ARE FAITH & HEALTH CARE COMPATIBLE?

Grand Rounds Presentation

BACKGROUND

CMDA member Don Foster, M.D., was assigned a date to present Grand Rounds to the department of pediatrics at Arkansas Children’s Hospital in Little Rock, Arkansas, where he serves as a pediatric emergency physician. At first, Dr. Foster recalls, the prospect of presenting a pediatric emergency topic did not evoke much passion. But with less than three months to prepare, the Christian physician soon became convicted that this might be a God-given opportunity to assimilate and share with his colleagues a sampling of the wealth of information currently available in both medical and lay literature about the health benefits of faith. Due to time constraints, Dr. Foster chose to limit the presentation’s focus to beliefs in the  “Bible Belt,” where the hospital is located.

The lecture from which the following article is adapted was presented February 22, 2000 to an audience of more than 100, including faculty, residents and medical students. It was accompanied by 82 “PowerPoint” slides, excerpts from some of which are included here as examples for readers who may wish to develop a similar Grand Rounds for their own setting.

OVERVIEW

In October 1999 the Association of American Medical Colleges (AAMC) issued part III of the Medical School Objectives Project (MSOP) reports, entitled: “Communication in Medicine.” MSOP identifies traits that all students should acquire before graduation from medical school. Part III provides learning objectives in the areas of spirituality, cultural issues and end-of-life care. The six spirituality objectives include the following three, which Dr. Foster used as the underlying foundation of his lecture’s four points: the ability to elicit a spiritual history; an understanding that the spiritual dimension of people’s lives is an avenue for caregiving; knowledge of research data on the impact of spirituality on health and on healthcare outcomes. One of Foster’s greatest challenges was to condense the vast wealth of information available into a one-hour lecture, while also applying the material to his specialty of Pediatric Emergency Medicine.

THE PRESENTATION

“Understanding Patients’ Beliefs in the ‘Bible Belt’” 
A 1999 CBS poll found that 87 percent of the American public think that personal prayer or other spiritual or religious practice can help the medical treatment of people who are ill. This echoed a 1996 report in USA Weekend that 79 percent of Americans believe that spiritual faith can help people recover from illness, injury or disease. Sixty-three percent of participants in this poll said they believed that it is good for doctors to talk to patients about spiritual faith.

Other supportive material appeared providentially. Two newspaper articles from Foster’s hometown included pertinent quotes. In one, a teenager who experienced a miraculous cure or recovery and his father said, respectively: “Without Jesus Christ I couldn’t have made it” and “We just knew God’s hand was in this.” In a note published in an Arkansas Children’s Hospital newsletter, a patient’s wife said: “He would not be here if it were not for the grace of God and the human kindness you have shown.”

“My goal in the first topic was to inform or remind the audience about what many patients and families in the ‘Bible Belt’ believe,” Foster said. “Specifically, they believe that God is involved in all aspects of life, that He is often supernaturally responsible for cures, and that He works through physicians and nurses, whose spiritual support is welcomed by a majority of patients.”

“The National Medical Awareness of Spirituality” 
The learning objectives of the MSOP reports (available at: http://www.aamc.org under Medical Education) make the spiritual history a legitimate discussion in medical education. The Web site of the National Institute of Health-care Research (NIHR) notes that about one-half of U.S. medical schools are teaching students about spirituality in healthcare (see: http://www.nihr.org). This site also lists medical schools that have won the annual John Templeton Faith and Medicine Curricular Awards.

A 1998 article in Academic Medicine states: “Courses in spirituality and medicine, which have recently been developed in many medical schools, have helped students learn to really listen to patients, and to understand and care about their patients’ suffering, beliefs, fears, and hopes and those things that give meaning to their patients’ lives. . . . Patients can and should expect their physicians to respect their beliefs and to be able to talk with them about spiritual concerns in a respectful, caring manner. They should expect physicians to be compassionate and to take the time to really listen to them and not just focus on the technical aspects of care when the patients’ spiritual dimension is central to their lives.”¹

Foster explained, “My goal in the second topic was to show that medical awareness of the role of spirituality in healthcare is rapidly increasing, and that the provision of ‘spiritual’ care by medical personnel is considered not only legitimate in medical education today, but has over recent years become something patients have ‘a right to expect’ from their medical caregivers.”

