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A Patient’s Perspective on the Importance of Teaching Spiritual Competencies to Medical Students

The following talk was presented by Eric Nelson at the April 2017 Stanford Medicine X | ED, an academic medical conference hosted by Stanford University devoted to the improvement of patient-centered medical education.

First of all, I want to thank you for choosing to attend a presentation with the word “spiritual” in the title. Either you have some level of interest in the subject and how it relates to the care of patients, or you have no idea what room you walked into and are now thinking of a way to slip out unnoticed.

I trust it’s the former. But if it happens to be the latter, I encourage you to stick around.

Whatever our background may be, I believe we’re all a lot more spiritually inclined than we think or perhaps let on, whether this spirituality – this sense of connectedness to something larger than ourselves – is inspired by a walk in the woods, a great baseball game, or a particular religious practice.

I also believe that it’s this quality of thought, cultivated within ourselves and supported in those we come in contact with, that can make a big difference in what we broadly define as “the healing process.”

To illustrate my point, I’d like to share a story – one that includes both drama and humor, and even a happy ending. It also happens to be a true story.

I had just turned 15 and a friend and I were on a hike in the San Jacinto Mountains near Palm Springs – specifically Tahquitz Peak, for those of you who may be familiar with the area. On our way back down the mountain, I lost my footing on a patch of ice and ended up sliding about a thousand feet down a snow- and rock-covered chute.

By the time I came to a stop, my body had taken quite a beating. My pelvis was shattered; my leg was broken in two; my hand was broken; my face was pretty banged up; and, as I would later find out, there was some internal bleeding.

The good news was that nothing had happened to my teeth. Actually, I’d call this great news given that a year or so before this, I’d had braces and knew that my parents would be pretty upset if they found out their investment had been wasted.

The other bit of good news was the apple I found in my daypack – an apple that, by some miracle, didn’t have a single bruise.

So there I was, wedged against a small shrub on the side of this icy slope – certainly in a lot of pain – eating my apple, and praying my heart out for the next three to four hours while my friend ran down the mountain to get help.

This was late afternoon in mid-February, so it was getting pretty cold. Fortunately, just before sunset, a rescue team arrived by helicopter and flew me (by this point unconscious) to a nearby hospital.

This was the first time I’d been admitted to any sort of medical facility, not because my parents or I had any aversion to doctors, but because there had never been any need.

I mention this because I was raised as a Christian Scientist, and there’s often the assumption that either the Church prohibits its members from going to the doctor (or at least encourages us not to do so), or that by receiving any kind of medical treatment, we’re putting our salvation in jeopardy.

Suffice it to say, neither of these assumptions is true.

The vast majority of Christian Scientists I know tend to rely – with success – on an exclusively prayer-based approach to health care. But that does not mean they’re compelled to do so, or that there haven’t been times when they’ve found themselves in a medical facility. That said, I can think of a number of close friends – some in their eighties and nineties – who, perhaps aside from giving birth, have never been to a doctor or used medication of any kind. Again, not because of any aversion to medicine, but because they’ve found prayer to be effective.

Getting back to the hospital, the first thing I remember when I regained consciousness was hearing a nurse ask my mom if I was allergic to any foods.

With my eyes still closed, it occurred to me to say, “Asparagus,” thinking that this might reduce the chances of anyone serving me what was then a dreaded vegetable.

“Asparagus,” repeated the nurse, while making a note on my admission form.

And then, with a chuckle and what I’m sure was a sense of relief to see me awake and alert, Mom said, “He’s not allergic to anything; he just doesn’t like asparagus. Obviously nothing has happened to his sense of humor.”

This is what I would call a spiritually competent parent; that is, someone who was capable of looking past what I’m sure was a pretty alarming picture and seeing a part of me that was neither beaten, bruised, nor broken. In fact, I’d say that it was what Mom discerned in that brief moment of levity that helped me – and maybe even the nurse – to see the very same thing, and in so doing, to alleviate whatever sense of fear might have been swirling around the room.

For me, this was the start of my healing process.

The reason for my including this part of the story is to illustrate that, in practice, there’s really not much difference between a spiritually competent parent and a spiritually competent doctor or nurse. At its root, spiritual competency is basically a willingness to take into account something other than mere physical appearances. Some might describe this as treating the “whole patient.” For me, it’s seeing the patient as inherently whole – defined, not by their body, but by their divinely bestowed, divinely maintained qualities, including good humor.

Last year at this same conference I moderated a panel discussion on the importance of teaching spiritual competencies to medical students, so I’m aware of the resistance to addressing something other than a patient’s physical needs.

