Friday, September 14, 2007
Spirituality Neglected in Palliative Care; The Good Works of AAHPM
1) Spirituality Neglected in Palliative Care
Howard Spiro, MD at the Yale Journal for Humanities in Medicine recently chided a Hastings Center report (Feb 2007) as an example where:
"...there was, as sadly usual, little consideration that what practicing physicians know provides a penumbra around the process of dying, and that is our inherited culture of religion and spirituality."I am not quite clear as to the meaning of this sentence. As I read it, Dr. Spiro highlights that when doctors talk about end-of-life issues, they frequently ignore the spiritual/religious side of the equation. This was clarified by a later statement:
"...the problem with exhortations about end-of-life care, that they too often ignore the spiritual baggage that we all bring with us. "What I found surprising about this was the amount to which palliative care aims to highlight the spiritual/religious side of a person in considering them as a whole person. A great example is the recent JAMA article by Sulmasy, Spiritual Issues in the Care of Dying Patients. Maybe it is not solely the role of the physician, given most of us work closely with chaplains, but most training for palliative care practitioners usually encourages basic spiritual assessments and helpful ways to discuss spiritual issues in patient care. It may be that Dr. Spiro was talking about medicine in general and not palliative medicine, but I find the claims to be unsupported by my experience with many practitioners in this field. Despite this critique, he has written a book titled "The Power of Hope," which from reading the synopsis, seems to
suggest an approach to patients in line with a palliative care philosophy. By the way if you have not read the Yale Journal for Humanities in Medicine, check out some of the other offerings.Also on the spiritulaity note, another study was done studing the effect of spirituality and religion on acute myocardial infarctions. The study essentially found no significant conclusion as far as effect., but there are some interesting points to discuss. I am getting ready to leave for Yosemite to climb Half Dome (not up the face), so I will write some commentary on this article, sometime next week.
2) A couple of notes about the AAHPM:
A) The AAHPM has opened up the call for submissions for the Case Conference. Now many of you reading this may be thinking., "I thought there were only two calls?" Well this is a niche call but an important one that our field should support. Basically this call is for clinical cases to be presented by trainees across all disciplines (MD, DO, SW, RN, PharmD, Chap, etc). It gives our junior members a chance to present at a national meeting, hopefully encouraging them to become leaders in our field and continue the great work that has been done before them. The reason this late call was created was to allow those in one-year training programs (that usually start July 1) a chance to present in the year they were training. Without this call in the autumn, trainees would miss the opportunity to submit and present a case.
Now in the past, these sessions have been sparsely attended. Maybe it was slotted against a heavyweight presenter, or probably because no one was sure what it was really about because the title may have made you think, 'Oh that's for trainees, not me.' But the cases have been good, really good, and the people who have gone have given great feedback. And you get time for great discussions and to test the trainees and make them show that they know their stuff.
So if you have never gone before, then plan on going to this 'hidden gem' of the AAHPM.
If you have gone or presented before, please feel free to leave a comment to let others know I am not making this up. If you know someone in training in any discipline, make sure they submit a case, so we can make sure the cases are the cream of the crop.
The call is open until October 24, 2007.
Disclaimer: I am heading up the session and selecting the cases with other faculty.
B) The AAHPM has a call for tools and instruments for use in fellowship programs. Laura Morrison, my good friend in Texas, is heading this up. So if you have anything to help other fellowship programs, please submit it to her.
C) A program just started with the AAHPM and the National Palliative Care Research Center (led by Dr. R. Sean Morrison) to fund junior faculty and pilot research projects for one or two years. If you have the facilities and means to get one of these off the ground, please submit a proposal to them. The deadline is November 1, 2007, so get cracking!
3) And a quick blogosphere side note...
Death Maiden posted a link to a site about figuring out the time of death if you were not present. As a interested scholar in prognostication this is the flip side of prognosis. Taking data in front of you and figuring out the past not the future. It is basically temperature based. Not sure it would be of much help to palliative care folks but it may help a home nurse out in the field some day or be useful fodder for a presentation for someone.
Photo from flickr.com user Wylie Maercklein
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1 Responses to “Spirituality Neglected in Palliative Care; The Good Works of AAHPM”
September 14, 2007
The yale humanities bit was so short and brief that I had a hard time interpreting it other than it seems like a general cry against the unchecked "influence of science and rationality on medical practice and on thinking," and an exhortation for...what exactly I don't know...the author sorta suggests bringing our own 'spiritual baggage' to the table.
I get a little nervous when I read statements like these which can be interpreted as calling for physicians to bring their religious experience/beliefs to the bedside in overt ways.
Without being explicit about what one really means (and people in the pall care world can do this as well) statements like this can be interpreted as meaning one or more of the following:
1) what's wrong with medicine today is that docs aren't religious enough or aren't able to display their religiosity/belief/faith enough
2) there is a dichotomy in clinical practice - in caring for patients - between rationality/science and spirituality/emotion/suffering/'the unseen'
3) those of us in pall care/other fields who acknowledge that our patients' spirituality/religion/faith is an integral part of their 'illness experience' (or whatever one wants to call it) and that medicine/the health care community needs to make sure our patients explicit spiritual needs are identified & addressed (by chaplaincy, patients' own clergy, whomever) feel that it is the physician's role to explicitly address them.
All three of these are wrong and IMHO dangerous ideas. The third in particular is an idea that is often misunderstood and when I talk with residents about spirituality I go to great lengths to make sure that I don't think #3 is appropriate.
What I think the doc in YJHM is speaking about is more of the role that all physicians/medical people have in healing - which implies maintaining/restoring the integrity of a whole person (body/mind/spirit) - and has always been a part of 'medicine'/healing and always presumably will insofar as being ill/sick is, for most people at least with severe/life-threatening illnesses, a state of disruption of one's self, one's whole self, and being cured or at least well cared for can/should be a process of restoration this. This may involve explicit discussions of religion/faith but the physician's role in this should be limited (in the sense that we should ask our patients about it, help them get help if they need/want explicit spiritual/religious help, but not actually engage in explicit religious/spiritual dialogue/discussion/healing - for so so many reasons but the simplest being we're not qualified!).
Instead what it usually involves is us listening carefully to our patients' emotions and stories, finding out how their illnesses (and our treatments) affect their lives, giving them the time they need, witnessing their suffering etc. etc. - all the basic, straightforward, Chochinovian 'ABC's of dignity preserving therapy' - doing this is the inherently 'spiritual' work that all medical people can/should be doing.
It does not require us to mention religion to our patients, nor does it require belief in God or the Unseen or skepticism toward science and rationality, instead it requires just a focused understanding that we are all mortal, and afraid, and that we look to each other for solace (and sometimes even cure) when we become ill.
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