As director of the Institute of Spirituality and Health at George Washington University, she works with the Association of American Medical Colleges to develop learning objectives and ethical guidelines for including spirituality in medical school training.
"It's not religion," she emphasizes, noting that the medical colleges would never accept proselytizing. "Spirituality is expressed in how someone finds meaning and purpose in life.
"It might be religion, but it might be family, nature, arts, humanities. Bike riding could be your source of transcendence. It's whatever puts you in touch with what awes and inspires you."
Puchalski became aware through studies and her own patients that spiritual beliefs or attitudes can have an impact on how people cope with things.
"If you are pessimistic about something or believe your illness is a curse, you are not likely to do as well as if you can find some hope and meaning," she says.
She started teaching a course at George Washington University in 1992 on spirituality and eventually founded the institute. At that point, not counting the religious medical schools, only two other medical schools included any curricula on spirituality. Now 102 of the 141 medical schools in the U.S. include spirituality in the training and 70 per cent of the schools make it compulsory.
Puchalski says she is very pleased with the trend because she wants medicine to return to its earlier focus on providing compassionate service to others.
"We take an oath to put our patients' needs above our own, but the health-care system makes that hard to do. We are trying to bring back that service."
After conducting a survey of Canadian medical schools and learning that spirituality is not taught here, Puchalski is working with the Association of Faculties of Medicine in Canada to develop similar programs.
She recommends that physicians conduct a spiritual history just as they do a medical history, lifestyle history and emotional history, when they meet a patient.
For example, she will ask patients if they consider themselves spiritual or religious. If they say no, she will ask what gives their lives meaning. Then she will determine how important those beliefs are in times of stress and if they have specific beliefs that might influence their health-care decisions -- beliefs such as those of a Jehovah Witness, who might refuse blood transfusions.
"If you are truly interested in a person and who they are as a human being, that will signal to them that you care," she says.
She says spirituality programs in medical schools also help set ethical limits on the risks of over-stepping personal boundaries.
"We teach that proselytizing is unethical. Don't do it," she says. "We say the physician has an obligation to respect the patient and must understand that there is often a power differential. In that case, it is beyond unethical, it's abusive because the patient may coerced."
But she says if a patient wants to talk about God, the doctor should listen even if the doctor doesn't agree with the beliefs. "You would talk about it just as you would talk about sports," Puchalski says. She doesn't have any interest in sports herself, but she will still discuss them if the patient wants.
"By understanding people's spiritual beliefs, we can make better diagnoses and treatment plans." email@example.com
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© The Vancouver Sun 2006