Based on comments made by some of the physicians I met, I’d say the three main objections, are (1) “That’s not part of my job description,” (2) “Even if it were, I don’t have time to do it,” and (3) “Even if I had the time, what good would it do?”

Since I’m speaking strictly from a patient’s perspective, I’m going to focus mostly on this last objection. But before I do, let me touch just briefly on the first two.

I get it that doctors shouldn’t be expected to be experts in all things religious and spiritual. Generally speaking, that’s chaplains’ work, at least from a medical school’s perspective. But given the fact that there are a whole lot more doctors than there are chaplains in our hospitals – and more patients than you might think who want to engage on this level (as many as 77% according to one survey I read) – it would appear to be in everyone’s best interest for doctors to at least know the basics.

Speaking of which, there’s a doctor I heard speak at a different conference who said that the most basic question he likes to ask his patients is simply this: “What do I need to know about you as a person to give you the best care possible?” It’s a question that not only opens the lines of communication – perhaps revealing something helpful about the life and character of the person behind the ailment – it can also help both patient and doctor alike dial-in to their innate spirituality, their sense of meaning and purpose. And in some cases, even their connection to a higher power.

As for not having enough time for this sort of thing, I’ve spoken with more than a few doctors who have said that even brief interactions along these lines can actually save both time and money.

This brings us to that third objection I mentioned: Assuming they have the time, what difference does it make to have a spiritually competent doctor?

For me, it made a huge difference.

Although I was in a hospital – mainly because my legs were in traction – the staff gave me plenty of leeway in terms of my decidedly non-medical, prayer-based approach to caring for myself. This meant, for instance, that after some initial surgery, I was not given, nor did I require, any pain medication.

By the way, when I say “prayer,” I’m not talking about a kind of wishful thinking that some might associate with this word, but rather, an ongoing and deeply profound awareness of and communion with that universal and wholly benevolent Principle I call God – an awareness that, for me, is the key to healing. Mary Baker Eddy, the founder of Christian Science, writes, “The prayer that… heals the sick is an absolute faith that all things are possible to God, – a spiritual understanding of Him, an unselfed love.”

Even if from the outside it doesn’t look like much is going on, that doesn’t mean that this kind prayer isn’t having a real and measurable impact on the individual involved.

I found this to be true one afternoon when one of my doctors recommended that I have immediate surgery to repair my pelvis. Apparently the bones weren’t knitting together as well as he had hoped and the plan was to insert a plate.

My parents and I asked if, instead of immediate surgery, we might take the rest of the afternoon and evening to pray about the situation. My doctor agreed and said that he would still plan on coming by in the morning to prep for an operation.

Although on the surface this seemed like a fairly unremarkable exchange between doctor and patient, what was left unsaid between the two of us was just as important as what was.

You see, during the previous three weeks, the hospital staff taking care of me had observed not only a pretty rapid recovery from what were considered life-altering if not life-threatening injuries, but also a patient – and a patient’s family – relying wholeheartedly on prayer for healing. And with good results.

On one occasion, during an operation shortly after my arrival at the hospital to stop my internal bleeding, the doctors ended up finding nothing wrong. As one of the members of the surgical team put it, “Someone must have gotten in there before us.” And within a relatively short time, every scratch and scar on my face had healed over without any medical intervention.

So, what my doctor didn’t say when my parents and I asked for some time before going ahead with the recommended surgery – but which we definitely sensed – was that he trusted us to make the right decision in terms of my health.

The next morning, new x-rays were taken which showed dramatic improvement. Instead of carting me off to the operating room, plans were made for me to complete my recovery at home. Within four months, I was up and out of my wheelchair and leading my high school marching band in a parade. Since then, I’ve been able to walk across the Grand Canyon in a single day and ride my bike for as many as 200 miles in a single stretch.

I don’t recall this doctor, or anyone else in the hospital for that matter, ever asking me if there was anything they needed to know about me as a person in order to give me the best care possible. I think for them it was more intuition. The important thing is that they both respected and were responsive to my spiritual needs.

And what was the effect? In my case, a sooner than expected discharge from the hospital; zero concern about prescribing potentially addictive pain medications; and what I’d call a textbook case of patient-centered care. Of course, this wasn’t true just for me, but countless others as well who have had the privilege of working with spiritually competent doctors and nurses.

By the way, I would be remiss if I didn’t mention that asparagus is now one of my favorite vegetables – a side effect, I suppose, of God’s ironic sense of humor.

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