Should the Roles of Physician and Chaplain be Fused? A Personal Reflection

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Should the Roles of Physician and Chaplain be
Fused?A Personal Reflection

• Robert M. Nelson, M.D., Ph.D.
• Assoc Prof of Anesthesiology, Critical Care and
  Pediatrics
• The Childrens Hospital of Philadelphia
• University of Pennsylvania School of Medicine

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Fusing the Roles

• We agree that the roles of physician and
  pastoral counselor should be separate in the
  early stages of the relationship because patients
  and their families may not be prepared initially
  to trust or understand the role of such a fused
  figure. However, as the patient-physician
  relationship develops, it may be of value to
  both the patient and the caregivers for the
  physician to explore the patient's existential
  and spiritual concerns. Our experience in a
  clinical pastoral education program modified for
  clinicians provided us with the skills, language,
  and experience.

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Context The Experience of Illness

• Religiosity and Spirituality
• Set of beliefs and practices finding meaning in
  relationship to transcendent (other than oneself)
• Vulnerability - the body betrays the spirit
• Depersonalization and technology
• Spiritual Crisis of Meaning (distress)
• Ethics How should I respond? (interpretation)
• The Goal of Medicine?
• Technical Good, Personal Good and Ultimate Good

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Spiritual Care Training Program

• Modified CPE Program (5 months)
• Weekly class work, 400 hours of supervision
• Didactic Sessions (e.g., faith traditions)
• Professional Training
• Pastoral call reports (verbatims)
• Personal Reflection
• Weekly process notes, experience of faith
• Goals
• allow them to accompany their patients along
  these pathways with similar spiritual integrity
• Incorporate spiritual care into clinical
  practice

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An Important Distinction

• Diagnostic Interventions (assessment)
• Knowledge of the impact of religion and
  spirituality on medical care
• Sensitive to spiritual distress
• Therapeutic Interventions
• Appropriate referral (non-controversial)
• Able to intervene personally?
• Too intrusive? Coercive? Crossing a fine line?
  Abuse of power?

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Spiritual Assessment Explore questions of
meaning, value and relationship
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Assessing Spiritual/Religious Needs
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Whose Job Is It, Anyway?

• Physicians should not ignore the spiritual needs
  of their patients, but neither should they
  over-estimate their skills in addressing these
  needs.
• Physicians should be able totake a spiritual
  history, elicit a patient's spiritual and
  religious beliefs and concerns, try to understand
  them, relate the patient's beliefs to decisions
  that need to be made regarding care, try to reach
  some preliminary conclusions about whether the
  patient's religious coping is positive or
  negative, and refer to pastoral care or the
  patient's own clergy as seems appropriate.

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Attending to Spiritual Needs?

• Language presence, accompany, partner
• Spiritual care is fundamentally relational.
• The Compassionate Clinician
• How can we nurture the ability to suffer with
  our patients?
• Presence requires being attentive to (mindful of)
  our own spiritual needs/distress.
• Making sense of the suffering we witness.
• Risk of burnout (jading) and loss of moral
  responsiveness (confronting the dark side)

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Some Reflections on Suffering

• The limits of technology
• Technical good fails to achieve personal good
• Technology obscures our vision of the good
• Common Assumption
• Technology is value neutral (apply/remove)
• Recapturing vision of good of the patient
• Set aside our attachment to technology
• Confront our own values, beliefs, meaning

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Physician and Chaplain?

• Technical Good
• Does it make a difference whether a physician who
  is technically competent also cares about the
  patients spiritual well-being?
• Good of the Patient
• Can a physician (or chaplain) who is not
  self-aware of their own questions of meaning
  assess a patients spiritual or religious needs?
• Ultimate Good
• Can a generic clinician meet the spiritual or
  religious needs of patients from various
  religious communities?