Saturday, June 20, 2009

Zen Buddhist Chaplains at Beth Israel Medical Center

The LA Times has a piece that describes a Zen Buddhism chaplaincy program at Beth Israel Medical Center in New York. Through this program, more than 20 Buddhist chaplains or chaplains in training provide spiritual care to the hospital (including patients, families, and employees). The article starts with a familiar scenario-- a man with lung cancer and cirrhosis who wishes to remain a full code. The authors use this scenario to dive into a main theme of the article: the tension between "alternative therapies" and traditional medicine. The Zen chaplain expresses a wish to disclose his past battle with alcoholism to the patient with hopes that this might lead to conversation that helps the man prepare for his death. A physician hints that this might not be appropriate to do. A psychologist indicates that this disclosure might not be appropriate for some providers, but perhaps okay for the chaplain to do.

The article further describes the tension between allopathic medicine and the program. One of the chaplains talks of "culture change" they hope to bring to medicine but later also discusses his hope that their methods might lend to the endpoints with which physicians are concerned (e.g. one suggests that alternative therapies may improve adherence to a diabetic regimen rather than providing a competitive alternative that detracts from the regimen's benefit). A physician who cares for the patient remains unconvinced.

Certainly, I could envision some of the tension described in the article, especially if there are circumstances when chaplains might recommend to non-compliant patients to pursue alternative "disease modifying" therapies versus medically proven treatments. I suspect the level of conflict between physicians and the chaplaincy program is overplayed for the sake of good storytelling, though.

I'd guess that physicians at Beth Israel have mixed feelings that are not adequately represented by this article. For instance, I'm ecstatic this program exists to explore and support the spiritual needs of patients from a unique perspective, ambivalent about the method of self-disclosure that the chaplain proposes in the case of the patient with lung cancer, and a little concerned that someone might recommend seeing an herbalist for poorly controlled diabetes. (The article only infers what the chaplain might be suggesting, and I'd like to hear more about how he thinks a referral to this clinic might support patient adherence.) I'd guess many physicians would respond to this type of program with indifference. What do you think?

The tension described in the article is a familiar one to palliative care providers. Even within the profession of medicine, philosophies and approaches of providers may conflict. One of the main challenges for palliative care providers is to champion the principles of our profession while at the same time helping other providers to see that those principles are not always in conflict with other important principles of medicine. There is a similar struggle described in this article.

Regarding self-disclosure, I'm certainly willing to entertain the psychologist's proposition that it may be okay for chaplains to self-disclose, realizing that there are risks of doing this (for example, the risk of transforming the encounter into a self-therapy session that detracts from the patient's therapy). Pallimed covered physician self-disclosure in 2007. I am curious to hear from chaplains of any denomination about the topic of self-disclosure, and wonder if there is something in particular about the Buddhist mindset that makes self-disclosure less risky and more rewarding for the patient. The author of this article seems suggests that the chaplain who wishes to apply this method "operates under different rules," but it's not described how this relates to Buddhism per se.

While the program is a general chaplaincy program not strictly focused on a palliative care population, it appears to have the support of at least one member of the palliative care team:
Supporters of the Zen chaplains program say the monks' presence brings a calming influence to the often frenetic hospital floors, and that patients, for the most part, are open to them. "I think a lot of it has to do with the fact that a lot of our patients don't really know what a Buddhist monk does," said Terry Altilio, a social worker in Beth Israel's palliative-care department, which focuses on relieving suffering of seriously ill patients. "For a lot of patients, there's a curiosity and an openness you don't necessarily see with rabbis, priests, etc."
This certainly rings a cord with my experience. Our team has a "spiritual adviser" rather than a chaplain, which does seem to help some suspicious patients keep an open mind about her role in their care (a role that is from a non-denominational, non-proselytizing stance). Speaking of non-Buddhist chaplains, some will take issue (rightfully) with the portrayal of "typical" hospital chaplains as somewhat feckless when it comes to difficult issues such as confronting death. As with any discipline, you'll find that some chaplains are more comfortable with these topics than others.

Lastly, picture #7 associated with the article made me dream about having a scalp massage each day at about noon (and q 3 hours prn afterwards).

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