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Many scientists and theologians who study these matters advocate a system in which both pastoral and medical care are offered as parts of a whole. If a woman given a diagnosis of breast cancer is already offered the services of an oncologist, a psychologist and a reconstructive surgeon, why shouldn't her doctor discuss her religious needs with her and include a pastor in the mix if that would help?
While churches are growing increasingly willing to accept the assistance of health-care experts, doctors and hospitals have been slower to seek out the help of spiritual counselors. The fear has long been that patients aren't interested in asking such spiritually intimate questions of their doctors, and the doctors, for their part, would be uncomfortable answering them. But this turns out not to be true. When psychologist Jean Kristeller of Indiana State University conducted a survey of oncologists, she found that a large proportion of them did feel it was appropriate to talk about spiritual issues with patients and to offer a referral if they weren't equipped to address the questions themselves. They didn't do so simply because they didn't know how to raise the topic and feared that their patients would take offense, in any event. When patients were asked, they insisted that they'd welcome such a conversation but that their doctors had never initiated one. What both groups needed was someone to break the ice. (See pictures of Billy Graham, America's Pastor.)
Kristeller, who had participated in earlier work exploring how physicians could help their patients quit smoking, recalled a short five- to seven-minute conversation that the leader of a study had devised to help doctors address the problem. The recommended dialogue conformed to what's known as patient-centered care a clinical way of saying doctors should ask questions then clam up and listen to the answers. In the case of smoking, they were advised merely to make their concern known to patients, then ask them if they'd ever tried to quit before. Depending on how that first question was received, they could ask when those earlier attempts had been made, whether the patients would be interested in trying again and, most important, if it was all right to follow up on the conversation in the future. "The more patient-centered the conversations were, the more impact they had," Kristeller says.
The success of that approach led her to develop a similar guide for doctors who want to discuss religious questions with cancer patients. The approach has not yet been tested in any large-scale studies, but in the smaller surveys Kristeller has conducted, it has been a roaring success: up to 90% of the patients whose doctors approached them in this way were not offended by the overture, and 75% said it was very helpful. Within as little as three weeks, the people in that group reported reduced feelings of depression, an improved quality of life and a greater sense that their doctors cared about them.
Even doctors who aren't familiar with Kristeller's script are finding it easier to combine spiritual care and medical care. HealthCare Chaplaincy is an organization of Christian, Jewish, Muslim and Zen Buddhist board-certified chaplains affiliated with more than a dozen hospitals and clinics in the New York City area. The group routinely provides pastoral care to patients as part of the total package of treatment. The chaplains, like doctors, have a caseload of patients they visit on their rounds, taking what amounts to a spiritual history and either offering counseling on their own or referring patients to others. The Rev. Walter Smith, president and CEO of the chaplaincy and an end-of-life specialist, sees what his group offers as a health-care product one that is not limited to believers.
What patients need, he says, is a "person who can make a competent assessment and engage a patient's spiritual person in the service of health. When people say, 'I'm not sure you can help because I'm not very religious,' the chaplains say, 'That's not a problem. Can I sit down and engage you in conversation?'"
Patients who say yes often find themselves exploring what they consider secular questions that touch on such primal matters of life and death, they might as well be spiritual ones. The chaplains can also refer patients to other care providers, such as social workers, psychologists and guided-imagery specialists. The point of all this isn't so much what the modality is; it's that the patient has a chance to find one that works. "People say you tell the truth to your doctor, your priest and your funeral director," says Smith, "because these people matter at the end." It's that truth or at least a path to it that chaplains seek to provide.
Smith's group is slowly going national, and even the most literal-minded scientists welcome the development. Says Sloan, the author of Blind Faith: "I think that a chaplain's job is to explore the patient's values and help the patient come to some decision. I think that's absolutely right."
Sloan's view is catching on. Few people think of religion as an alternative to medicine. The frontline tools of an emergency room will always be splints and sutures, not prayers and well-applied medicine along with smart prevention will always be the best ways to stay well. Still, if the U.S.'s expanding health-care emergency has taught us anything, it's that we can't afford to be choosy about where we look for answers. Doctors, patients and pastors battling disease already know that help comes in a whole lot of forms. It's the result, not the source, that counts the most.
With reporting by Alice Park and Bryan Walsh / New York