“The Scientific Evidence of Religious Benefits” 
A search of “faith,” “prayer,” and “religion” in the recent literature yields multiple articles. Some of the better and more recent articles were on the NIHR Web site. Most of the studies are from adult populations, but a few are based on adolescents and young adults. This topic and these articles show that faith, prayer, and intrinsic religiosity are beneficial to one’s health in regards to: less cigarette smoking and subsequently less death,² lower diastolic blood pressure,^3,4 faster remission from depression,⁵ a stronger immune system,⁶ and less mortality.⁷ The latter article speculates that becoming religious just for the health benefits may not work very well: “Sitting in church doesn’t make you a Christian any more than sitting in a garage makes you a car.”

First Corinthians 6:19, 20 was proposed as a explanation for why conservative Protestants usually abstain from cigarettes, alcohol and drugs: “Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought with a price. Therefore honor God with your body.”

Foster stated, “My goal in the third section was to show that there is a growing body of literature published in respected scientific journals supporting the premise that religious practices are beneficial to health, and that this is true in the general population across all age groups.”

“How to Integrate Faith into Healthcare” 
This topic was both the most important and most difficult one. It included three areas: obtaining a spiritual history, praying for/with patients/parents, with a specific application to pediatrics and the care of adolescents, in particular.

1. Obtaining a spiritual history
   Two different acronyms, which can be used to obtain a spiritual history, were presented: FICA and SPIRIT.
   • FICA, developed by Christina Puchalski, M.D., at NIHR, is described on the organization’s Web site as follows:
     • F = Faith and belief (Q: Do you consider yourself spiritual or religious?);
     • I = Importance and influence (Q: What importance does faith have in your life? Have your beliefs influenced how you take care of yourself/child in this illness?);
     • C = Community (Q: Are you part of a spiritual or religious community? Is there a group of people you really love or who are important to you?);
     • A = Address in care (Q: How would you like me, as your physician, to address these issues in your [child’s] health care?).
   • SPIRIT,⁸ developed by Todd Maugans, M.D., is for:
     • S = Spiritual belief system;
     • P = Personal spirituality;
     • I = Integration with a spiritual community;
     • R = Ritualized practices and restrictions;
     • I = Implications for medical care;
     • T = Terminal events planning.

This article includes a table with many more questions per letter than FICA, e.g. for “S”: “What is your formal religious affiliation?” and “Name or describe your spiritual belief system.” Several other articles cite questions that can be used by doctors who want something simpler than the FICA or SPIRIT methods. For example: “Do you have spiritual/religious beliefs that would influence your medical decisions if you become gravely ill?”⁹ or “Do you belong to a particular church or subscribe to a particular faith?”¹⁰

CMDA member Dr. Dale Matthews mentioned in the 1996 USA Weekend poll cited earlier that he listens for “God language” from patients, i.e. expressions of faith that are an open door for him to talk with the patient about faith and health.

Differential spiritual needs were mentioned; for example, Protestants desire the knowledge of God’s presence, expression of caring and support from a person, and prayer while Catholics want relief from fear of death, visit from a clergyman and to receive the sacraments.¹¹

Dr. Foster used the concept of patients’ “God language” as a springboard to mention doctors’ “God language.” He explained the use of “faith flags,” which he had learned at a Saline Solution conference. He gave several examples and shared a personal faith story to demonstrate the meaning and use of this method. He suggested that where medical caregivers are not comfortable discussing matters of faith (their own faith or their patients’ faith), offering consultation with the hospital chaplain is an acceptable alternative. Despite the legitimacy of physician involvement in such referrals, one study indicates that this is done much more frequently by nurses than by doctors.¹²

1. Praying For/WithPatients/ Parents
   Foster used the faith flag, “I will be/have been praying that you would respond to the treatment” to introduce this subtopic. He cited a study that found that many, but not all, patients desire prayer.¹³ A 1996 Time/CNN poll found that 64 percent of patients believe doctors should pray with patients when it is requested. At this point, Foster shared a few boundaries learned at the Saline Solution conference; specifically, that healthcare professionals should always remember that patients come to them primarily for medical care, that “baiting and switching” and/or proselytizing patients are unethical, and that the healthcare professional must always ask permission to pray with a patient or to share his/her personal beliefs. Foster reiterated, however, that addressing spiritual matters is part of treating the whole patient, because the spiritual dimension is an avenue for caregiving.¹⁴ Studies have shown that patients want prayer for such matters as: healing/recovery, peace/comfort for the patient/family, relief from suffering and for God’s will to be done.
2. Application for pediatrics and adolescents
   Dr. Foster cited research showing that teenagers who believe in God and attend church are less likely to use drugs and alcohol.^15-17 He quoted Proverbs 22:6: “Train a child in the way he should go, and when he is old he will not turn from it” as a possible explanation for this.

   He mentioned that while there are many things medical professionals can do individually, e.g. speak at a school, advocate abstinence education, teach Sunday school, or work with the youth group at church, they can also assist parents who would like spiritual advice about how to raise their children.

   For him, this advice includes recommending books by Judeo-Christian authors such as Dr. James Dobson, (Preparing for Adolescence, Raising Teenagers Right, Parenting Isn’t for Cowards, The Strong-Willed Child, The New Dare to Discipline), Dennis and Barbara Rainey (Parenting Today’s Adolescents), Paul Reisser, M.D., et al (The Complete Book of Baby and Child Care), Kevin Leman, Ph.D., (Making Children Mind Without Losing Yours), and Dr. Laura Schlessinger (The 10 Commandments: The Significance of God’s Laws in Everyday Life). Emphasis was placed on the Raineys’ concept of teaching pre-teens and teenagers to “decide in advance” on the issues they will face and on Leman’s “reality discipline” which is basically a biblical model of choices we make and the consequences.

   Dr. Foster’s goal in this fourth topic was to challenge his audience to accept, integrate, and apply all the concepts he had shared. Several times he asked them: “Can you advance to the next level?” That is, can you go from: a. understanding patients’ beliefs, to: b. accepting the scientific evidence of faith, to: c. obtaining a spiritual history, to: d. praying for/with patients/parents (or referring them to a chaplain or minister)? Specifically, in relation to pediatrics, Foster tried to demonstrate the importance and legitimacy of the medical caregiver lending support to parents through offering both personal advice and access to excellent child-rearing resources. Foster affirmed that this level of involvement falls within the purview of the acceptable standard of medical care and is something parents want not only as a part of the treatment of health-related issues (whether crisis or chronic), but also as part of the prevention of future health problems through proper education and training at home.

RESULTS:
Although most of the pediatric faculty members in attendance were churchgoers, as were many of the residents, most of them were not familiar with all of the material that was presented. “Everyone was very attentive and appeared to be receptive to the information,” Dr. Foster said. “The only surprises were the unsolicited, positive feedback from nurses who were in attendance and the almost negligible negative feedback. Only one evaluator was negative. He/she said, ‘Christian proselytizing. Missed a great opportunity to give insight into spiritual aspects of being.’” Several people estimated that this topic drew the largest Grand Rounds audience of the year, and one colleague, a devout Sikh Indian, said that it was the best Grand Rounds this year. Other comments included:

• “Very relevant. Needed to be addressed.”
• “Excellent job on a tough topic.”
• “Well presented and useful.”
• “Best part was on the spiritual history—something I plan to implement.”
• “Very informative and challenging. Thanks. Nice, balanced approach.”

Over half of the evaluators gave the presentation the highest possible rating.

For Foster, the most personally significant comment came from a colleague who said, “With the mixed audience that you had this morning, you had a touch of the Holy Spirit to deliver a message that needs to be heard by our faculty and residents.” This colleague, and others in a men’s group Foster attends, prayed for him during the preparatory phase, and they prayed over him just before the Grand Rounds.

Foster was encouraged to see a resident a week or so later with the Grand Rounds outline on his clipboard, ready to be used, including the FICA and SPIRIT acronyms for obtaining a spiritual history. A strong Christian intern told Foster that she thinks about this more now whenever she enters a patient’s room.

“I am confident God will use the seed to produce results that I will never know about on this side of heaven,” Dr. Foster said.